The Bipartisan “PBM Sunshine and Accountability Act” Would Establish New, Public Reporting Requirements for Pharmacy Benefit Managers (PBMs)
WASHINGTON, D.C. — U.S. Representative Abigail Spanberger helped introduced bipartisan legislation to help tackle the prescription drug affordability crisis, hold pharmacy benefit managers (PBMs) accountable, and lower drug costs.
In the face of high prescription drug costs, many independent experts are concerned that the practice of using PBMs as the middlemen between drug manufacturers, health insurers, and pharmacies is contributing to rising prescription drug prices and increasing out-of-pocket costs for American patients. In 2019, PBMs took in an estimated $28.05 billion in gross profits as consumer drug costs skyrocketed. And right now, the three largest PBMs — CVS Caremark, Express Scripts and OptumRx — control nearly 80 percent of the prescription drug market. However, pharmacists are unable to see the rebates and discounts received by these powerful PBMs, meaning consumers are unable to learn more about how PBMs could be benefiting from rising drug prices and increasing their out-of-pocket costs.
The Spanberger-led PBM Sunshine and Accountability Act would establish new, public reporting requirements for Pharmacy Benefit Managers (PBMs). Specifically, the legislation would require PBMs to report to the U.S. Department of Health and Human Services (HHS) their aggregate rebates, administrative fees, and other revenue received from drug manufacturers and healthcare entities. To improve the ability of patients, health policy researchers, and other stakeholders to gauge the effectiveness of their PBMs, these reporting requirements would be made public at least once a year. Additionally, this increased transparency would allow Members of Congress to take further action to lower drug costs.
“During this moment when PBMs hold tremendous power across the American pharmaceutical industry, we need to know if the behaviors of these middlemen are contributing to higher drug prices for American consumers,” said Spanberger. “By increasing reporting requirements, our PBM Sunshine and Accountability Act would help shed more light on the murky world of PBMs. Our bipartisan bill would give Congress more tools to dig into their practices — and it would give the American people more information about how PBMs might be manipulating the sticker prices of medications. In this way, we can pursue reforms that will lower drug costs for the Virginians I serve.”
In addition to Spanberger, this bipartisan legislation is led by U.S. Representatives Diana Harshbarger (R-TN-01), Raja Krishnamoorthi (D-IL-08), and Mariannette Miller-Meeks (R-IA-02).
“For far too long, PBM middlemen have exploited a lack of transparency and created conflicts of interest in ways significantly distorting competition at consumer expense – and where there’s mystery, there’s margin,” said Harshbarger. “My PBM Sunshine and Accountability Act will finally require PBMs to report critical financial information on their operations, which will enable patients and providers to see which PBMs are adding value, and which ones are printing their own money. This legislation will shine a bright light on the ways that PBMs avoid regulation and siphon off countless dollars from our supply chains, and equip policymakers to prevent these practices to save healthcare dollars.”
The PBM Sunshine and Accountability Act is endorsed by the National Community Pharmacists Association, Virginia Pharmacy Association, and additional healthcare advocacy organizations.
Click here to read the full bill text.
Spanberger has long worked to hold PBMs accountable for increasing prescription drug prices. In 2019, the U.S. House passed her bipartisan Public Disclosure of Drug Discounts Act on a vote of 403-0 to help tackle the prescription drug affordability crisis and bring greater transparency to prescription drug negotiations. And in 2021, she also introduced the bipartisan Improving Transparency to Lower Drug Costs Act to hold PBMs accountable by requiring PBMs to report their aggregate rebates, discounts, and other price concessions for prescription drugs to a public website.
And in April 2023, Spanberger reintroduced the bipartisan Preserving Rules Ordered for the Entities Covered Through (PROTECT) 340B Act to prohibit insurers and Pharmacy Benefit Managers (PBMs) from discriminating against providers or contract pharmacies that dispense discounted 340B drugs. Spanberger originally introduced the bipartisan bill in July 2021.