美国劳工部发布 PBM 费用披露最终规则，覆盖约 1.36 亿美国人

136 Million Americans to Benefit as Health Plans Gain Access to Drug Price Markup Data

, /PRNewswire/ -- PatientRightsAdvocate.org (PRA) founder and chair Cynthia A. Fisher today praised the U.S. Department of Labor's (DOL) new final rule requiring pharmacy benefit managers (PBMs) to disclose how they make their money from employer health plans. For the first time, PBMs will have to reveal upfront their payment deals with the pharmacies and drugmakers they manage on behalf of self-insured employer-sponsored plans.

"Secretary Sonderling and the Trump administration have delivered a transparency rule that will reform the cost structure of employer-sponsored health plans," said Fisher, who spoke alongside DOL leadership today at its announcement of the rule. "No longer will 136 million Americans be left in the dark about how much the PBM middlemen are trying to siphon off their paychecks. This rule gives their employers long-sought leverage to run their health care plans by the numbers and crack down on rebates, recouped payments, spread pricing, and other PBM profiteering."

DOL's Improving Transparency Into Pharmacy Benefit Manager Fee Disclosure rule is the first-ever price transparency reform for drug costs borne by self-insured employer-sponsored health plans and those they cover, approximately 136 million Americans. PBMs have not been required before to disclose significant details to these plans about how they set prices or how they make their profits.

Pharmacy costs outranked chronic conditions, cancer care and medical inflation in a recent survey of the factors driving employers' rising health care costs. They are projected to account for 27% of employer health care spending in 2027.

Under the new rule, PBMs will have to disclose details of their drug rebates, which can create incentives to favor higher-priced drugs for employers' workers. They will also have to disclose other compensation from drug companies and revenue from spread pricing, which is the difference between what a health plan pays for a drug and what the PBM reimburses the pharmacy. Health plans will also have the authority to audit PBM disclosures annually to verify their accuracy, identify improper payments and collect overcharges.

DOL also makes clear that transparency obligations do not stop at PBMs. It confirms that under ERISA Section 408(b)(2)(B), third-party administrators and other health plan service providers are covered service providers that must disclose their direct and indirect compensation to plan sponsors. The Department expects them to make a good-faith effort to comply now. Disclosure is the condition for ERISA's prohibited transaction exemption, so a service provider that fails to disclose loses that protection

The Department signals that more detailed disclosure requirements for TPAs and other vendors will follow. Equally important, the rule guarantees employers the right to audit their PBM's disclosures and requires the PBM to give the employer's auditor "all records, claims and transaction-level data" needed to verify them. That means seeing where prescription drug dollars go, who receives them, and how much is retained by middlemen and their affiliates. 

DOL also declined to let PBMs limit audits to samples, citing the risk that sampling could be used to obscure improper transactions.

About PatientRightsAdvocate.org
PatientRightsAdvocate.org is a 501(c)(3) nonprofit, nonpartisan organization focused on ushering in systemwide healthcare price transparency. Through advocacy, testimony, media, legal research and grassroots campaigns, the organization seeks actual, upfront healthcare prices that will greatly lower costs through a functional, competitive healthcare marketplace.

SOURCE Patient Rights Advocate