Latest news and updates about the Medicare and pharmacy industries.

August 2: A New Senate Act Targets PBMs and Moves Toward Greater Transparency

Posted on in Industry Updates by Amplicare Team

Plus, the latest pharmacy and healthcare news to know this week. 

The Story

In the midst of Congress’ ongoing fight to lower drug prices, the Senate Finance Committee has passed the Prescription Drug Pricing Reduction Act of 2019 (PDPRA). The much-anticipated proposal will require PBMs to publish their yearly reports on any rebates, discounts, or price concessions that they negotiate for payers, and state how much of those savings were actually passed on to payers. In addition to this, Part D payers will be required to audit their PBM contracts, report price adjustments made after the sale by PBMs or insurers to pharmacies, and report both actual and expected DIRs. 

Why It Matters

This new bipartisan bill addresses high prescription drug prices by targeting PBMs and making sure there is an accountability system in place, especially when it comes to clawbacks and price spreading. Clawbacks, or prescription drug overpayments by patients, cost Americans $135 million in 2013, with 23% of Americans overpaying for their medications. In price spreading, PBMs negotiate drug prices with insurance plans without passing on the savings to pharmacies. The PBMs essentially pocket the extra dollars from both practices. 

The new legislation is taking a step toward more transparency, as its conditions would make information about traditionally secret negotiations public knowledge. PBMs who do not comply with the regulations may face serious fines. In a statement Matt Eyles, president and CEO of America’s Health Insurance Plans (AHIP), supported the PDPRA, saying, “These common-sense solutions will keep billions of dollars in seniors’ and taxpayers’ pockets, rather than going toward Big Pharma’s bottom line.” In fact, the legislation would save Medicare about $100 billion over the next decade. The bill is expected to go through some changes before being proposed to the full Senate.  

More Healthcare News to Watch

  1. President Trump is preparing a proposal that would allow the U.S. to import drugs from Canada and reduce out-of-pocket costs for American patients. The New York Times.
  2. Big tech companies and health plans are working together to help customers get easier access to their medical claims information through apps. CNBC.
  3. A new law in Arkansas allows pharmacists to give vaccinations to kids aged seven and older using a general standing order with a collaborative practice or physician. THV11.
  4. Rite Aid is partnering with telehealth company InTouch Health to launch its RediClinic Express, a new virtual care service in stores.
    Drug Store News.
  5. Surescripts is threatening to take its battle with Amazon to the FBI, accusing a third party company of providing PillPack with patient prescription information “fraudulently.” CNBC.

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