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Second, the average aggregate amount and characterization of rebates and other discounts paid by manufacturers, and the aggregate amount kept by PBMs.
Third, the average aggregate difference between the amount the PBM is paid by the plan and the average aggregate amount the retail and mail-order pharmacies are paid, respectively, for dispensing a prescription.
These requirements only apply to PBMs operating in the health insurance exchanges created by the bill. But enacting even these modest requirements would still represent an important step toward a more efficient prescription drug marketplace part of a growing national trend.
In July, the House Energy and Commerce Committee approved a similar amendment, authored by Rep. Anthony Weiner (D-N.Y.), to its health care reform plan (H.R. 3200). The Congressional Budget Office confirmed that the disclosure provision would not increase federal spending.
The Pentagon anticipates $1.67 billion in savings by negotiating drug discounts on its own instead of using a PBM for the 9 million individuals covered by the TRICARE program.
Texas estimates reducing costs by $265 million by requiring a transparent PBM contract for state government and university employees.
Next year Medicare will implement pass through pricing to crack down on spread pricing, whereby PBMs charge health plan sponsors one amount and pay the pharmacy a much lower amount, pocketing the difference.Community pharmacists are grateful for Cantwells leadership and urge all Members of Congress to support such PBM transparency provisions in health care reform to deliver real savings to patients and plan sponsors.Organizations Supporting PBM Transparency:
Consumer Federation of America
Change to Win and its key member unions: International Brotherhood of Teamsters, Laborers International Union of North America, Service Employees International Union, United Farm Workers of America, and United Food and Commercial Workers International Union
U.S. Public Interest Research Groups
AARP (filed amicus in support of Washington, D.C., PBM transparency law)
Prescription Access Litigation Project
National Alliance of State Pharmacy Associations
National Legislative Association on Prescription Drug Prices
National Community Pharmacists AssociationMajor Employers with PBM Transparency:
Lear CorporationGovernment Programs Using Transparent PBMs:
Medicare Part D
TRICARE/DODStates with PBM Transparency Laws/Contracts:
ArkansasBruce Roberts is executive vice president and CEO of the National Community Pharmacists Association.