40 min

What's the Impact of the Pharmacy Benefit Manager Transparency Act of 2022 Pharmacy Podcast Network

    • Business News

Senator Chuck Grassley (R-Iowa) and Maria Cantwell (D-Wash.) introduced the Pharmacy Benefit Manager Transparency Act of 2022 on May 24, which would make it illegal for PBMs to engage in “spread pricing.” Spread pricing occurs when PBMs charge health plans and payers more for a prescription drug than what they reimburse to the pharmacy — and then keep the difference. For example, when a pharmacist fills a prescription, a PBM handles the process, informing the pharmacy it will be reimbursed $90. 

The PBM then charges the health insurance plan $100 for processing the same prescription. The spread of $10 is pocketed by the PBMs. Related: New PBM players banking on drug pricing transparency for success The bipartisan legislation would empower the Federal Trade Commission (FTC) to increase drug pricing transparency and hold pharmacy benefit managers (PBMs) accountable for unfair and deceptive practices that drive up the costs of prescription drugs at the expense of consumers. 

It also would prohibit arbitrary clawbacks of payments made to pharmacies and require PBMs to report to the FTC how much money they make through spread pricing and pharmacy fees.

SCPC, CEO, Alan Rosenbloom & Senior Director, Regulatory Policy at APhA, Michael Baxter join Todd Eury with the Pharmacy Podcast Network to discuss the impact of the Pharmacy Benefit Manager Transparency Act of 2022 on the Pharmacy Profession.
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Senator Chuck Grassley (R-Iowa) and Maria Cantwell (D-Wash.) introduced the Pharmacy Benefit Manager Transparency Act of 2022 on May 24, which would make it illegal for PBMs to engage in “spread pricing.” Spread pricing occurs when PBMs charge health plans and payers more for a prescription drug than what they reimburse to the pharmacy — and then keep the difference. For example, when a pharmacist fills a prescription, a PBM handles the process, informing the pharmacy it will be reimbursed $90. 

The PBM then charges the health insurance plan $100 for processing the same prescription. The spread of $10 is pocketed by the PBMs. Related: New PBM players banking on drug pricing transparency for success The bipartisan legislation would empower the Federal Trade Commission (FTC) to increase drug pricing transparency and hold pharmacy benefit managers (PBMs) accountable for unfair and deceptive practices that drive up the costs of prescription drugs at the expense of consumers. 

It also would prohibit arbitrary clawbacks of payments made to pharmacies and require PBMs to report to the FTC how much money they make through spread pricing and pharmacy fees.

SCPC, CEO, Alan Rosenbloom & Senior Director, Regulatory Policy at APhA, Michael Baxter join Todd Eury with the Pharmacy Podcast Network to discuss the impact of the Pharmacy Benefit Manager Transparency Act of 2022 on the Pharmacy Profession.
Learn more about your ad choices. Visit megaphone.fm/adchoices

40 min