Pharmacists Fight Back in Medicare and Medicaid Act
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed House
- Passed Senate
- To President
- Became Law
Overview
The Pharmacists Fight Back in Medicare and Medicaid Act aims to increase transparency and accountability within the prescription drug benefit programs of Medicare and Medicaid. Specifically, it introduces requirements for pharmacy benefit managers (PBMs) to disclose their payment practices, rebate pass-throughs, and reporting activities. The bill also seeks to ensure fair reimbursement rates for in-network pharmacies and addresses potential steering practices by PBMs. Furthermore, it modifies reporting requirements for States regarding drug acquisition costs and introduces criminal and civil penalties for non-compliant PBMs.
Key provisions
- Requires PBMs to disclose pharmacy payment practices, rebate pass-throughs, and reporting activities.
- Establishes a minimum reimbursement rate for in-network pharmacies based on ingredient costs and a 4% markup.
- Prohibits PBMs from engaging in ‘steering,’ which directs enrollees to specific pharmacies.
- Mandates that PBMs remit rebates to PDP sponsors or States, depending on the circumstances.
- Requires PBMs to submit annual reports detailing compliance with payment and rebate requirements.
- Introduces criminal and civil penalties for PBMs that fail to comply with the new requirements.
- Modifies Medicaid reporting requirements to include covered outpatient drugs and acquisition prices.
- Requires States to survey pharmacies regarding drug acquisition costs and prohibits the use of non-retail pharmacy pricing information for retail reimbursement rates.
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42 on record
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