To amend title XVIII of the Social Security Act to provide for enforcement of standards for reasonable and relevant contract terms and conditions and essential retail pharmacy protections under the Medicare program.
This bill strengthens protections for independent community pharmacies in the Medicare prescription drug program by creating a formal process for them to report violations by drug plan sponsors. The legislation requires the federal government to establish an allegation submission system by January 2028 where pharmacies can report unfair contract terms or inadequate reimbursement rates. Pharmacies would be able to submit complaints about contract terms once per year and about reimbursement issues quarterly, with the Secretary of Health and Human Services investigating and enforcing violations through existing penalty authorities. If a drug plan sponsor underpays a pharmacy, it must reimburse the difference plus face potential civil penalties. The bill affects Medicare prescription drug plans and independent community pharmacies nationwide, with no specific new federal funding identified but enforcement carried out through existing agency authorities.
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.