To amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes.
This bill amends Medicare Part D (the prescription drug program) to create fairer rules for how insurance plans evaluate pharmacy performance and pay them. Starting in 2025, insurance plans can only use standardized pharmacy performance measures that are established by the federal government and published publicly, rather than allowing each plan to create its own measures. The government must base these measures on evidence, make them appropriate for different pharmacy types, and can adopt measures endorsed by multi-stakeholder organizations like the Pharmacy Quality Alliance. Additionally, the bill requires insurance plans to provide pharmacies with clear, standardized information about how claims are priced, including fees, discounts, and other payments that affect reimbursement. The bill appropriates $4 million in 2025 for the Centers for Medicare & Medicaid Services to implement the standardized measures and $2 million for transparency requirements, and directs the Office of the Inspector General to study current pharmacy performance practices and report findings to Congress by the end of 2025.
Take Action
Your position
Add a comment
to comment on this bill.
Annotate the text
Highlight any passage on the Summary or Full Text tab to attach a note. Annotations appear on the Annotations tab.