New Drug Price Transparency for Specialty and Mail-Order Pharmacies in Medicaid.
This law mandates the collection of actual drug acquisition costs from specialty and mail-order pharmacies participating in the Medicaid program. The goal is to ensure the government pays accurate and fair prices for medications, protecting taxpayer funds and improving spending efficiency. The new rules increase drug price transparency and establish financial penalties for pharmacies that fail to report the required cost data.
Key points
The government will survey drug prices (net of discounts) from specialty and mail-order pharmacies to set fair Medicaid reimbursement rates.
Specialty pharmacies that fail to provide the required pricing data face potential civil monetary penalties to enforce full cost transparency.
Increased oversight is established to study how Pharmacy Benefit Managers (PBMs) influence drug costs, particularly for affiliated pharmacies, to detect potential price inflation.
The drug pricing information collected through the surveys will be made publicly available, increasing transparency in drug spending.
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