Prescription Drug Transparency and Affordability Act

Increased Transparency for Health Plans: Entities providing pharmacy benefit management services must provide reports to group health plans at least every 6 months, which helps plans understand their drug spending and compensation structures. (Section 2(a)(1); Section 2(b)(1))

Access to Information for Participants: Participants and beneficiaries can request specific information regarding their claims and a summary document to better understand their plan or coverage. (Section 2(c)(1) and (2))

Improved Insight into Drug Costs: Reports must include specific data such as the wholesale acquisition cost for brand name drugs and the average wholesale price for generic drugs, as well as net prices after rebates. (Section s 2(b)(2)(A)(vi)(aa) and (VII))

Oversight of Affiliated Pharmacies: The bill requires explanations of benefit design parameters that encourage use of affiliated pharmacies and provides cost comparisons for drugs dispensed by those pharmacies. (Section 2(b)(2)(A)(iv))

Accountability through Penalties: The Act establishes civil monetary penalties of $10,000 per day for failure to provide required information and up to $100,000 for providing false information, ensuring entities follow the rules. (Section 2(d)(2) and (3))

Delayed Implementation: The new oversight and reporting requirements do not take effect until 30 months after the date of enactment. (Section 2(a)(1); Section 2(b)(1))

Potential Privacy Risks: While the bill includes privacy protections, it requires the transmission of information that must be handled in accordance with HIPAA and other privacy regulations to protect sensitive health data. (Section 2(a)(4))