Bill > S1038

This bill aims to improve transparency and prevent the use of abusive spread pricing and related practices in the Medicaid program. The key provisions of the bill include: 1. Requiring pass-through pricing for payments made by Medicaid managed care entities or pharmacy benefit managers (PBMs) to pharmacies, ensuring that the full payment is passed through to the pharmacy with only a reasonable administrative fee retained by the entity or PBM. This is intended to prevent excessive "spread pricing" where the entity or PBM charges more than what is paid to the pharmacy. 2. Enhancing the existing requirement for 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, including requirements for pharmacies to participate in the survey and for the survey results to be publicly reported. 3. Requiring a report from the Secretary on specialty drug coverage and reimbursement under Medicaid, including how states define and pay for specialty drugs and the extent to which specialty pharmacy acquisition costs are captured in the national average drug acquisition cost survey. 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 18 months after the date of enactment.