Bill > HR6609

This bill, titled the "Pharmacists Fight Back in Medicare and Medicaid Act," aims to increase transparency and fairness in prescription drug benefits under Medicare and Medicaid by imposing new requirements on Pharmacy Benefit Managers (PBMs), which are companies that manage prescription drug benefits on behalf of health insurers or other payers. Key provisions include requiring PBMs and their affiliates to reimburse pharmacies for the ingredient cost of drugs based on national average acquisition costs plus a small percentage or a fixed amount, whichever is less, and to pay dispensing fees that match what pharmacies receive under state Medicaid programs. The bill also mandates that PBMs pass through manufacturer rebates to patients at the point of sale, reducing their out-of-pocket costs, and requires PBMs to report their compliance with these rules. Furthermore, it prohibits PBMs from engaging in "steering," which involves directing patients to specific pharmacies, often their own affiliates, and introduces penalties, including criminal charges and significant fines, for PBMs that violate these new regulations. The bill also seeks to improve transparency in the Medicaid program by requiring pharmacies to report their net acquisition costs for drugs and making national drug acquisition price information publicly available.

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https://www.congress.gov/bill/119th-congress/house-bill/6609/all-info