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Congress recently passed the Pharmacy Benefit Manager (PBM) Reform Act, along with new rules from the Department of Labor proposed to increase transparency in PBM fees. Pharmacy benefit managers have become major cost drivers in health care and this legislation signals a shift towards fairness and affordability for prescription drugs.

The PBM Reform Act contains new laws that put consumers first. For commercial plans, these laws include:

Full rebate pass-through to plans. Pharmacy benefit managers and their affiliates must forward all rebates, fees and discounts directly to health payers and therefore consumers.

Oversight of PBM management services. Pharmacy benefit managers must submit full drug-level reporting to group health plans, reporting on compensation, reimbursements, spread and rebates.

Blue Shield has long championed a more transparent and affordable prescription drug system. In January of this year, Paul Markovich, president and CEO of Blue Shield’s parent company Ascendiun, testified at two congressional hearings around healthcare affordability.

Blue Shield led the effort to launch CivicaScript in 2020 with the goal of making generic medications available at one clear, consistent, and affordable price. In 2023, Pharmacy Care Reimagined was launched by Blue Shield as a first-of-its-kind initiative that moves away from the traditional PBM model.

For More Information or Help Quoting Blue Shield, Please Contact Your Dickerson Sales Representative.