New PBM Transparency Bill Covers More Federal Programs

A bill to make pharmacy benefit managers’ reimbursements for generic drugs more transparent will cover more federal health care programs than a bill introduced earlier this year.

Representative Doug Collins (R-GA) and Representative Dave Loebsack (D-Iowa introduced both bills. The earlier bill applied only to Medicare Part D; however, the new bill will also cover the military’s TRICARE program and the Federal Employees Health Benefits Program.

The earlier bill, called the Generic Drug Pricing Transparency Act and introduced in April, would clarify the process used to determine Maximum Allowable Cost lists, the timing of updates to the lists, and the appeals process for disputes over payment levels. It would also force pharmacy benefit managers to disclose deceptive practices used to generate profit.

Despite its introduction during the close of the legislative year, Reps. Collin and Loebsack are expected to re-introduce the bill once Congress reconvenes.

The National Community Pharmacists Association (NCPA) endorsed both bills, noting that the bills go further than the Center for Medicare and Medicaid Services final rule on generic drug pricing.

“Under this legislation, community pharmacies would have basic insights into the criteria PBMs use to calculate reimbursements and experience more timely updates when generic price spikes occur,” B. Douglas Hoey, RPh, MBA, NCPA CEO, said in a press release. “This proposal would allow community pharmacists to spend more time helping patients maximize their health outcomes.”