A pharmacy benefit manager must repay a sponsor for penalties on delegated work
What the document says“each contract entered into with a PDP sponsor under this part with respect to a prescription drug plan offered by such sponsor shall provide that any pharmacy benefit manager acting on behalf of such sponsor has a written agreement with the PDP sponsor under which the pharmacy benefit manager agrees to reimburse the PDP sponsor for any amounts paid”
Subsection (d) of section 6223 adds a new paragraph (9) to section 1860D-12(b) of the Social Security Act. For plan years beginning on or after January 1, 2029, a contract with a sponsor must provide that a pharmacy benefit manager acting for the sponsor has a written agreement to reimburse the sponsor for penalties paid to the Secretary, where the violation related to a responsibility the sponsor delegated to the manager. The same rule is applied to MA-PD plans through section 1857(f)(3).
What the document actually says“each contract entered into with a PDP sponsor under this part with respect to a prescription drug plan offered by such sponsor shall provide that any pharmacy benefit manager acting on behalf of such sponsor has a written agreement with the PDP sponsor under which the pharmacy benefit manager agrees to reimburse the PDP sponsor for any amounts paid”
The deal must say that the drug middleman signs a written promise. The promise is to pay the plan back for what the plan is fined.
A plan often hands the pharmacy deals to a middleman. Then the plan gets fined for what the middleman did. This makes the middleman carry the cost.
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