Bill > S2973

This bill aims to improve transparency and accountability in the prescription drug market, particularly in the Medicare and Medicaid programs. Key provisions include: - Requiring pharmacy benefit managers (PBMs) to meet certain requirements when contracting with Medicare prescription drug plans, such as not deriving remuneration other than bona fide service fees and providing detailed annual reports on drug costs, utilization, and PBM revenues. - Establishing standardized pharmacy performance measures that Medicare plans must use when determining pharmacy incentive payments, price concessions, or fees. - Prohibiting "spread pricing" in Medicaid managed care, where PBMs charge the state more than they pay pharmacies, and requiring transparent pass-through pricing models. - Mandating the Secretary of Health and Human Services conduct surveys on pharmacy acquisition costs for Medicaid drug reimbursement. - Directing the HHS Inspector General to study the impact of related party transactions within vertically integrated PBM entities on Medicare drug prices. - Allowing midyear formulary changes to add biosimilar drugs at the same or lower cost-sharing as the reference biologic drug. - Enhancing PBM transparency requirements for health plans. The bill aims to increase oversight and accountability in the prescription drug supply chain to protect patients and payers.

Budget and Finance

https://www.congress.gov/bill/118th-congress/senate-bill/2973/all-info