HR7895119th CongressWALLET

PBM Kickback Prohibition Act

Sponsored By: Representative Allen

Introduced

Summary

Bans PBM kickbacks for referrals to ERISA-covered plans. This bill would prohibit pharmacy benefit managers from paying, directly or indirectly, brokerage firms, brokers, consultants, advisors, or any other individual for referring a covered plan's or health insurer's PBM business. The prohibition would apply for plan years beginning after the date of enactment.

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  • Plan sponsors and health insurers: Would no longer receive PBM-paid referral fees when choosing a pharmacy benefit manager for a covered plan.
  • Brokers, consultants, and advisors: Would be barred from accepting compensation from PBMs for referring a plan's or issuer's PBM business.
  • PBMs and PBM service providers: Would be prohibited from paying intermediaries for referrals tied to PBM contracts with covered plans or health insurers.

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Bill Overview

Analyzed Economic Effects

1 provisions identified: 1 benefits, 0 costs, 0 mixed.

Ban PBM payments to brokers

If enacted, the bill would ban pharmacy benefit managers (PBMs) from paying brokerage firms, brokers, consultants, advisors, or any other individual for referring a plan's or health insurer's PBM business. The ban would bar any amount of compensation, directly or indirectly. It would apply to contracts for PBM services for plan years beginning after the date of enactment. Employers and workers could see plan contracts, fees, networks, or out-of-pocket costs change depending on how plans respond.

Sponsors & CoSponsors

Sponsor

Allen

GA • R

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

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