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Bill117th CongressFiled May 24, 2022Health
S. 4293

Pharmacy Benefit Manager Transparency Act of 2022

Bill journey · stage 2 of 5

Under committee review

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What it doesSummary reported to senate (Dec 14, 2022)

Pharmacy Benefit Manager Transparency Act of 2022

This bill generally prohibits pharmacy benefit managers (PBMs) from engaging in certain practices when managing the prescription drug benefits under a health insurance plan, including charging the plan a different amount than the PBM reimburses the pharmacy.

The bill also prohibits PBMs from arbitrarily, unfairly, or deceptively (1) clawing back reimbursement payments, or (2) increasing fees or lowering reimbursements to pharmacies to offset changes to federally funded health plans.

PBMs are not subject to these prohibitions if they (1) pass along 100% of any price concession or discount to the health plan, and (2) disclose specified costs, prices, reimbursements, fees, markups, discounts, and aggregate payments received with respect to their PBM services.

Further, PBMs must report annually to the Federal Trade Commission (FTC) certain information about payments received from health plans and fees charged to pharmacies.

The FTC and state attorneys general are authorized to enforce the provisions of the bill.

What just happenedDec 14, 2022

Placed on Senate Legislative Calendar under General Orders. Calendar No. 647.

Who’s behind it

Sen. Cantwell, Maria [D-WA](D-WA)Sponsor
8 cosponsors1 D7 R
Read on Congress.gov
8cosponsors1committees6actions2related bills8subjects
  1. Dec 14, 2022Calendars

    Placed on Senate Legislative Calendar under General Orders. Calendar No. 647.

  2. Dec 14, 2022Committee

    Committee on Commerce, Science, and Transportation. Reported by Senator Cantwell with an amendment in the nature of a substitute. Without written report.

    Commerce, Science, and Transportation Committee
  3. Dec 14, 2022Committee14000

    Committee on Commerce, Science, and Transportation. Reported by Senator Cantwell with an amendment in the nature of a substitute. Without written report.

    Commerce, Science, and Transportation Committee
  4. Jun 22, 2022Committee

    Committee on Commerce, Science, and Transportation. Ordered to be reported with an amendment in the nature of a substitute favorably.

    Commerce, Science, and Transportation Committee
  5. May 24, 2022IntroReferral

    Read twice and referred to the Committee on Commerce, Science, and Transportation.

    Commerce, Science, and Transportation Committee
  6. May 24, 2022IntroReferral10000

    Introduced in Senate

Reported to SenateDec 14, 202225

Pharmacy Benefit Manager Transparency Act of 2022

This bill generally prohibits pharmacy benefit managers (PBMs) from engaging in certain practices when managing the prescription drug benefits under a health insurance plan, including charging the plan a different amount than the PBM reimburses the pharmacy.

The bill also prohibits PBMs from arbitrarily, unfairly, or deceptively (1) clawing back reimbursement payments, or (2) increasing fees or lowering reimbursements to pharmacies to offset changes to federally funded health plans.

PBMs are not subject to these prohibitions if they (1) pass along 100% of any price concession or discount to the health plan, and (2) disclose specified costs, prices, reimbursements, fees, markups, discounts, and aggregate payments received with respect to their PBM services.

Further, PBMs must report annually to the Federal Trade Commission (FTC) certain information about payments received from health plans and fees charged to pharmacies.

The FTC and state attorneys general are authorized to enforce the provisions of the bill.

Introduced in SenateMay 24, 2022

Pharmacy Benefit Manager Transparency Act of 2022

This bill generally prohibits pharmacy benefit managers (PBMs) from engaging in certain practices when managing the prescription drug benefits under a health insurance plan, including charging the plan a different amount than the PBM reimburses the pharmacy.

The bill also prohibits PBMs from arbitrarily, unfairly, or deceptively (1) clawing back reimbursement payments, or (2) increasing fees or lowering reimbursements to pharmacies to offset changes to federally funded health plans.

PBMs are not subject to these prohibitions if they (1) pass along 100% of any price concession or discount to the health plan, and (2) disclose specified costs, prices, reimbursements, fees, markups, discounts, and aggregate payments received with respect to their PBM services.

Further, PBMs must report annually to the Federal Trade Commission (FTC) certain information about payments received from health plans and fees charged to pharmacies.

The FTC and state attorneys general are authorized to enforce the provisions of the bill.

Pharmacy Benefit Manager Transparency Act of 2022 — Informed