PBM Price Transparency and Accountability Act

Increased Medicaid Price Accuracy: The bill requires the Secretary to conduct monthly surveys of drug prices for retail and non-schedules pharmacies to determine national average acquisition costs, which helps ensure accurate payments to pharmacies. (Section 2(a)(1)(A))

Elimination of Abusive Pricing: By requiring a transparent pass-through pricing model, the bill prevents "spread pricing" where entities charge more than they pay to the pharmacy. (Section 2(b)(1)(A))

Improved Pharmacy Choice in Medicare: The bill requires drug plan sponsors to permit any pharmacy that meets standard contract terms to participate in their network, ensuring more options for beneficiaries. (Section 3(a)(1)(A)(i))

Protection for Local Pharmacies: The creation of "essential retail pharmacies" helps track and protect pharmacies located in rural, suburban, or urban areas that may be underserved. (Section 3(a)(2))

Enhanced PBM Accountability: Pharmacy Benefit Managers are prohibited from deriving income from anything other than bona fide service fees, which helps ensure they operate transparently. (Section 3(b)(1)(A)(i))

Greater Transparency for Beneficiaries: The bill mandates detailed annual reports regarding drug costs, rebates, and pharmacy reimbursements to provide clarity on how drug spending affects enrollees. (Section 3(b)(1)(C)(i))

Financial Penalties for Pharmacies: Retail and non-retail pharmacies may face civil money penalties of up to $100,000 for failing to respond to price surveys or providing false information. (Section 2(a)(1)(H)(iii)(I))

Increased Administrative Burden: Pharmacies are required to respond to monthly surveys regarding their pricing and drug acquisition costs. (Section 2(a)(1)(F))

Potential Litigation and Investigation Costs: The Secretary is granted the authority to investigate allegations of unfair contract terms, which could lead to legal scrutiny for drug plan sponsors. (Section 3(a)(3)(A)(ii))