PBM Price Transparency and Accountability in Medicare and Medicaid
This act aims to increase drug price transparency and accountability for Pharmacy Benefit Managers (PBMs) within the Medicare and Medicaid programs. It introduces new rules for pharmacy payments, prevents abusive pricing practices, and ensures better pharmacy access for Medicare beneficiaries, potentially leading to lower drug costs and greater choice for citizens.
Key points
Increased drug price transparency: Pharmacies will be required to report actual drug acquisition costs, and this data will be publicly available, potentially helping to lower prices.
Elimination of abusive spread pricing in Medicaid: PBMs will be required to pass through full payments to pharmacies for drugs, preventing inflated charges to the state and patients.
Improved pharmacy access for Medicare beneficiaries: Insurance plans must allow any willing pharmacy meeting standard terms to participate, increasing patient choice, especially in rural areas.
Enhanced PBM accountability: PBMs will need to disclose revenues and manufacturer agreements, and be subject to audits, to prevent conflicts of interest and unfair practices.
Introduced
Citizen Poll