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.
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.
Read twice and referred to the Committee on Finance.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, the Budget, the Judiciary, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in Senate
Read twice and referred to the Committee on Finance.
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