Saving Seniors Money on Prescriptions Act
The Saving Seniors Money on Prescriptions Act would require heightened transparency from pharmacy benefit managers (PBMs) that work with Medicare prescription drug plans (PDPs) and MA-PD plans (Medicare Advantage plans with drug coverage). Starting with plan years that begin in 2028, PBMs must have written agreements with PDP sponsors and meet extensive reporting obligations. Each year, PBMs would provide a detailed, machine-readable report to PDP sponsors and, on request, to the Secretary of Health and Human Services, covering everything from drug lists and usage to pricing, rebates, affiliate relationships, and broker/consultant compensation. The bill also creates audit rights for sponsors, confidentiality protections, and penalties for noncompliance, plus a separate GAO study to examine the broader landscape of health plan and PBM reporting and ways to streamline it. In addition, MA-PD plans would be required to follow these PBM reporting requirements.
Key Points
- 1New requirements for PBMs in PDP contracts: PBMs must have a written agreement with PDP sponsors agreeing to detailed transparency and reporting obligations starting plan years beginning January 1, 2028.
- 2Comprehensive annual reporting: By July 1 each year, PBMs must deliver a wide-ranging, plan-by-plan report to PDP sponsors (and to the Secretary on request) that includes per-drug data, dispensing channels, pricing benchmarks, rebates, net costs, and total revenue retained by the PBM or its affiliates, among other items.
- 3Affiliate and pricing transparency: For PBMs with affiliates (retail, mail, specialty pharmacies), the report must cover affiliate share of prescriptions, cost comparisons between affiliate and non-affiliate pharmacies, and specific cost metrics for drugs available through the network.
- 4Access, formats, and confidentiality: Reports must be in machine-readable formats (and other formats as determined by the Secretary); standard reporting formats to be established by June 1, 2025; information not publicly released unless specified, with strict confidentiality protections to prevent disclosure of sensitive identifiers or prices.
- 5Audit and enforcement: PDP sponsors can audit PBMs at least annually; PBMs must cooperate and provide records, subject to restrictions to protect privacy and prevent redisclosure; PBMs are responsible for reimbursement of penalties or enforcement remedies if they breach the contract.
- 6Certification and definitions: PDP sponsors must certify compliance annually; the bill defines PBM and its affiliates broadly (including entities that perform related functions or operate as contractors/agents).
- 7MA-PD plans: The act adds a new reporting requirement for PBMs under MA-PD plans, tying them to the same subsection (h) as PDPs.
- 8GAO study: The Comptroller General must study federal and state reporting requirements related to PBMs and prescription drug costs, assess overlaps/burdens, and report within 2 years with recommendations to streamline the process.