# Plain Language Summary: Pharmacy Benefit Manager Sunshine and Accountability Act

Pharmacy Benefit Managers, or PBMs, are companies that sit between insurance companies, employers, and pharmacies to manage prescription drug benefits. They negotiate drug prices, decide which medications are covered, and handle claims. This bill requires PBMs to be much more transparent about the money they're making from these arrangements—specifically, it forces them to publicly report how much money they're keeping versus how much they're passing along to the insurance plans and employers that hired them.

Right now, PBMs collect money from drug manufacturers in the form of rebates and fees, but they don't have to tell anyone exactly how much they're keeping for themselves. This bill changes that by requiring PBMs to report detailed information about all the money flowing through their hands, including rebates from drug makers, administrative fees they collect, and crucially, how much of that money they're actually keeping rather than passing through to the health plans. The bill also expands who has to report this information—it adds regular health insurance companies and employer health plans to the list of organizations that must disclose their PBM dealings. The government will then publish all this information on a public website so patients, employers, and regulators can see what's really happening with drug pricing.

The practical effect is that PBMs will lose much of their ability to hide how profitable their operations are. If a PBM is keeping 40 percent of rebates while passing only 60 percent to the insurance plan, everyone will know it. This transparency could put pressure on PBMs to pass more money through to health plans, which could theoretically lower insurance premiums or out-of-pocket costs for patients. However, PBMs might respond by restructuring their business models or raising other fees, so the real-world impact on what patients actually pay remains uncertain. What's clear is that this bill is designed to shine a light on a part of the healthcare system that has operated largely in the shadows.

Pharmacy Benefit Manager Sunshine and Accountability Act

Harshbarger, Diana

Pharmacy Benefit Manager Sunshine and Accountability Act This bill expands and otherwise modifies reporting requirements for pharmacy benefit managers (PBMs). Current law requires PBMs that contract with plans under the Medicare prescription drug benefit or plans that are offered on state health insurance exchanges to report certain information regarding rebates, fees, and other related information. The bill applies these requirements to PBMs that contract with private health insurers, and it expands these requirements to include more specific information relating to prices and fees, such as rebates that the PBM receives from drug manufacturers that are not passed through to other entities and the highest and lowest rebate percentages the PBM receives among all its contracts. The bill also requires the Department of Health and Human Services to annually post the information reported by PBMs on its website.