H.R.979 - FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act112th Congress (2011-2012)
Summary: H.R.979 — 112th Congress (2011-2012)
Introduced in House (03/09/2011)
FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act - Prohibits the Office of Personnel Management (OPM) from entering a contract or approving a health benefits plan with a carrier that is a party to a pharmacy benefit manager (PBM) carrier arrangement to provide or administer prescription drug coverage under the Federal Employees Health Benefits Program (FEHBP) unless the PBM and the carrier comply with the requirements for PBM carrier arrangements set forth by this Act. Directs OPM to terminate a contract or discontinue a plan that fails to comply with such requirements.
Prohibits: (1) a PBM under a carrier arrangement from being under common corporate control with a prescription drug manufacturer or a retail pharmacy, and (2) OPM from permitting a carrier under common corporate control with a PBM to earn a profit from such control.
Sets forth terms and requirements for PBM carrier arrangements under the FEHBP, including: (1) drug substitution restrictions, (2) PBM reimbursement of carriers, (3) sale by a PBM of utilization and claims data, (4) drug pricing and the basis for reimbursement, (5) PBM provision to plan enrollees of an explanation of benefits statement regarding prescription drugs, (6) nondiscriminatory contracts regarding required participation, (7) OPM access to PBM contract information, and (8) civil monetary penalties for making false statements or claims to the government.