Request for Information: Pharmacy Benefit Manager Compensation and Data Collection

Transparency Rising, representing companies in the pharmacy benefit management and prescription drug supply chain, submitted comments supporting a transparent and competitively neutral regulatory framework for Part D drug compensation. They provide technical input on definitions for PBMs, affiliates, and "bona fide service fees," while advocating for disclosure-based transparency and the use of existing industry data formats to reduce reporting burdens.

The PBM Accountability Project, representing a coalition of organizations, supports the proposed PBM reform and requests specific, broad language to define PBMs and their affiliates. They urge CMS to mandate comprehensive reporting of all compensation and intra-entity transfers to ensure transparency and prevent PBMs from exploiting loopholes.

The Alliance of Community Health Plans (ACHP) supports CMS's efforts to implement PBM reforms that increase transparency and tie PBM compensation to bona fide services rather than drug prices. They advocate for clear definitions of PBMs and affiliates to ensure that nonprofit, provider-aligned health plans are not inadvertently regulated as third-party PBMs.

HealthHIV supports the effort to reform Pharmacy Benefit Manager (PBM) compensation in Medicare Part D but urges CMS to ensure that reforms do not simply shift costs to patients or other parts of the system. They advocate for rigorous oversight of "fair market value" fees, the establishment of firm guardrails on incentive payments, and the collection of data on patient-facing measures like medication access and out-of-pocket costs.

The American Pharmacists Association (APhA) supports the RFI's goal of regulating PBM compensation and data collection. They urge CMS to use a broad definition of PBMs and "affiliates," strictly define "bona fide service fees" to exclude those tied to drug prices or volume, and ensure reporting requirements are comprehensive and harmonized with other federal rules.

The American Society of Consultant Pharmacists (ASCP) supports the CMS Request for Information regarding PBM compensation and data collection. They advocate for specific definitions of "affiliates" to distinguish between traditional and PBM-owned GPOs, request that "fair market value" reflect the higher costs of long-term care pharmacy services, and urge CMS to require more transparent, standardized data reporting from PBMs.

The Biotechnology Innovation Organization (BIO), a trade association representing biotechnology companies, supports the CMS Request for Information regarding PBM compensation and data collection. They advocate for broad definitions of PBM services and affiliates, strict "bona fide service fee" requirements, and extensive data reporting to ensure transparency and patient access to medicines.

The Food Industry Association (FMI) supports CMS's implementation of Section 6224 to restrict PBM compensation and advocates for broad definitions of "PBM" and "affiliate" to capture entities that shift costs onto community and supermarket pharmacies. They urge CMS to require independent, third-party determination of fair market value and to ensure that reimbursement terms are sustainable enough to keep pharmacies operational.

McKesson Corporation, a global healthcare supply chain leader, argues that CMS should adopt a narrow definition of "PBM" and "affiliate" for the implementation of Section 6224 of the CAA. They contend that the regulations should only apply to entities that exercise substantive decision-making authority over Part D drug benefits on behalf of PDP sponsors, specifically excluding pharmaceutical wholesalers and other supply chain participants who do not perform these core functions.

The Blue Cross Blue Shield Association (BCBSA) supports CMS's efforts to implement Section 6224 of the CAA, 2026, to improve transparency in PBM compensation. They recommend a narrow, function-based definition of PBMs and affiliates, the preservation of bona fide service fee frameworks, and the use of arm's-length transactions or independent valuations to determine fair market value.