Patients Before Middlemen Act
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Senate
- Passed House
- To President
- Became Law
Overview
The Patients Before Middlemen Act aims to improve pharmacy access and choice for Medicare beneficiaries by addressing the roles of prescription drug plan sponsors, pharmacy benefit managers (PBMs), and pharmacies. It establishes standards for contracts between these entities, requires the Centers for Medicare & Medicaid Services (CMS) to report on essential retail pharmacies, and limits PBM income to flat service fees. The bill also seeks to increase transparency and accountability in PBM practices and ensure fair reimbursement for pharmacies.
Key provisions
- Establishes standards for contract terms and conditions between PDP sponsors and pharmacies.
- Requires CMS to publish biennial reports on essential retail pharmacies, including cost and participation trends.
- Limits PBM income to flat, bona fide service fees.
- Requires PBMs to reimburse PDP sponsors for civil penalties related to contract violations.
- Mandates PBMs to turn over excess income to PDP sponsors.
- Requires PBMs to report detailed information on dispensed drugs and related costs to PDP sponsors and CMS.
- Establishes a process for pharmacies to submit allegations of contract violations to CMS.
- Requires pharmacy benefit managers to provide transparency regarding their agreements with drug manufacturers and pharmacies.
Who is affected
- Medicare beneficiaries
- Prescription drug plan sponsors (PDPs)
Bill text
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Sponsors
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8 on record
Primary sponsor
Cosponsors
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