Prescription Drug Transparency and Affordability Act

Summary

Requires pharmacy benefit managers (PBMs), group health plans, and health insurance issuers to allow full disclosure and to provide standardized, plain‑language, machine‑readable drug‑level and therapeutic‑class reports to plans and issuers on a regular basis. Contracts that limit or delay the flow of information needed for these reports would be prohibited. The reporting regime—covering items such as contracted compensation, amounts paid to pharmacies, rebates and other remuneration, net prices, out‑of‑pocket spending, formulary placement, and affiliated‑pharmacy relationships—starts for plan years beginning 30 months after enactment, with reports provided at least every six months (or quarterly if requested by the plan).

• Creates a federal transparency regime requiring PBMs to deliver standardized, machine‑readable, plain‑language reports to group health plans and issuers.
• Prohibits contracts that limit or delay disclosure of information needed for the required reporting.
• Reports must include detailed drug‑level and claim‑level data: NDC, drug names, dispensing channel, pricing, rebates, PBM compensation, pharmacy payments, and participant out‑of‑pocket amounts.
• Requires aggregated therapeutic‑class reporting covering gross/net spending, PBM receipts, utilization, and lists of drugs in each class.
• Reports are required at least twice a year, with quarterly reporting available at the plan’s request under equivalent terms and cost.
• Mandates disclosure of formulary placement, utilization management rules, rationales for formulary changes, and affiliations with pharmacies.
• Effective for plan years beginning 30 months after the law is enacted, giving time for systems and contracts to be updated.
• Creates significant data collection, IT, and administrative obligations for PBMs, plans, issuers, and potentially manufacturers and pharmacies.