Bill > S3345

This bill aims to enhance transparency and accountability in pharmacy benefit management (PBM) for Medicare and Medicaid prescription drug programs. It introduces several key provisions to improve how pharmacy benefit managers operate and are regulated. The bill requires PBMs to provide detailed annual reports on drug pricing, rebates, and pharmacy reimbursements, ensuring more transparency about how prescription drug costs are determined and distributed. It establishes new standards for PBM contracts, including limitations on revenue sources and requirements for fair market value fees. The legislation creates an audit mechanism for PBMs, mandates that they pass through all manufacturer rebates to plan sponsors, and prohibits practices that could create conflicts of interest. For Medicaid, the bill prevents "spread pricing" by requiring PBMs to transparently pass through drug costs and fees. For Medicare, it ensures pharmacies have fair contract terms and creates a process for pharmacies to challenge unreasonable contract conditions. The bill also requires the creation of a list of "essential retail pharmacies" in areas with limited pharmacy access and mandates studies on prescription drug pricing and compensation structures across the pharmaceutical supply chain. Implementation of most provisions would begin in 2028, with funding allocated for government agencies to support these new oversight mechanisms.

Budget and Finance

https://www.congress.gov/bill/119th-congress/senate-bill/3345/all-info