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Pharmacy Benefit Manager Reform Act

USA118th CongressS-1339| Senate 
| Updated: 6/22/2023
Bernard Sanders

Bernard Sanders

Independent Senator

Vermont

Cosponsors (4)
Bill Cassidy (Republican)Mike Braun (Republican)Roger Marshall (Republican)Patty Murray (Democratic)

Health, Education, Labor, and Pensions Committee

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
Pharmacy Benefit Manager Reform Act This bill establishes various requirements for pharmacy benefit managers (PBMs) with respect to services provided to health insurance plans. First, PBMs must report annually to the plan sponsor certain information about the PBM's services, including the amount of prescription drug copayment assistance funded by drug manufacturers, a list of covered drugs billed under the plan during the reporting period, and the total net spending by the health plan on prescription drugs. PBMs also must provide plan sponsors with a supplementary report every six months with specified information about drugs that were dispensed under the plan by pharmacies that are wholly or partially owned by the PBM. Second, the bill prohibits spread pricing. Under the bill, spread pricing occurs when a PBM charges an insurance plan (or an insurance plan charges plan participants) a price for a prescription drug that exceeds the price paid to the pharmacy for the drug. Finally, PBMs must remit to the plan sponsor all rebates, fees, alternative discounts, and other remuneration received from a drug manufacturer. The bill establishes civil penalties for violations of these requirements and provides funding for the Centers for Medicare & Medicaid Services and the Department of Labor to implement the provisions of this bill.

Bill Text Versions

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2 versions available

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Timeline
Apr 27, 2023
Introduced in Senate
Apr 27, 2023
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
May 11, 2023
Committee on Health, Education, Labor, and Pensions. Ordered to be reported with an amendment in the nature of a substitute favorably.
Jun 22, 2023
Committee on Health, Education, Labor, and Pensions. Reported by Senator Sanders with an amendment in the nature of a substitute. Without written report.
Jun 22, 2023
Placed on Senate Legislative Calendar under General Orders. Calendar No. 113.
  • April 27, 2023
    Introduced in Senate


  • April 27, 2023
    Read twice and referred to the Committee on Health, Education, Labor, and Pensions.


  • May 11, 2023
    Committee on Health, Education, Labor, and Pensions. Ordered to be reported with an amendment in the nature of a substitute favorably.


  • June 22, 2023
    Committee on Health, Education, Labor, and Pensions. Reported by Senator Sanders with an amendment in the nature of a substitute. Without written report.


  • June 22, 2023
    Placed on Senate Legislative Calendar under General Orders. Calendar No. 113.

Health

Related Bills

  • S 118-652: Safe Step Act
  • HR 118-4712: Patient Right to Shop Act
  • HR 118-4005: Naloxone Affordability Act of 2023
  • HR 118-2630: Safe Step Act
Civil actions and liabilityCongressional oversightDisability and health-based discriminationEmployment discrimination and employee rightsGovernment information and archivesGovernment studies and investigationsHealth care costs and insuranceHealth care coverage and accessHealth information and medical recordsPrescription drugsRight of privacy

Pharmacy Benefit Manager Reform Act

USA118th CongressS-1339| Senate 
| Updated: 6/22/2023
Pharmacy Benefit Manager Reform Act This bill establishes various requirements for pharmacy benefit managers (PBMs) with respect to services provided to health insurance plans. First, PBMs must report annually to the plan sponsor certain information about the PBM's services, including the amount of prescription drug copayment assistance funded by drug manufacturers, a list of covered drugs billed under the plan during the reporting period, and the total net spending by the health plan on prescription drugs. PBMs also must provide plan sponsors with a supplementary report every six months with specified information about drugs that were dispensed under the plan by pharmacies that are wholly or partially owned by the PBM. Second, the bill prohibits spread pricing. Under the bill, spread pricing occurs when a PBM charges an insurance plan (or an insurance plan charges plan participants) a price for a prescription drug that exceeds the price paid to the pharmacy for the drug. Finally, PBMs must remit to the plan sponsor all rebates, fees, alternative discounts, and other remuneration received from a drug manufacturer. The bill establishes civil penalties for violations of these requirements and provides funding for the Centers for Medicare & Medicaid Services and the Department of Labor to implement the provisions of this bill.

Bill Text Versions

View Text
2 versions available

Suggested Questions

Get AI-generated questions to help you understand this bill better

Timeline
Apr 27, 2023
Introduced in Senate
Apr 27, 2023
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
May 11, 2023
Committee on Health, Education, Labor, and Pensions. Ordered to be reported with an amendment in the nature of a substitute favorably.
Jun 22, 2023
Committee on Health, Education, Labor, and Pensions. Reported by Senator Sanders with an amendment in the nature of a substitute. Without written report.
Jun 22, 2023
Placed on Senate Legislative Calendar under General Orders. Calendar No. 113.
  • April 27, 2023
    Introduced in Senate


  • April 27, 2023
    Read twice and referred to the Committee on Health, Education, Labor, and Pensions.


  • May 11, 2023
    Committee on Health, Education, Labor, and Pensions. Ordered to be reported with an amendment in the nature of a substitute favorably.


  • June 22, 2023
    Committee on Health, Education, Labor, and Pensions. Reported by Senator Sanders with an amendment in the nature of a substitute. Without written report.


  • June 22, 2023
    Placed on Senate Legislative Calendar under General Orders. Calendar No. 113.
Bernard Sanders

Bernard Sanders

Independent Senator

Vermont

Cosponsors (4)
Bill Cassidy (Republican)Mike Braun (Republican)Roger Marshall (Republican)Patty Murray (Democratic)

Health, Education, Labor, and Pensions Committee

Health

Related Bills

  • S 118-652: Safe Step Act
  • HR 118-4712: Patient Right to Shop Act
  • HR 118-4005: Naloxone Affordability Act of 2023
  • HR 118-2630: Safe Step Act
  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
Civil actions and liabilityCongressional oversightDisability and health-based discriminationEmployment discrimination and employee rightsGovernment information and archivesGovernment studies and investigationsHealth care costs and insuranceHealth care coverage and accessHealth information and medical recordsPrescription drugsRight of privacy