Lower Drug Costs, More Pharmacy Choice in Medicare and Medicaid
This act aims to reduce prescription drug costs for individuals enrolled in Medicare and Medicaid programs. It introduces new rules for Pharmacy Benefit Managers (PBMs) to ensure payments to pharmacies are based on ingredient costs and dispensing fees, pass manufacturer rebates directly to patients at the point of sale, and prohibit steering patients to specific pharmacies. The goal is to increase transparency and choice for patients, and it establishes strict penalties for non-compliance.
Key points
Reduced Drug Costs: Manufacturer rebates will be passed directly to patients at the point of sale, lowering coinsurance or copayments in Medicare Part D.
Increased Pharmacy Choice: Pharmacy Benefit Managers are prohibited from forcing patients to use specific pharmacies or favoring affiliate pharmacies.
Fairer Pharmacy Payments: Ensures pharmacies receive reimbursement for drug acquisition costs plus a dispensing fee consistent with state rates.
Penalties for Non-Compliance: Imposes significant fines (up to $1,000,000) and imprisonment (up to 10 years) for PBMs that knowingly and willfully fail to adhere to the new regulations.
Introduced
Citizen Poll