This bill mandates that pharmacy benefits managers (PBMs) disclose specific information to health benefits plan sponsors to enhance transparency and accountability in the management of pharmacy benefits. PBMs are required to submit detailed reports to plan sponsors and the relevant department at least every six months. These reports must include comprehensive data on drug claims, including contracted compensation, out-of-pocket spending by beneficiaries, net spending on drugs, and any rebates or discounts received. Additionally, the reports must provide insights into therapeutic classes of drugs, including gross and net spending, and the number of beneficiaries who filled prescriptions within those classes.
Furthermore, the bill stipulates that PBMs must provide summary documents to plan sponsors and beneficiaries, containing essential information to aid in understanding the health benefits plan and selecting pharmacy benefit management services. It also grants plan sponsors the right to audit PBMs annually to ensure compliance with contract terms and the accuracy of reported information. This legislation aims to improve the overall transparency of pharmacy benefit management and ensure that plan sponsors and beneficiaries have access to critical information regarding drug costs and management practices.