Kuster, Carter, Eshoo, Guthrie Introduce Bill To Increase Transparency Around Health Insurance Benefits

WASHINGTON, April 21 -- Rep. Ann Kuster, D-New Hampshire, issued the following news release on April 20, 2023:

This week, Congresswoman Annie Kuster (D-NH) introduced bipartisan legislation alongside Representatives Earl "Buddy" Carter (R-GA), Anna Eshoo (D-CA), and Brett Guthrie (R-KY) to increase oversight of pharmacy benefits manager (PBM) services. H.R. 2679, the Pharmacy Benefits Manager Accountability Act, would raise reporting requirements for PBMs to increase transparency in the drug supply chain.

"Understanding your health care benefits should not require an advanced medical degree - yet, millions of Americans are left in the dark on what they are paying for and what their insurance plan covers," said Kuster. "Patients across the country deserve transparency around what they pay for prescription drugs. I am proud to introduce this legislation to shine a light on how drugs are covered and paid for and to ensure transparency throughout the health system."

"PBMs are the parasites of the pharmaceutical industry and the time for accountability has come. The PBM Accountability Act is an important step towards bringing down prescription drug prices by addressing the root cause of rising prices, the middlemen that prey on patients for profits. I'm glad that there is bipartisan support for building a health care system that puts patients first," said Carter.

"I'm proud to introduce the Pharmacy Benefits Manager (PBM) Accountability Act to hold the secretive middlemen of the drug industry accountable for their role in skyrocketing drug prices. The legislation will increase reporting requirements of PBMs to shed a light on the opaque drug pricing system they use during their dealings with manufacturers and insurance plans," said Eshoo. "This will enable pharmacies and insurers to better negotiate prices which will lower drug costs for hardworking Americans and potentially save the federal government over $2 billion over the next ten years."

"Unleashing price transparency across the health care system is key to uncover and address the root causes of why health care costs continue to rise. The PBM Accountability Act would shine a light on the prescription drug middlemen and provide more transparency to the pharmaceutical supply chain. I'm proud to support this legislation as part of my bipartisan work to empower patients and drive competition to ultimately make health care more affordable and accessible for patients," said Guthrie.

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Background:

Pharmacy Benefits Managers (PBMs) manage prescription drug benefits on behalf of health insurers, drug plans, large employers, and other payers. In their role as middlemen conducting negotiations between drug manufacturers and insurance issuers, PBMs have a significant behind-the-scenes impact on how much prescription drugs ultimately cost, and are taking home large profits because of the way the current system operates, ultimately raising the cost of prescription drugs across the board. Increasing transparency around PBMs actions will better inform employers and plan sponsors on how prescription drugs are covered and paid for under their plan.

Specifically, the PBM Accountability Act will:

* Require PBMs to provide annual reporting to plan sponsors beginning after January 1, 2025, on certain information, such as

- The drugs covered by such plan that were dispensed during the reporting period, including each drug's wholesale acquisition cost, the total out-of-pocket spending by enrollees on such drug, the rationale for formulary placement for certain drugs, and other information;

- The amount received by the PBM in rebates, fees, and alternative discounts for certain therapeutic categories of drugs;

- The total net spending on prescription drugs by the health plan during the reporting period; and

- Other information related to the spending on prescription drugs by such health plan.

* Require a report to GAO on the practices of pharmacy networks of group health plans, including networks that have pharmacies that are under common ownership with group health plans,

* Empower the Secretaries of Health and Human Services, Labor, and Treasury to enforce reporting requirements through civil monetary penalties in cases of violation.

Full bill text is available here (https://kuster.house.gov/UploadedFiles/PBM_Accountability_Act.pdf).

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Original text here: https://kuster.house.gov/news/documentsingle.aspx?DocumentID=5287