§1320b–23 Pharmacy Benefit Managers Transparency Requirements

Summary

Requires health plans and pharmacy benefit managers (PBMs) that run drug coverage for Medicare Part D plans or for qualified health plans sold through a State exchange to report certain data each contract year. PBM here means a plan or company that manages prescription drug benefits under those contracts. The reports must show: the share of prescriptions filled at retail versus mail-order pharmacies and the generic dispensing rate by pharmacy type (independent, chain, supermarket, or mass‑merchandiser pharmacies licensed by the State); the total amount and kinds of rebates, discounts, or price concessions linked to patient use, how much of those are passed on to the plan sponsor, and the total number of prescriptions; and the total difference between what the plan pays the PBM and what the PBM pays retail and mail‑order pharmacies, with the total prescriptions dispensed. Exclude bona fide service fees (for example, distribution service fees, inventory management fees, product stocking allowances, and fees tied to administrative services agreements and patient care programs). The information is confidential and cannot be released in identified form, but the Secretary may share non‑identifying summaries to carry out this law or Part D, and may share them with the Comptroller General, the Congressional Budget Office, and States for carrying out section 18031. If a plan or PBM fails to provide the required information on time or knowingly gives false information, the penalties in subsection (b)(3)(C) of 42 U.S.C. 1396r–8 apply to them in the same way they apply to a manufacturer under that provision.