An annual report on every dispensed drug is due each July 1 from 2028
What the document says“Not later than July 1 of each year, beginning in 2028, the pharmacy benefit manager shall submit to the PDP sponsor, and to the Secretary, a report, in accordance with this subparagraph, and shall make such report available to such sponsor at no cost to such sponsor in a format specified by the Secretary under paragraph (5).”
Each year from 2028, by July 1, the manager must report to the sponsor and the Secretary on the previous plan year, at no cost to the sponsor. The report must list every covered drug dispensed with its names and National Drug Code, counts of enrollees, claims and dosage units, claims by dispensing channel, acquisition cost, wholesale price, enrollee out-of-pocket spending, rebates and other remuneration, average pharmacy reimbursement, the National Average Drug Acquisition Cost, and manufacturer-derived revenue retained. Where the manager owns a pharmacy it must give shares dispensed by affiliates and cost ranges at affiliate and non-affiliate pharmacies. It must set out generics and biosimilars not covered or placed on higher tiers, with a written justification, plus gross and net spending, revenue retained, benefit designs steering enrollees to affiliate pharmacies, broker and consultant compensation, a list of affiliates, and a summary on a standard template.
What the document actually says“Not later than July 1 of each year, beginning in 2028, the pharmacy benefit manager shall submit to the PDP sponsor, and to the Secretary, a report, in accordance with this subparagraph, and shall make such report available to such sponsor at no cost to such sponsor in a format specified by the Secretary under paragraph (5).”
Each year by July 1 the middleman must send a report. It goes to the plan and to the health chief. The plan pays nothing for it.
The report is long. It covers every drug the plan paid for. It shows what the drug cost, what people paid, and what the middleman kept.
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