Pharmacists Fight Back in Medicare and Medicaid Act

This bill sets new rules, starting in 2027, for Medicare drug plans, Medicaid contracts, and the pharmacy benefit managers (PBMs) that run drug benefits for them. It sets how much plans and PBMs must pay pharmacies for drugs, based on a national average drug cost plus the lesser of 4 percent or $50, plus a dispensing fee matching the state Medicaid rate. It requires drug maker rebates to lower patients' copays at the pharmacy counter in Medicare and to be passed to the state in Medicaid, and it bans 'steering' patients toward certain pharmacies. PBMs that knowingly break these rules could face felony charges with fines up to $1,000,000 and up to 10 years in prison, or civil fines. The bill also requires more types of pharmacies to answer Medicaid drug price surveys and requires the federal government to publish survey results.

Full text and official record on Congress.gov

Sponsors

• Jake Auchincloss Democrat sponsor
• 41 cosponsors