To require the Secretary of Health and Human Services to conduct a study on pharmacy benefit manager audit practices.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
This bill requires the Secretary of Health and Human Services to study and report to Congress on how pharmacy benefit managers (PBMs) audit pharmacies. The study must cover audits of drugs dispensed under Medicare, Medicaid, group health plans, and individual health insurance, and must be completed within one year of enactment.
Who Benefits and How
Independent and retail community pharmacies are the primary beneficiaries. They have long complained that PBM audit practices are burdensome, financially harmful, and lack transparency. The study specifically examines the financial and operational impacts on these pharmacies and seeks best practices to reduce their burden. Pharmacists broadly benefit from recommendations to make audit requirements more transparent and fair.
Who Bears the Burden and How
Pharmacy benefit managers (PBMs) -- such as CVS Caremark, Express Scripts, and OptumRx -- face potential regulatory scrutiny as the study evaluates the fairness and transparency of their audit practices. The Department of Health and Human Services bears the administrative cost of conducting the study, including gathering input from pharmacists, PBMs, healthcare providers, and relevant agencies.
Key Provisions
- Mandates an HHS study on PBM audit practices within 1 year of enactment
- Requires assessment of financial and operational impacts on independent and retail community pharmacies
- Evaluates appropriateness of purchase documentation timeframes relative to medication shelf lives
- Evaluates transparency of current and historic PBM audit requirements
- Requires recommendations for best practices ensuring fairness while maintaining audit integrity
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Requires the Secretary of Health and Human Services to conduct a study and report to Congress on pharmacy benefit manager (PBM) audit practices affecting pharmacies that dispense drugs under Medicare, Medicaid, and commercial health plans.
Key Policy Areas
Healthcare, Government Operations
Primary Purpose
Requires the Secretary of Health and Human Services to conduct a study and report to Congress on pharmacy benefit manager (PBM) audit practices affecting pharmacies that dispense drugs under Medicare, Medicaid, and commercial health plans.
Policy Domains
Whole Bill
Identified Gains
Contextual inference, no direct clause citation- Independent pharmacies
- Retail community pharmacies
- Pharmacists
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Pharmacy benefit managers (PBMs)
- Department of Health and Human Services
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
IntroducedMs. Maloy (for herself, Mr. Krishnamoorthi, and Mrs. Harshbarger) introduced …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology