H.R.1971 - Pharmacy Competition and Consumer Choice Act of 2011112th Congress (2011-2012)
Summary: H.R.1971 — 112th Congress (2011-2012)
Introduced in House (05/24/2011)
Pharmacy Competition and Consumer Choice Act of 2011 - Amends the Public Health Service Act, the Employee Retirements 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 or individual health plan from entering into a contract with any pharmacy benefits manager (PBM) to manage the prescription drug coverage provided under such plan or to control the costs of such coverage unless the PBM satisfies the requirements of this Act.
Directs a PBM to provide at least annually a report to each plan sponsor that includes information on the number and total costs of prescriptions under the contract, payments to pharmacies, payments from pharmaceutical manufacturers, and generic drugs and brand name drugs dispensed.
Sets forth provisions governing the interaction between a PBM and pharmacies that contract with the PBM, including requiring a PBM to: (1) include in contracts drug pricing information and agree to provide timely updates on pricing, (2) agree to pay pharmacies promptly for clean claims, (3) not exclude qualifying pharmacies willing to accept terms and conditions of the PBM, and (4) require each pharmacy to sign a contract before assuming responsibility to fill prescriptions for the PBM.
Prohibits a PBM from mandating or providing incentives to beneficiaries for use of a pharmacy in which the PBM has an ownership interest.
Sets forth limits on audits of pharmacy providers by a PBM, including with respect to record keeping, appeals, and recoupment.
Establishes limits and notice requirements related to PBMs selling claims or utilization data.