Protecting Pharmacies in Medicaid Act
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Senate
- Passed House
- To President
- Became Law
Overview
The Protecting Pharmacies in Medicaid Act aims to ensure fair payments to pharmacies under Medicaid and prevent abusive practices. It requires the Centers for Medicare & Medicaid Services to conduct surveys of pharmacies to determine average drug prices and imposes civil penalties for non-participation. The bill also mandates transparent prescription drug pass-through pricing models, prohibiting spread pricing, and establishes oversight mechanisms to monitor pricing practices and ensure accurate data reporting. Finally, it provides funding for the Office of the Inspector General to study the survey results and report on findings.
Key provisions
- Requires surveys of retail and non-retail pharmacies to determine average prices of covered outpatient drugs.
- Establishes civil penalties for pharmacies that fail to participate in the surveys.
- Mandates transparent prescription drug pass-through pricing models with limitations on payment amounts.
- Prohibits spread pricing practices under Medicaid.
- Requires States to require pharmacies to respond to price surveys.
- Creates a public database of drug acquisition prices.
- Provides funding for the Office of the Inspector General to study survey results.
- Defines ‘pharmacy benefit manager’ for the purposes of the Act.
Who is affected
- Pharmacies (retail and non-retail)
- Medicaid recipients
- Pharmacy Benefit Managers (PBMs)
- State Medicaid agencies
- The Department of Health and Human Services
Bill text
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Sponsors
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4 on record
Primary sponsor
Cosponsors
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