This bill regulates how pharmacy benefits managers, or PBMs, pay pharmacies and handle prescription drug coverage under federal health programs including Medicare, Medicaid, TRICARE, and the federal employee health plan. The legislation requires PBMs to reimburse pharmacies based on the actual drug acquisition cost plus a small markup, pay professional dispensing fees matching state Medicaid rates, and pass at least 80 percent of manufacturer rebates to patients at the point of sale to lower their out-of-pocket costs. The bill prohibits PBMs from steering patients to affiliated pharmacies, engaging in spread pricing practices that unfairly profit PBMs, or reducing reimbursements through post-claim adjustments and hidden fees. Violations are treated as felonies punishable by up to $1 million in fines and 10 years imprisonment per violation, and the bill allows individuals to sue PBMs on behalf of the federal government. Additionally, the legislation expands Medicaid transparency requirements by requiring all pharmacies receiving payments to report drug pricing information to the government and making that data publicly available.
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