Promoting Transparency and Healthy Competition in Medicare Act

Promoting Transparency and Healthy Competition in Medicare Act

This bill requires Medicare Advantage (MA) organizations and prescription drug plan (PDP) sponsors and pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit to report certain information relating to their ownership interests in participating providers.

Specifically, MA organizations must report on items and services, patient risk scores and associated diagnoses, prior authorization requests, and incentive payments with respect to providers in which the MA organization has an ownership interest as compared to other providers.

Similarly, PDP sponsors under the Medicare prescription drug benefit must report on the prices of prescription drugs with respect to pharmacies in which the PDP sponsor has an ownership interest as compared to other pharmacies. The bill also prohibits PDP sponsors from contracting with PBMs in which the PDP sponsor has an ownership interest unless the PBM reports certain information on rebates and payments between the PBM, PDP sponsor, pharmacies, and drug manufacturers.