S-882 : Still Just a Bill

The "Patients Before Middlemen Act" (S. 882) aims to reform pharmacy practices within Medicare Part D. Key provisions include:

• Pharmacy Access and Choice: Ensures any pharmacy meeting standard contract terms can participate in a prescription drug plan network.
• Reasonable Contract Terms: Requires the Secretary of Health and Human Services to establish standards for reasonable contract terms between drug plans and pharmacies.
• Essential Retail Pharmacies: Mandates reports on trends affecting essential retail pharmacies (those in underserved or rural areas) and their participation in Medicare Part D networks.
• Enforcement: Establishes a process for pharmacies to report contract violations, with penalties for non-compliance. It also protects pharmacies from retaliation for reporting violations.
• Pharmacy Benefit Manager (PBM) Requirements:
  • Bona Fide Service Fees: Limits PBM income to bona fide service fees, preventing revenue based on drug prices or rebates (with certain exceptions for rebates passed on to plan sponsors).
  • Transparency: Requires PBMs to be transparent about pricing guarantees and cost performance evaluations.
  • Information Provision: Mandates PBMs to provide detailed information to plan sponsors and the Secretary of Health and Human Services on drug costs, rebates, and PBM revenue.
  • Audit Rights: Grants plan sponsors the right to audit PBMs to ensure compliance.

The Act also includes provisions for reporting alleged violations, certifying compliance, and protecting the confidentiality of disclosed information.