Bill > S927

This bill aims to improve transparency and accuracy in Medicaid pharmacy payments by establishing new requirements for drug pricing and reimbursement. The bill introduces two main components: first, it mandates the creation of a comprehensive survey to determine national average drug acquisition costs for both retail and non-retail pharmacies, with detailed reporting requirements and potential penalties for non-compliance. Pharmacies will be required to report pricing information, including discounts, rebates, and other price concessions, and the Secretary of Health and Human Services will make this information publicly available. Second, the bill requires a transparent "pass-through" pricing model for pharmacy benefit managers (PBMs) and managed care entities, which limits payments to actual ingredient costs and professional dispensing fees, prohibits spread pricing (where PBMs charge more than they pay pharmacies), and mandates that all administrative fees reflect fair market value. The legislation also requires detailed reporting of drug-related costs and payments, with provisions to prevent excessive charges and ensure more accurate Medicaid drug reimbursements. The bill will be implemented in stages, with different effective dates for retail and non-retail pharmacies, and includes provisions to streamline the implementation process by exempting it from certain administrative procedures.

Budget and Finance

https://www.congress.gov/bill/119th-congress/senate-bill/927/all-info