A pharmacy benefit manager may take only bona fide service fees
What the document says“The pharmacy benefit manager and any affiliate of such pharmacy benefit manager shall not derive any remuneration with respect to any services provided on behalf of any entity or individual, in connection with the utilization of covered part D drugs, from any such entity or individual other than bona fide service fees, subject to clauses (ii) and (iii).”
Subsection (a) of section 6224 adds a new subsection (h) to section 1860D-12 of the Social Security Act. For plan years beginning on or after January 1, 2028, a contract with a sponsor must provide that any pharmacy benefit manager acting for the sponsor has a written agreement to meet the listed requirements. The first is that neither the manager nor its affiliates take any payment for part D work other than bona fide service fees.
What the document actually says“The pharmacy benefit manager and any affiliate of such pharmacy benefit manager shall not derive any remuneration with respect to any services provided on behalf of any entity or individual, in connection with the utilization of covered part D drugs, from any such entity or individual other than bona fide service fees, subject to clauses (ii) and (iii).”
The drug middleman and its related firms may take only true service fees. That holds for all work they do on part D drugs.
A middleman sits between the plan, the drug maker and the pharmacy. It has been paid in ways tied to a drug's price. This says it may be paid only for work done.
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