Saving Seniors Money on Prescriptions Act
Saving Seniors Money on Prescriptions Act
Plain Language Summary
# Summary: Saving Seniors Money on Prescriptions Act **What the bill does:** This bill would require pharmacy benefit managers (PBMs)—companies that manage prescription drug benefits for Medicare plans—to provide detailed financial information about the drugs they dispense and the costs involved. PBMs would have to report data on specific medications, pricing, claims, and affiliated pharmacies to the Medicare plans that hire them. The bill also allows these plans to audit PBMs for compliance and requires the Government Accountability Office to study how health plans and PBMs currently report information. **Who it affects:** Primarily Medicare beneficiaries (seniors on Medicare), as well as the PBMs that manage their prescription drug coverage and the Medicare plans that contract with these PBMs.
The increased transparency requirements would also create new compliance responsibilities for the pharmacy industry. **Key provisions:** PBMs must disclose detailed cost information and explain how they calculate performance metrics; they face civil penalties for non-compliance. Medicare plans gain auditing authority to verify PBMs are following the rules. A government study will examine federal and state reporting standards for health plans and PBMs. **Current status:** The bill is currently in committee, meaning it has not yet been voted on by the full House of Representatives.
CRS Official Summary
Saving Seniors Money on Prescriptions ActThis bill establishes reporting requirements for pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit and Medicare Advantage, particularly relating to the prices of prescription drugs.Specifically, PBMs must (1) disclose certain information underlying cost performance measurements (e.g., exclusions and terms), and (2) report to prescription drug plan (PDP) sponsors (and to the Centers for Medicare & Medicaid Services upon request) an itemized list of prescription drugs that were dispensed during the previous year and related data about costs, claims, affiliated pharmacies, and other specified information. PDP sponsors may audit PBMs to ensure compliance with this bill's requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations.In addition, the Government Accountability Office must study federal and state reporting requirements for health plans and PBMs with respect to prescription drug price transparency and recommend ways to streamline these requirements.
Latest Action
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.