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Medicare Part D Cost Sharing Cannot Exceed Net Price In House PBM, Transparency Bill

 
• By Cathy Kelly

The legislation’s pharmacy benefit manager-related provisions emphasize reporting over more direct reforms, which is similar to other PBM transparency bills circulating in Congress.

The Ways and Means Committee moved Relatively Modest PBM Oversight Legislation. • Source: Shutterstock

Medicare Part D beneficiaries cannot be subject to cost sharing greater than the net cost of a drug after rebates under legislation passed by the House Ways and Means Committee during a markup 26 July.

Key Takeaways

  • House Ways and Means Committee bill’s cost-sharing protections would begin in Medicare Part D in 2027.

  • PBMs would be required to report details of drug lists and list costs, manufacturer provided copay assistance and formulary decisions to plan sponsors

The cost sharing protection would begin “on or after” 1 January 2027 and apply to beneficiaries who have met their deductible and have

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