H.R.4489 - FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act111th Congress (2009-2010)
|Sponsor:||Rep. Lynch, Stephen F. [D-MA-9] (Introduced 01/21/2010)|
|Committees:||House - Oversight and Government Reform|
|Latest Action:||03/24/2010 Forwarded by Subcommittee to Full Committee (Amended) by Voice Vote .|
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Summary: H.R.4489 — 111th Congress (2009-2010)All Bill Information (Except Text)
Introduced in House (01/21/2010)
FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act - Prohibits the Office of Personnel Management (OPM) from entering a contract or approving a health benefits plan with a carrier that is a party to a pharmacy benefit manager (PBM) carrier arrangement to provide or administer prescription drug coverage under the Federal Employees Health Benefits Program (FEHBP) unless the PBM and the carrier comply with requirements of this Act. Directs OPM to terminate a contract or discontinue a plan that fails to comply.
Prohibits: (1) a pharmaceutical drug manufacturer or retail pharmacy from having a controlling interest in the PBM; or (2) the PBM from having a controlling interest in a retail pharmacy. Requires each carrier to certify PBM compliance annually. Prohibits OPM from permitting a carrier that has a controlling interest in a PBM to earn a profit from such interest with respect to an FEHBP contract.
Sets forth requirements of PBM arrangements under the FEHBP, including regarding: (1) drug substitution restrictions; (2) PBM reimbursement of carriers; (3) sale by a PBM of utilization and claims data; (4) drug pricing and the basis for reimbursement; (5) provisions of an explanation of benefits to enrollees; (6) nondiscriminatory contracts regarding required participation; (7) OPM access to PBM contract information; (8) civil monetary penalties for making false statements or claims to the government; and (9) reports from drug manufacturers on average manufacturer prices for drugs each quarter.