; (B) the extent to which rebates are kept by such pharmacy benefit managers; and (C) the role of any fees charged by such pharmacy benefit managers. (4) Whether pharmacy benefit managers structure their formularies with respect to such Exchanges in favor of high-rebate prescription drugs over lower-cost, lower-rebate alternatives. (5) The average prior authorization approval time for pharmacy benefit managers with respect to such Exchanges. (6) Factors affecting the use of step therapy by pharmacy benefit managers with respect to such Exchanges. (7) The extent to which the price that pharmacy benefit managers charge private payors on such Exchanges for a drug is more than such pharmacy benefit managers pay the pharmacy for the drug. (c) Report Not later than the date that is three years after the date of enactment of this Act, the Comptroller General shall submit to the Secretary of Health and Human Services, the Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce of the House of Representatives a report containing the results of the study conducted under subsection (a), including policy recommendations.