Prescription Drug Transparency and Affordability Act

Key Points

• This bill requires pharmacy benefit managers (PBMs) to submit detailed reports at least every six months to group health plans showing exactly what they pay pharmacies, what rebates they collect from drug makers, and the spread between those amounts. Plans with 100+ employees get the most detailed drug-by-drug breakdowns.
• Patients enrolled in group health plans can request summary documents showing how their plan handles drug costs, and can see the specific markup on their own prescription claims. Plans must also send annual written notice telling members about these new transparency rights.
• PBMs that own or are affiliated with pharmacies must disclose whether they steer patients toward those pharmacies, what share of prescriptions those pharmacies fill, and how their prices compare to other pharmacies in the network. This targets a common conflict of interest in the industry.
• Companies that fail to share the required data face fines of $10,000 per day. Those that knowingly provide false information can be fined up to $100,000 per false item. The Secretary can waive penalties for entities making a good-faith effort to comply.
• The new reporting rules would not kick in until about two and a half years after the bill is signed into law. Federal agencies have 18 months to write the regulations that set the standard reporting format.