H.R.4489 - FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act

To amend chapter 89 of title 5, United States Code, to ensure program integrity, transparency, and cost savings in the pricing and contracting of prescription drug benefits under the Federal Employees Health Benefits Program. view all titles (2)

All Bill Titles

  • Official: To amend chapter 89 of title 5, United States Code, to ensure program integrity, transparency, and cost savings in the pricing and contracting of prescription drug benefits under the Federal Employees Health Benefits Program. as introduced.
  • Short: FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act as introduced.

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Introduced
 
House
Passes
 
Senate
Passes
 
President
Signs
 

 
01/21/10
 
 
 
 
 
 
 

Official Summary

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 admini

Official Summary

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.

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