S.Amdt. 2789

This amendment, submitted by Mr. Grassley, aims to add a chapter focused on Pharmacy Benefit Manager (PBM) Transparency to bill H.R. 1. Its primary purpose is to stop unfair or deceptive pricing practices and increase oversight of how PBMs handle prescription drug costs.

Key changes and additions include:

• Prohibitions on Pricing Practices: It makes it illegal for PBMs to keep the difference between what they charge a health plan and what they pay a pharmacy. It also bans the unfair "claw back" of reimbursement payments from pharmacists, except in cases of fraud or inconsistent contract terms.

• Transparency and Reporting: PBMs must annually report specific financial data to the Federal Trade Commission (FTC) and the Secretary of Health and Human Services. This includes the difference between payments from health plans and payments to pharmacies, as well as explanations for moving drugs to higher-cost formulary tiers.

• Government Oversight: The amendment requires the FTC and the Comptroller General of the United States (GAO) to submit reports to Congress regarding PBM competition, market share, and the impact of their practices on consumer costs.

• Whistleblower Protections: It prohibits retaliation against employees or contractors who report violations of this chapter to the government.

• Enforcement: The FTC is granted authority to enforce these rules, including the ability to impose civil penalties of up to $1,000,000. State attorneys general are also permitted to bring civil actions to protect their residents.