S. 298Senate117th Congress (2021-2023)In Committee

Pharmacy Benefit Manager Accountability Study Act of 2021

AI-Generated Summary

Updated February 7, 2026 at 10:27 PM UTC

The Pharmacy Benefit Manager Accountability Study Act of 2021 directs the Government Accountability Office to examine how pharmacy benefit managers (PBMs) operate within the drug supply chain. Within one year, the GAO must report on PBM competition, rebates, fees, formulary practices, prior‑authorization times, step‑therapy use, and pricing mark‑ups. The findings and policy recommendations are aimed at lowering prescription‑drug costs and increasing transparency for patients, payors, and government programs.

Key Provisions

GAO must deliver a report to the Senate Finance, HELP, and House Ways & Means and Energy & Commerce committees within one year of enactment.
The report must detail PBMs’ role in the supply chain and market share of the ten largest PBMs.
It must provide data on rebates and fees for each drug in the top ten PBMs’ formularies, showing amounts passed to patients, payors, kept by PBMs, and related fees.
The study must assess whether PBM formularies favor high‑rebate drugs over lower‑cost alternatives.
It must include average prior‑authorization approval times for each of the ten largest PBMs.
It must analyze factors influencing step‑therapy use by these PBMs.
The report must evaluate the extent PBMs charge payors more than they pay pharmacies for drugs.
Recommendations must propose legislative actions to reduce drug costs, improve supply‑chain efficiency, boost competition, and increase PBM transparency.

Legislative Activity

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1 earlier action

SenateIntro Referral Latest Action

Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

Health, Education, Labor, and Pensions Committee

February 8, 2021

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SenateIntro Referral

Introduced in Senate

February 8, 2021

SenateIntro Referral

Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

Health, Education, Labor, and Pensions Committee

February 8, 2021

Bill Text

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Introduced in SenateIssued February 8, 2021

117th CONGRESS

1st Session

S. 298

IN THE SENATE OF THE UNITED STATES

February 8, 2021

Mrs. Blackburn (for herself and Mr. Braun) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

A BILL

To require the Government Accountability Office to study the role pharmaceutical benefit managers play in the pharmaceutical supply chain and provide Congress with appropriate policy recommendations, and for other purposes.

Short title

This Act may be cited as the Pharmacy Benefit Manager Accountability Study Act of 2021.

GAO Study

Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Finance and the Committee on Health, Education, Labor, and Pensions of the Senate and to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives a report that—

(1)

addresses, at minimum—

(A)

the role that pharmacy benefit managers play in the pharmaceutical supply chain;

(B)

the state of competition among pharmacy benefit managers, including the market share for the Nation's 10 largest pharmacy benefit managers;

(C)

the use of rebates and fees by pharmacy benefit managers, including data for each of the 10 largest pharmacy benefit managers that reflects, for each drug in the formulary of each such pharmacy benefit manager—

(i)

the amount of the rebate passed on to patients;

(ii)

the amount of the rebate passed on to payors;

(iii)

the amount of the rebate kept by the pharmacy benefit manager; and

(iv)

the role of fees charged by the pharmacy benefit manager;

(D)

whether pharmacy benefit managers structure their formularies in favor of high-rebate prescription drugs over lower-cost, lower-rebate alternatives;

(E)

the average prior authorization approval time for each of the 10 largest pharmacy benefit managers;

(F)

factors affecting the use of step therapy in each of the 10 largest pharmacy benefit managers; and

(G)

the extent to which the price that pharmacy benefit managers charge payors, such as the Medicare program under title XXVIII of the Social Security Act (42 U.S.C. 1395 et seq.), State Medicaid programs under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), the Federal Employees Health Benefits Program under chapter 89 of title 5, United States Code, or private payors, for a drug is more than such pharmacy benefit managers pay the pharmacy for the drug; and

(2)

provides recommendations for legislative action to lower the cost of prescription drugs for consumers and payors, improve the efficiency of the pharmaceutical supply chain by lowering intermediary costs, improve competition in pharmacy benefit management, and provide transparency in pharmacy benefit management.