Prescription Drug Transparency and Affordability Act

Specifically, a PBM contracted to provide services to an employer or sponsor offering a large group health insurance plan (i.e., a plan with at least 100 employees or participants) must report to the plan certain information for prescription drug claims under the plan. This includes, for each drug, the difference between the compensation paid by the plan to the PBM and the compensation paid by the PBM to the pharmacy.

Further, for each therapeutic class of drugs under the plan, a PBM must report (1) the total amount it received in rebates, fees, and discounts; and (2) the net spending for each class after such rebates, fees, and discounts.

Each PBM also must report certain information about (1) drugs for which total spending exceeded $10,000; and (2) drugs dispensed through pharmacies affiliated with the plan or PBM, such as the percentage of prescriptions dispensed by such affiliates.

Finally, a PBM providing services to any group health insurance plan must provide the plan with a summary document that includes similar information for prescription drug claims under the plan, as determined by the Department of Health and Human Services. Plans must also make certain aggregate summary information available to plan participants.

PBMs and plans that violate these requirements are subject to civil penalties.