To amend title XIX of the Social Security Act to require the Secretary of Health and Human Services to conduct surveys of non-retail pharmacy drug prices, and for other purposes.
About This Bill
Committee
Latest Action · November 7, 2023
Read twice and referred to the Committee on Finance.
This bill requires the federal government to survey prices at specialty pharmacies and mail-order pharmacies to establish accurate drug cost benchmarks for Medicaid reimbursement. Currently, Medicaid reimbursement rates are based on surveys of retail community pharmacy prices, which may not reflect the actual costs at specialty pharmacies that handle complex medications. The legislation directs the Secretary of Health and Human Services to conduct monthly surveys of non-retail pharmacy prices and make the results publicly available, while prohibiting states from using specialty pharmacy pricing data to set reimbursement rates for retail pharmacies. Non-retail pharmacies that fail to respond to surveys face civil penalties, and the bill appropriates $9 million annually starting in 2024 for the survey program, plus $5 million for fiscal year 2024 to fund oversight by the Inspector General. The bill takes effect 18 months after enactment, with implementation beginning in January 2027.
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