Advancing transparency, reducing costs, and improving patient access to essential medications through comprehensive reform.
Pharmacy Benefits Managers play a critical role in healthcare, yet their practices have raised concerns about transparency and cost.
Hidden rebates and spread pricing make it difficult to understand true medication costs.
Complex pricing structures contribute to increased out-of-pocket expenses for patients.
Restrictive formularies and prior authorization barriers delay patient care.
Comprehensive measures designed to create a more transparent and patient-centered pharmacy benefits system.
Require disclosure of all rebates, fees, and pricing arrangements to ensure stakeholders understand true costs.
Prohibit the practice of charging health plans more than what is paid to pharmacies.
Ensure patients and providers have clear information about medication coverage and alternatives.
Establish clear guidelines to prevent steering and ensure access to local pharmacies.
How PBM reform creates positive impacts across the healthcare ecosystem.
Reduced out-of-pocket expenses through transparent pricing and elimination of unnecessary markups.
Streamlined approval processes and broader pharmacy networks enhance medication availability.
Clear reporting requirements create a more accountable and competitive marketplace.
Standardized processes reduce administrative delays in medication authorization.
Increased medication adherence through affordability and accessibility improvements.
Competitive transparency encourages development of more efficient benefit models.
A phased approach to ensuring smooth transition and maximum effectiveness.
Establish comprehensive regulatory framework and disclosure requirements for PBM operations.
PBMs implement necessary systems and processes to meet new transparency and reporting standards.
Regulatory bodies establish oversight mechanisms to ensure ongoing compliance and data accuracy.
Analyze outcomes and refine policies based on real-world data and stakeholder feedback.
Healthcare Policy Rating
Legislative Compliance
Patient Advocacy Endorsed
Public Support
"This reform represents a critical step forward in ensuring patients have access to affordable medications. Transparency in PBM practices will help rebuild trust in our healthcare system."
"Independent pharmacies have struggled under opaque PBM practices for years. These reforms level the playing field and allow us to better serve our communities."
"As an employer providing health benefits, understanding true medication costs is essential. PBM reform gives us the transparency we need to make informed decisions for our employees."