CMS’ Proposed Drug Pricing Transparency Rule Impacting PBMs and Other PBM Updates

Lexology October 12, 2023
Riker Danzig LLP

The United States Centers for Medicare & Medicaid Services (“CMS”) has proposed new rulemaking (88 FR 34238) to increase drug price transparency by drug manufacturers and pharmacy benefit managers (“PBMs”). Specifically, the proposed rule seeks to increase drug pricing transparency by:

1. establishing a Medicaid drug price verification survey which would require manufacturers to submit certain detailed pricing information to CMS;
2. requiring PBMs to report the cost of dispensing and administering drugs to managed care plans separately from any additional costs charged by the PBM; and
3. granting CMS increased oversight of drug classifications in Medicaid and the ability to require corrective actions from manufacturers if a drug is incorrectly classified as brand name rather than generic.

Significantly, the proposed...

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