Pharmacy Benefit Manager Accountability Study Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 1829 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 HOUSE OF REPRESENTATIVES MARCH 11, 2021 Mrs. HARSHBARGER (for herself and Mr. CARTER of Georgia) introduced the following bill; which was referred to the Committee on Energy and Commerce 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 20:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1829.IH H1829 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 1829 IH 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 Ways and Means, the 4 Committee on Energy and Commerce, and the Committee 5 on Education and Labor of the House of Representatives 6 and to the Committee on Finance and the Committee on 7 Health, Education, Labor, and Pensions of the Senate a 8 report that— 9 (1) addresses, at minimum— 10 (A) the role that pharmacy benefit man- 11 agers play in the pharmaceutical supply chain; 12 (B) the state of competition among phar- 13 macy benefit managers, including the market 14 share for the Nation’s 10 largest pharmacy 15 benefit managers; 16 (C) the use of rebates and fees by phar- 17 macy benefit managers, including data for each 18 of the 10 largest pharmacy benefit managers 19 that reflects, for each drug in the formulary of 20 each such pharmacy benefit manager— 21 (i) the amount of the rebate passed on 22 to patients; 23 (ii) the amount of the rebate passed 24 on to payors; 25 VerDate Sep 11 2014 20:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1829.IH H1829 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 1829 IH (iii) the amount of the rebate kept by 1 the pharmacy benefit manager; and 2 (iv) the role of fees charged by the 3 pharmacy benefit manager; 4 (D) whether pharmacy benefit managers 5 structure their formularies in favor of high-re- 6 bate prescription drugs over lower-cost, lower- 7 rebate alternatives; 8 (E) the average prior authorization ap- 9 proval time for each of the 10 largest pharmacy 10 benefit managers; 11 (F) factors affecting the use of step ther- 12 apy in each of the 10 largest pharmacy benefit 13 managers; and 14 (G) the extent to which the price that 15 pharmacy benefit managers charge payors, such 16 as the Medicare program under title XXVIII of 17 the Social Security Act (42 U.S.C. 1395 et 18 seq.), State Medicaid programs under title XIX 19 of the Social Security Act (42 U.S.C. 1396 et 20 seq.), the Federal Employees Health Benefits 21 Program under chapter 89 of title 5, United 22 States Code, or private payors, for a drug is 23 more than such pharmacy benefit managers pay 24 the pharmacy for the drug; and 25 VerDate Sep 11 2014 20:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1829.IH H1829 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 1829 IH (2) provides recommendations for legislative ac- 1 tion to lower the cost of prescription drugs for con- 2 sumers and payors, improve the efficiency of the 3 pharmaceutical supply chain by lowering inter- 4 mediary costs, improve competition in pharmacy 5 benefit management, and provide transparency in 6 pharmacy benefit management. 7 Æ VerDate Sep 11 2014 20:28 May 03, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\H1829.IH H1829 pamtmann on DSKBC07HB2PROD with BILLS