S-2973 : Still Just a Bill

The Modernizing and Ensuring PBM Accountability Act (S. 2973) aims to increase transparency and accountability of Pharmacy Benefit Managers (PBMs) within Medicare and Medicaid. Key provisions include:

• PBM Compensation: Limits PBM income to bona fide service fees, preventing revenue generation from sources other than service fees, while protecting the use of rebates and discounts to lower drug costs.
• Transparency: Requires PBMs to provide detailed information on drug pricing, rebates, and affiliations to plan sponsors and the Secretary of Health and Human Services.
• Auditing: Grants PDP sponsors audit rights to ensure PBM compliance and accuracy of reported information.
• Standardized Performance Measures: Mandates the use of standardized pharmacy performance measures for incentive payments and price concessions.
• Pharmacy Transparency: Requires PDP sponsors and MA organizations to furnish detailed claim information to pharmacies upon payment.
• Medicaid Pricing: Enforces transparent pass-through pricing models in Medicaid, preventing spread pricing and ensuring fair payments to pharmacies.
• Biosimilars: Facilitates mid-year formulary changes to promote the use of biosimilar drugs.
• Limited Access Drugs: Prevents limitations on pharmacy access to covered drugs, with specific procedures for drugs with restricted distribution or special handling requirements.
• Studies and Reports: Mandates various studies and reports on drug pricing, mark-ups, compensation structures, drug shortages, and biosimilar access.

The Act also includes funding for the Centers for Medicare & Medicaid Services and the Inspector General to implement and oversee these changes.