Generic Drug Pricing Fairness Act - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to require each contract entered into with a prescription drug plan (PDP) sponsor with respect to a PDP the sponsor offers to prohibit the PDP from entering into a contract with any pharmacy benefits manager (PBM) to manage the prescription drug coverage provided under such plan, or to control the costs of the prescription drug coverage under it, unless the PBM adheres to specified criteria when handling personally identifiable utilization and claims data or other sensitive patient data.
Revises requirements for contracts with PDP sponsors to require that the PDP sponsor disclose to applicable pharmacies the sources used for making any update of the prescription drug pricing standard, and if the source for such a standard is not publicly available, disclose to such pharmacies all individual drug prices to be so updated in advance of their use for the reimbursement of claims.
Requires the PDP sponsor, as well, to establish a process to appeal, investigate, and resolve disputes regarding individual drug prices that are less than the pharmacy acquisition price for a drug.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4437 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 4437
To amend title XVIII of the Social Security Act to provide for pharmacy
benefits manager standards under the Medicare prescription drug program
to further transparency of payment methodologies to pharmacies, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 9, 2014
Mr. Collins of Georgia (for himself and Mr. Loebsack) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for pharmacy
benefits manager standards under the Medicare prescription drug program
to further transparency of payment methodologies to pharmacies, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Generic Drug Pricing Fairness Act''.
SEC. 2. PHARMACY BENEFITS MANAGER STANDARDS UNDER THE MEDICARE PROGRAM.
(a) In General.--Section 1860D-12(b) of the Social Security Act (42
U.S.C. 1395w-112(b)) is amended by adding at the end the following new
paragraphs:
``(7) Pharmacy benefits manager transparency
requirements.--Each contract entered into with a PDP sponsor
under this part with respect to a prescription drug plan
offered by such sponsor shall provide that the PDP may not
enter into a contract with any pharmacy benefits manager
(referred to in this paragraph as a `PBM') to manage the
prescription drug coverage provided under such plan, or to
control the costs of the prescription drug coverage under such
plan, unless the PBM adheres to the following criteria when
handling personally identifiable utilization and claims data or
other sensitive patient data:
``(A) The PBM may not transmit any personally
identifiable utilization or claims data, with respect
to a plan enrollee, to a pharmacy owned by a PBM if the
plan enrollee has not voluntarily elected in writing or
via secure electronic means to fill that particular
prescription at the PBM-owned pharmacy.
``(B) The PBM may not require that a plan enrollee
use a retail pharmacy, mail order pharmacy, specialty
pharmacy, or other pharmacy entity providing pharmacy
services in which the PBM has an ownership interest or
that has an ownership interest in the PBM or provide an
incentive to a plan enrollee to encourage the enrollee
to use a retail pharmacy, mail order pharmacy,
specialty pharmacy, or other pharmacy entity providing
pharmacy services in which the PBM has an ownership
interest or that has an ownership interest in the PBM,
if the incentive is applicable only to such
pharmacies.''.
(b) Regular Update of Prescription Drug Pricing Standard.--
Paragraph (6) of section 1860D-12(b) of the Social Security Act (42
U.S.C. 1395w-112(b)) is amended to read as follows:
``(6) Regular update of prescription drug pricing
standard.--
``(A) In general.--If the PDP sponsor of a
prescription drug plan uses a standard for
reimbursement (as described in subparagraph (B)) of
pharmacies based on the cost of a drug, each contract
entered into with such sponsor under this part with
respect to the plan shall provide that the sponsor
shall--
``(i) update such standard not less
frequently than once every 7 days, beginning
with an initial update on January 1 of each
year, to accurately reflect the market price of
acquiring the drug;
``(ii) disclose to applicable pharmacies
the sources used for making any such update;
``(iii) if the source for such a standard
for reimbursement is not publicly available,
disclose to the applicable pharmacies all
individual drug prices to be so updated in
advance of the use of such prices for the
reimbursement of claims; and
``(iv) establish a process to appeal,
investigate, and resolve disputes regarding
individual drug prices that are less than the
pharmacy acquisition price for such drug.
``(B) Prescription drug pricing standard defined.--
For purposes of subparagraph (A), a standard for
reimbursement of a pharmacy is any methodology or
formula for varying the pricing of a drug or drugs
during the term of the pharmacy reimbursement contract
that is based on the cost of the drug involved,
including drug pricing references and amounts that are
based upon average wholesale price, wholesale average
cost, average manufacturer price, average sales price,
maximum allowable cost (MAC), or other costs, whether
publicly available or not.''.
(c) Effective Date.--The amendments made by this section shall
apply to plan years beginning on or after January 1, 2015.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
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