Key pricing terms must be defined and applied consistently
What the document says“define, interpret, and apply, in a fully transparent and consistent manner for purposes of calculating or otherwise evaluating pharmacy benefit manager performance against pricing guarantees or similar”
The manager must define, interpret and apply terms such as generic drug, brand name drug, specialty drug, rebate and discount in a fully transparent and consistent way when its performance is measured against pricing guarantees, with generic drug and brand name drug consistent with section 423.4 of title 42 of the Code of Federal Regulations. It must identify any drugs, claims or price concessions excluded from a guarantee, and where a guarantee uses a benchmark other than wholesale acquisition cost, must provide an equivalent based on that cost.
What the document actually says“define, interpret, and apply, in a fully transparent and consistent manner for purposes of calculating or otherwise evaluating pharmacy benefit manager performance against pricing guarantees or similar”
The middleman must set out what its key words mean. It must use them the same way every time. That matters when its promises on price are scored.
A promise to hold down costs turns on how words are read. If the middleman can move a drug from one group to another, the promise means little.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.