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Subcommittee weighs PBM oversight changes, including spread-pricing disclosure and audits
Summary
The House Commerce and Consumer Affairs subcommittee reviewed an amended PBM oversight bill that would expand PBM licensure, require written agreements and reporting, add a spread-pricing disclosure to group plans, and raise per-violation fines; industry witnesses said major concerns were addressed but cautioned about audit frequency and lingering provisions.
The House Commerce and Consumer Affairs subcommittee on Thursday reviewed a set of amendments aimed at increasing transparency of pharmacy benefit managers and clarifying enforcement tools for regulators.
Michelle Heaton of the New Hampshire Insurance Department told the panel the amendment removes a proposed fiduciary-duty requirement but tightens contract and reporting rules: insurer-owned PBM subsidiaries would be subject to PBM licensure, written agreements would be required to preserve audit access, some reporting would move from semiannual to annual, and a definition and disclosure requirement for spread pricing…
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