3.0.0 5234 2023-01-11T13:20:13Z 2023-01-11T13:20:13Z House H HR 2010-05-06 111 hsed00 Education and the Workforce Committee House Standing hsed02 Health, Employment, Labor, and Pensions Subcommittee Referred to 2010-05-27T14:20:04Z Referred to 2010-05-06T14:02:41Z hswm00 Ways and Means Committee House Standing hswm02 Health Subcommittee Referred to 2010-05-10T19:26:01Z Referred to 2010-05-06T14:02:40Z hsif00 Energy and Commerce Committee House Standing Referred to 2010-05-06T14:02:39Z 2010-05-27 hsed02 Health, Employment, Labor, and Pensions Subcommittee 1 House committee actions Referred to the Subcommittee on Health, Employment, Labor, and Pensions. Committee 2010-05-10 hswm02 Health Subcommittee 1 House committee actions Referred to the Subcommittee on Health. Committee 2010-05-06 Referred to House Education and Labor IntroReferral H11100 2 House floor actions hsed00 Education and the Workforce Committee 2010-05-06 Referred to House Ways and Means IntroReferral H11100 2 House floor actions hswm00 Ways and Means Committee 2010-05-06 Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. IntroReferral H11100-A 9 Library of Congress 2010-05-06 Referred to House Energy and Commerce IntroReferral H11100 2 House floor actions hsif00 Energy and Commerce Committee 2010-05-06 Introduced in House IntroReferral Intro-H 9 Library of Congress 2010-05-06 Introduced in House IntroReferral 1000 9 Library of Congress W000792 Rep. Weiner, Anthony D. [D-NY-9] ANTHONY WEINER D NY D. 9 N M000934 Rep. Moran, Jerry [R-KS-1] Jerry Moran R KS 1 2010-05-06 True H000712 Rep. Holden, Tim [D-PA-17] TIM HOLDEN D PA 17 2010-05-12 False R000575 Rep. Rogers, Mike D. [R-AL-3] Mike Rogers R AL 3 2010-05-13 False R000573 Rep. Ross, Mike [D-AR-4] MIKE ROSS D AR 4 2010-05-18 False W000800 Rep. Welch, Peter [D-VT-At Large] Peter Welch D VT 0 2010-05-20 False J000255 Rep. Jones, Walter B., Jr. [R-NC-3] WALTER JONES R NC B. 3 2010-06-08 False B000716 Rep. Boyd, Allen [D-FL-2] ALLEN BOYD D FL JR. 2 2010-06-08 False C001069 Rep. Courtney, Joe [D-CT-2] Joe Courtney D CT 2 2010-06-16 False V000108 Rep. Visclosky, Peter J. [D-IN-1] PETER VISCLOSKY D IN J. 1 2010-06-21 False H001047 Rep. Himes, James A. [D-CT-4] James Himes D CT A. 4 2010-06-24 False O000169 Rep. Owens, William L. [D-NY-23] William Owens D NY L. 23 2010-06-24 False B000490 Rep. Bishop, Sanford D., Jr. [D-GA-2] SANFORD BISHOP D GA D. 2 2010-06-24 False B001252 Rep. Barrow, John [D-GA-12] John Barrow D GA 12 2010-06-28 False K000220 Rep. Kingston, Jack [R-GA-1] JACK KINGSTON R GA 1 2010-06-28 False F000339 Rep. Frank, Barney [D-MA-4] BARNEY FRANK D MA 4 2010-06-29 False P000258 Rep. Peterson, Collin C. [D-MN-7] COLLIN PETERSON D MN C. 7 2010-07-14 False C001080 Rep. Chu, Judy [D-CA-32] Judy Chu D CA 32 2010-07-19 False G000549 Rep. Gerlach, Jim [R-PA-6] Jim Gerlach R PA 6 2010-07-20 False W000799 Rep. Walz, Timothy J. [D-MN-1] Timothy Walz D MN J. 1 2010-07-29 False L000563 Rep. Lipinski, Daniel [D-IL-3] Daniel Lipinski D IL William 3 2010-07-29 False L000565 Rep. Loebsack, David [D-IA-2] David Loebsack D IA 2 2010-07-29 False B001242 Rep. Bishop, Timothy H. [D-NY-1] Timothy Bishop D NY H. 1 2010-07-30 False I000057 Rep. Israel, Steve [D-NY-2] STEVE ISRAEL D NY 2 2010-09-29 False C001065 Rep. Carney, Christopher P. [D-PA-10] Christopher Carney D PA P. 10 2010-09-29 False D000610 Rep. Deutch, Theodore E. [D-FL-19] Theodore Deutch D FL E. 19 2010-09-29 False R000011 Rep. Rahall, Nick J., II [D-WV-3] NICK RAHALL D WV J. 3 2010-09-29 False B000657 Rep. Boucher, Rick [D-VA-9] RICK BOUCHER D VA 9 2010-09-29 False B000420 Rep. Berry, Marion [D-AR-1] MARION BERRY D AR 1 2010-09-29 False H001037 Rep. Herseth Sandlin, Stephanie [D-SD-At Large] Stephanie Herseth Sandlin D SD 0 2010-09-29 False A000361 Rep. Alexander, Rodney [R-LA-5] Rodney Alexander R LA 5 2010-09-29 False S001156 Rep. Sánchez, Linda T. [D-CA-39] Linda Sánchez D CA T. 39 2010-09-29 False M001169 Rep. Murphy, Christopher [D-CT-5] Christopher Murphy D CT S. 5 2010-11-18 False Health Administrative remedies Business ethics Contracts and agency Employee benefits and pensions Health care costs and insurance Medicare Prescription drugs Health 00 2010-05-06 Introduced in House 2010-06-16T18:11:51Z PBM Audit Reform and Transparency Act of 2010 - Amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), the Internal Revenue Code, and part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to prohibit a group health plan from entering into a contract with any pharmacy benefit manager (PBM) to manage the prescription drug coverage provided under the plan, or to control the costs of such coverage, unless the PBM satisfies the following requirements.

Requires the PBM to report at least annually to each plan, including regarding the PBM's payments to pharmacies, payments received by the PBM from plans and drug manufacturers, and information on generic drugs.

Sets forth provisions governing the interaction between a PBM and pharmacies that contract with the PBM, including: (1) requiring the PBM to disclose reimbursement information; (2) requiring prompt payment for clean claims; (3) prohibiting the exclusion of qualified pharmacies from participation in a network; and (4) requiring a pharmacy owner to sign a contract with a PBM before assuming responsibility to participate in a network managed by the PBM.

Prohibits a PBM from requiring or offering incentives to a beneficiary to fill a prescription at a pharmacy that the PBM has an ownership interest in or at a pharmacy with an ownership interest in the PBM.

Sets forth requirements for PBM audits of a contract pharmacy, including requirements for prior written notice and an appeals process.

Establishes limitations on a PBM seeking to sell, lease, or rent utilization or claims data that a PBM possesses as a result of a contract with a health plan, including requiring a PBM to: (1) provide prior notification of, and receive written approval from, the plan; and (2) provide an opportunity for covered individuals to opt-out of a sale, leasing, or renting of data related to such individual. Prohibits a PBM from directly contacting a covered individual without express written permission of the plan and the individual. Limits data sharing with PBM-owned pharmacies or pharmacies with ownership interests in the PBM.

Applies the provisions of this Act to health insurance coverage offered in the individual market.

]]> PBM Audit Reform and Transparency Act of 2010 Display Title PBM Audit Reform and Transparency Act of 2010 Official Title as Introduced To amend the Public Health Service Act, the Employee Retirement Income Security Act, the Internal Revenue Code of 1986, and title XVIII of the Social Security Act to ensure transparency and proper operation of pharmacy benefit managers. Introduced in House IH Short Titles as Introduced PBM Audit Reform and Transparency Act of 2010 Introduced in House 2010-05-06T04:00:00Z https://www.govinfo.gov/content/pkg/BILLS-111hr5234ih/xml/BILLS-111hr5234ih.xml 2010-05-27 Referred to the Subcommittee on Health, Employment, Labor, and Pensions. text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. Congressional Research Service, Library of Congress This file contains bill summaries and statuses for federal legislation. A bill summary describes the most significant provisions of a piece of legislation and details the effects the legislative text may have on current law and federal programs. Bill summaries are authored by the Congressional Research Service (CRS) of the Library of Congress. As stated in Public Law 91-510 (2 USC 166 (d)(6)), one of the duties of CRS is "to prepare summaries and digests of bills and resolutions of a public general nature introduced in the Senate or House of Representatives". For more information, refer to the User Guide that accompanies this file.