On January 25, Senators Maria Cantwell, D-Washington and Chuck Grassley, R-Iowa, reintroduced the Pharmacy Benefit Manager Transparency Act and the Prescription Pricing for the People Act.
The proposed legislation would prohibit clawbacks of pharmacy payments, as well as other pharmacy benefit management (PBM) changes like mandating that PBMs file an annual report detailing pricing practices with the Federal Trade Commission (FTC).
According to the National Community Pharmacists Association, describes the practice of copay clawback in the following way:
Under almost all health care plans, patients are responsible for a certain level of cost sharing. With this model, the patient assumes they are paying a portion of the cost and their insurance company is paying the remainder. The practice known as "copay clawback" turns this premise upside down. In this case, the cost of the medication is lower than the patient's copay, but the patient's PBM instructs the pharmacy to charge the patient an inflated copay. Later the PBM "claws back" the excess from the pharmacy and keeps it for themselves.
This latest move could signal that lawmakers are unwilling to back down from PBM reform in the latest Congress.
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