Pharmacy Benefit Manager Transparency (CMS-10725)

The Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L.111-152) (collectively, the Patient Protection and Affordable Care Act (PPACA)) were signed into law in 2010. The PPACA established competitive private health insurance markets, called Marketplaces or Exchanges, which give millions of Americans and small businesses access to qualified health plans (QHPs), including stand-alone dental plans (SADPs) — private health and dental insurance plans that are certified as meeting certain standards. The PPACA added section 1150A of the Social Security Act, which requires pharmacy benefit managers (PBMs) to report prescription benefit information to the Department of Health and Human Services (HHS). PBMs are third-party administrators of prescription programs for a variety of types of health plans, including QHPs. The Centers for Medicare and Medicaid Services (CMS) files this information collection request (ICR) in connection with the prescription benefit information that PBMs must provide to HHS under section 1150A. The burden estimate for this ICR reflects 1) the time and effort for PBMs to submit the information regarding PBMs and prescription drugs, and 2) the time and effort for QHP issuers to identify which plans are QHPs for the PBMs.

The latest form for Pharmacy Benefit Manager Transparency (CMS-10725) expires 2027-11-30 and can be found here.

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Federal Enterprise Architecture: Health - Health Care Services