A bill to amend title XIX of the Social Security Act to ensure accurate payments to pharmacies under Medicaid and to prevent the use of abusive spread pricing practices under Medicaid.
Latest action, Mar 11, 2025Read twice and referred to the Committee on Finance.
Summary
Library of Congress, Mar 11, 2025
Protecting Pharmacies in Medicaid Act
This bill provides funds beginning in FY2026 for the Centers for Medicare & Medicaid Services to survey retail and non-retail pharmacies (e.g., mail-order pharmacies) to determine average prices of covered outpatient drugs under Medicaid. Pharmacies that fail to participate in the surveys are subject to civil penalties.
The bill additionally provides funds for FY2026 for the Office of the Inspector General of the Department of Health and Human Services to study the results of the survey and report accordingly to Congress.
The bill also requires pass-through pricing models, and prohibits spread-pricing, for payment arrangements with pharmacy benefit managers under Medicaid.
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Protecting Pharmacies in Medicaid ActShort Title(s) as Introduced
Official titles
A bill to amend title XIX of the Social Security Act to ensure accurate payments to pharmacies under Medicaid and to prevent the use of abusive spread pricing practices under Medicaid.Official Title as Introduced