Overview
- The Employee Benefits Security Administration proposed requiring pharmacy benefit managers to disclose rebates and other manufacturer payments, spread-pricing compensation, and funds recouped from pharmacies.
- Employers would gain the right to audit PBM disclosures for accuracy, and the rule contemplates enforcement actions and civil penalties for noncompliance.
- The proposal targets self-insured group health plans and requests feedback on extending similar disclosures to fully insured plans and other health services entities.
- PBMs would need to share the net cost of each drug on an employer’s formulary, identify products placed due to compensation, disclose therapeutically equivalent alternatives, and report conflicts such as step-therapy incentives.
- The action follows a presidential directive on drug pricing and builds on years of federal scrutiny and legislative efforts focused on CVS Caremark, Express Scripts, Optum Rx and other PBMs.