Pharmacy Benefit Manager Accountability Study Act of 2021

II 117TH CONGRESS 1ST SESSION S. 298 To require the Government Accountability Office to study the role pharma- ceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other purposes. IN THE SENATE OF THE UNITED STATES FEBRUARY 8, 2021 Mrs. BLACKBURN (for herself and Mr. BRAUN) introduced the following bill; which was read twice and referred to the Committee on Health, Edu- cation, Labor, and Pensions A BILL To require the Government Accountability Office to study the role pharmaceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other pur- poses. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Pharmacy Benefit 4 Manager Accountability Study Act of 2021’’. 5 VerDate Sep 11 2014 01:56 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S298.IS S298 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 298 IS SEC. 2. GAO STUDY. 1 Not later than 1 year after the date of enactment 2 of this Act, the Comptroller General of the United States 3 shall submit to the Committee on Finance and the Com- 4 mittee on Health, Education, Labor, and Pensions of the 5 Senate and to the Committee on Ways and Means and 6 the Committee on Energy and Commerce of the House 7 of Representatives a report that— 8 (1) addresses, at minimum— 9 (A) the role that pharmacy benefit man- 10 agers play in the pharmaceutical supply chain; 11 (B) the state of competition among phar- 12 macy benefit managers, including the market 13 share for the Nation’s 10 largest pharmacy 14 benefit managers; 15 (C) the use of rebates and fees by phar- 16 macy benefit managers, including data for each 17 of the 10 largest pharmacy benefit managers 18 that reflects, for each drug in the formulary of 19 each such pharmacy benefit manager— 20 (i) the amount of the rebate passed on 21 to patients; 22 (ii) the amount of the rebate passed 23 on to payors; 24 (iii) the amount of the rebate kept by 25 the pharmacy benefit manager; and 26 VerDate Sep 11 2014 01:56 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S298.IS S298 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 298 IS (iv) the role of fees charged by the 1 pharmacy benefit manager; 2 (D) whether pharmacy benefit managers 3 structure their formularies in favor of high-re- 4 bate prescription drugs over lower-cost, lower- 5 rebate alternatives; 6 (E) the average prior authorization ap- 7 proval time for each of the 10 largest pharmacy 8 benefit managers; 9 (F) factors affecting the use of step ther- 10 apy in each of the 10 largest pharmacy benefit 11 managers; and 12 (G) the extent to which the price that 13 pharmacy benefit managers charge payors, such 14 as the Medicare program under title XXVIII of 15 the Social Security Act (42 U.S.C. 1395 et 16 seq.), State Medicaid programs under title XIX 17 of the Social Security Act (42 U.S.C. 1396 et 18 seq.), the Federal Employees Health Benefits 19 Program under chapter 89 of title 5, United 20 States Code, or private payors, for a drug is 21 more than such pharmacy benefit managers pay 22 the pharmacy for the drug; and 23 (2) provides recommendations for legislative ac- 24 tion to lower the cost of prescription drugs for con- 25 VerDate Sep 11 2014 01:56 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S298.IS S298 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 298 IS sumers and payors, improve the efficiency of the 1 pharmaceutical supply chain by lowering inter- 2 mediary costs, improve competition in pharmacy 3 benefit management, and provide transparency in 4 pharmacy benefit management. 5 Æ VerDate Sep 11 2014 01:56 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\S298.IS S298 pamtmann on DSKBC07HB2PROD with BILLS