# Plain Language Summary: Saving Seniors Money on Prescriptions Act

## What This Bill Does

This bill requires pharmacy benefit managers (PBMs)—the companies that manage prescription drug benefits for Medicare plans—to provide detailed, transparent reports about drug pricing and performance. Starting in 2028, PBMs must clearly explain how they calculate drug costs, what drugs are covered, and how much seniors are actually paying out-of-pocket. The bill aims to make the prescription drug system more transparent so that Medicare plans can better understand and potentially negotiate better prices for seniors.

## Who Is Affected

**Medicare seniors** would be the primary beneficiaries, as the bill is designed to help lower their prescription drug costs. **Medicare prescription drug plans** (both standalone drug plans and Medicare Advantage plans with drug coverage) would be affected because they must now require their PBMs to follow these new reporting rules. **Pharmacy benefit managers** would face new compliance requirements and must provide detailed annual reports about drug pricing, rebates, and discounts to the Medicare plans they work with.

## Key Requirements

PBMs must now:
- Define and apply pricing terms (like "generic drug," "rebate," and "discount") consistently and transparently
- Clearly identify which drugs or claims are excluded from pricing guarantees
- Provide detailed annual reports by July 1st including drug names, number of prescriptions filled, costs at different pharmacy types, and what seniors actually paid out-of-pocket
- Make this information available in machine-readable formats so it can be easily analyzed

The goal is to shine a light on PBM practices and give Medicare plans better information to negotiate lower drug prices for seniors.

Saving Seniors Money on Prescriptions Act

Landsman, Greg

Saving Seniors Money on Prescriptions ActThis bill establishes reporting requirements for pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit and Medicare Advantage, particularly relating to the prices of prescription drugs.Specifically, PBMs must (1) disclose certain information underlying cost performance measurements (e.g., exclusions and terms), and (2) report to prescription drug plan (PDP) sponsors (and to&nbsp;the Centers for Medicare &amp; Medicaid Services upon request) an itemized list of prescription drugs that were dispensed during the previous year and related data about costs, claims, affiliated pharmacies, and other specified information. PDP sponsors may audit&nbsp;PBMs to ensure compliance with this bill's requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations.In addition, the Government Accountability Office must study federal and state reporting requirements for health plans and PBMs with respect to prescription drug price transparency and recommend ways to streamline these requirements.