A Democratic bill with 2 Republican cosponsors · See all 3 cosponsors
Last activity — Read twice and referred to the Committee on Finance.
In committee
Introduced and handed to a committee in the chamber it started in.
The committee holds it, and most bills are never heard from again. A hearing or a committee vote would be news; silence is the usual outcome, and it kills the bill without anyone voting against it.
Its path through Congress
- Introduced
- In Committee
What this bill would do
The Protecting Pharmacies in Medicaid Act aims to amend the Social Security Act to improve pharmacy payments and prevent abusive spread pricing practices within Medicaid. It requires the Secretary to conduct monthly surveys of retail and non-retail pharmacy drug prices to establish national average acquisition cost benchmarks. The bill establishes civil money penalties for pharmacies that fail to comply with survey requirements or provide false information. Additionally, it mandates a transparent prescription drug pass-through pricing model for contracts involving pharmacy benefit managers or managed care entities. This model limits payments to ingredient costs and professional dispensing fees while requiring administrative fees to reflect fair market value. Finally, the act prohibits certain forms of spread pricing to ensure more accurate financial reporting and oversight.
Yes· 3 of 8
- Scored +7
Does this make what the government does easier for the public to see?
The bill significantly enhances transparency by requiring public disclosure of pharmacy drug pricing and survey data.
- Scored +6
Does this lower the price of prescription medicines?
By targeting spread pricing and increasing transparency, the bill aims to control and more accurately reflect drug costs.
- Scored +5
Does this give people more protection from unfair business practices?
The bill increases consumer protection by increasing drug pricing transparency and preventing abusive spread pricing practices.
The opposite
- Scored -5
Would business owners be better off under this?
Pharmacies face increased compliance costs, monthly survey requirements, and significant potential fines.
- Scored -5
Would billionaires be better off under this?
Entities such as Pharmacy Benefit Managers (PBMs) face restrictions on their previous pricing models and administrative fees.
- Scored -2
Does this leave more decisions to the states?
The bill imposes more federal mandates and oversight on state-managed Medicaid pharmacy processes.
Who it would affect, and how
Potential Positive Impacts for People
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Improved Pricing Accuracy: The Secretary will conduct monthly surveys of retail and non-retail pharmacy drug prices to determine national average drug acquisition cost benchmarks, which helps ensure pharmacies are paid accurately (Section 2(a)(1)).
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Increased Transparency: The bill requires that information on national drug acquisition prices, including monthly response rates and sampling methodology, be made publicly available (Section 2(a)(1)(G)).
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Prevention of Abusive Pricing: The act mandates a transparent prescription drug pass-through pricing model, which limits payments to the ingredient cost and a professional dispensing fee, thereby preventing "spread pricing" where entities charge more than they pay to pharmacies (Section 3(a)(1)(A)).
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Enhanced Oversight: The Inspector General of the Department of Health and Human Services is tasked with conducting periodic studies of survey data to identify substantial variations in costs and how internal transfer prices influence reported costs (Section 2(a)(4)(A)).
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Fairer Administrative Costs: Payments for administrative services performed by a pharmacy benefit manager or managed care entity must be limited to an administrative fee that reflects fair market value (Section 3(a)(1)(A)(ii)).
Potential Negative Impacts for People
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Financial Penalties for Pharmacies: Retail and non-retail pharmacies may face civil money penalties of up to $100,000 for each violation if they fail to respond to survey requests, provide false information, or otherwise fail to comply with the new requirements (Section 2(a)(1)(H)).
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Increased Compliance Burdens: Pharmacies are required to respond to monthly surveys regarding drug prices, including information on discounts, rebates, and other price concessions (Section 2(a)(1)(F)).
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Restrictions on Pricing Models: Entities and pharmacy benefit managers will have their payment structures strictly limited to ingredient costs and specific dispensing fees, which changes how they handle drug coverage and related administrative services (Section 3(a)(1)(A)).
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Tap or hover a score for the reason it gave.
- Governance And Ideology
- Does this make what the government does easier for the public to see? — The bill significantly enhances transparency by requiring public disclosure of pharmacy drug pricing and survey data. Does this give the federal government more power? — The bill increases federal oversight and the authority of the Secretary of HHS over pharmacy payments and PBM practices. Does this leave more decisions to the states? — The bill imposes more federal mandates and oversight on state-managed Medicaid pharmacy processes.
- Healthcare
- Does this lower the price of prescription medicines? — By targeting spread pricing and increasing transparency, the bill aims to control and more accurately reflect drug costs. Does this put more money into Medicaid, the health coverage for people on low incomes? — The bill improves the efficiency and accuracy of Medicaid pharmacy payments, though it does not directly increase total funding levels.
- Economy And Finance
- Does this give people more protection from unfair business practices? — The bill increases consumer protection by increasing drug pricing transparency and preventing abusive spread pricing practices.
- Demographic And Interest Groups
- Would households on low incomes be better off under this? — Low-income households relying on Medicaid may benefit from more stable and transparent drug pricing structures. Would retired people be better off under this? — Retirees on Medicaid may benefit from more transparent and accurate pricing for outpatient drugs. Would people over 65 be better off under this? — Seniors on Medicaid may benefit from more accurate and transparent drug pricing and more predictable pharmacy service costs. Would billionaires be better off under this? — Entities such as Pharmacy Benefit Managers (PBMs) face restrictions on their previous pricing models and administrative fees. Would business owners be better off under this? — Pharmacies face increased compliance costs, monthly survey requirements, and significant potential fines.
- 3/11/2025
- Read twice and referred to the Committee on Finance.
- 3 Cosponsors added.
- Introduced in Senate
2 bills Congress.gov lists as related to this one — companions in the other chamber, earlier versions, and bills this one absorbed or was folded into.
Bill CassidyRepublican · Louisiana
Roger MarshallRepublican · Kansas
Mark WarnerDemocrat · Virginia