Read twice and referred to the Committee on Finance.
The bill amends Medicaid drug payment law to require HHS to conduct monthly surveys of retail and non-retail pharmacy acquisition costs and publish national benchmarks, and to require State contracts with PBMs and certain managed care entities to use a transparent pass-through pricing model. It mandates reporting and data disclosure by PBMs/entities to States and HHS, prohibits Federal matching for spread pricing amounts, establishes civil money penalties for pharmacies that refuse or falsify survey responses, directs OIG studies, and provides limited appropriations.
Left emphasizes pharmacy protection and PBM transparency.
Relative to its intended legislative type, this bill is a substantive statutory reform that is detailed and operationally oriented: it codifies survey-based acquisition cost benchmarks, prescribes pass-through pricing and disclosure obligations for PBMs/entities, establishes enforcement tools and reporting, and integrates with existing Medicaid law while providing some funding for implementation and oversight.
The bill amends Medicaid drug payment law to require HHS to conduct monthly surveys of retail and non-retail pharmacy acquisition costs and publish national benchmarks, and to require State contracts with PBMs and certain managed care entities to use a transparent pass-through pricing model.
It mandates reporting and data disclosure by PBMs/entities to States and HHS, prohibits Federal matching for spread pricing amounts, establishes civil money penalties for pharmacies that refuse or falsify survey responses, directs OIG studies, and provides limited appropriations.
Implementation deadlines, definitions for applicable non-retail pharmacies and affiliates, and exemptions from APA and the Paperwork Reduction Act are included.
Substantive, targeted reform with some bipartisan appeal to protect pharmacies, but strong PBM/managed‑care opposition, fiscal impacts, and implementation complexity lower probability.
Relative to its intended legislative type, this bill is a substantive statutory reform that is detailed and operationally oriented: it codifies survey-based acquisition cost benchmarks, prescribes pass-through pricing and disclosure obligations for PBMs/entities, establishes enforcement tools and reporting, and integrates with existing Medicaid law while providing some funding for implementation and oversight.
Left emphasizes pharmacy protection and PBM transparency.
These are examples from the analysis, not a ranked list of the most-affected groups.
Left emphasizes pharmacy protection and PBM transparency.
Generally supportive: the bill increases transparency, limits PBM spread pricing, and aims to protect community pharmacies and patient access under Medicaid.
Concerned about enforcement details, the size of penalties on pharmacies, and exemptions from administrative procedures that could reduce stakeholder input.
Cautiously favorable: the bill targets clearly identified problems—opaque spread pricing and inconsistent pharmacy reimbursement—but increases reporting and administrative complexity.
Would want cost estimates, phased implementation safeguards, and avenues for correcting erroneous penalties.
Skeptical or opposed: the bill imposes federal mandates on contracting, extensive reporting, and payment controls that limit state and market flexibility.
Concerns include federal overreach, burdens on PBMs and entities, disclosure of proprietary information, and added federal spending.
Reached or meaningfully advanced
Reached or meaningfully advanced
Still ahead
Still ahead
Still ahead
Substantive, targeted reform with some bipartisan appeal to protect pharmacies, but strong PBM/managed‑care opposition, fiscal impacts, and implementation complexity lower probability.
The bill has not accumulated any surfaced votes yet.
Left emphasizes pharmacy protection and PBM transparency.
Substantive, targeted reform with some bipartisan appeal to protect pharmacies, but strong PBM/managed‑care opposition, fiscal impacts, and…
Relative to its intended legislative type, this bill is a substantive statutory reform that is detailed and operationally oriented: it codifies survey-based acquisition cost benchmarks, prescribes pass-through pricing a…
Go beyond the headline summary with full stakeholder mapping, legislative design analysis, passage barriers, and lens-by-lens tradeoff breakdowns.