Bill > HR1613

This bill, the Drug Price Transparency in Medicaid Act of 2023, aims to improve transparency and prevent the use of abusive spread pricing and related practices in the Medicaid program. The key provisions are: 1. Pass-through pricing requirement: The bill amends the Social Security Act to require that contracts between states and pharmacy benefit managers (PBMs), managed care entities, or other specified entities in Medicaid must use a pass-through pricing model. This means that any payments made by these entities for covered outpatient drugs must be limited to the ingredient cost and a professional dispensing fee, which must be passed on to the pharmacy or provider in full. 2. Ensuring accurate payments to pharmacies: The bill also amends the Social Security Act to require the Secretary of Health and Human Services to conduct a survey of retail community pharmacy drug prices to determine the national average drug acquisition cost. The bill also requires pharmacies that receive any payment, reimbursement, or discount related to dispensing Medicaid drugs to respond to these surveys. 3. Reporting requirements: The bill requires the Secretary to make the survey information publicly available, including the monthly response rate, sampling frame, and information on price concessions. The Secretary is also required to submit a report to Congress examining specialty drug coverage and reimbursement under Medicaid. The amendments made by this bill would apply to contracts between states and managed care entities, other specified entities, or PBMs that are entered into or renewed on or after 18 months after the date of enactment.