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Enforcement of fair contracts and reimbursement for pharmacies under Medicare drug plans.

This bill establishes a new process allowing pharmacies to report violations of contract terms and reimbursement requirements by Medicare Prescription Drug Plan (PDP) sponsors. The goal is to ensure fair contract conditions and guarantee that independent community pharmacies receive the required total reimbursement amounts. For citizens, this aims to stabilize the local pharmacy network, potentially improving access to essential prescription drugs.
Key points
Pharmacies can now submit allegations of violations regarding unreasonable contract terms and conditions by Medicare PDP sponsors.
The law mandates that PDP sponsors must pay independent community pharmacies the full required reimbursement amount if the initial payment was deficient.
The Secretary of Health and Human Services (HHS) will investigate allegations and can impose civil monetary penalties on non-compliant sponsors.
A standardized, confidential template will be created for pharmacies to submit allegations, protecting the information from public disclosure under FOIA.
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Additional Information
Print number: 118_HR_7716
Sponsor: Rep. Gallego, Ruben [D-AZ-3]
Process start date: 2024-03-19
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Source data: api.congress.gov
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OFFICIAL LEGAL TITLE

To amend title XVIII of the Social Security Act to provide for enforcement of standards for reasonable and relevant contract terms and conditions and essential retail pharmacy protections under the Medicare program.

FREQUENTLY ASKED QUESTIONS

What is the official ID of this bill?

The official print number for this legislation is 118_HR_7716.

Which chamber initiated this legislation?

This legislation was initiated in the House of Representatives.

When did the legislative process begin?

The process officially started on 2024-03-19.

What are the main provisions?

Key points include:

  • Pharmacies can now submit allegations of violations regarding unreasonable contract terms and conditions by Medicare PDP sponsors.
  • The law mandates that PDP sponsors must pay independent community pharmacies the full required reimbursement amount if the initial payment was deficient.
  • The Secretary of Health and Human Services (HHS) will investigate allegations and can impose civil monetary penalties on non-compliant sponsors.
  • A standardized, confidential template will be created for pharmacies to submit allegations, protecting the information from public disclosure under FOIA.
What is the specific legal status?

The current status is Expired.

Where can I read the full text of this legislation?

The full official text is available at: View full text

Who is the primary sponsor?

The primary sponsor is Rep. Gallego, Ruben [D-AZ-3].

What is the latest detailed status?

The latest detailed status is: Referred to the Subcommittee on Health.

Is this summary verified?

Yes. This content was analyzed by AI and verified by the Lustra Judge System on 2025-12-30.

CATEGORIES

Health Benefits Courts and Law