Pharmacists Fight Back in Medicare and Medicaid Act
Summary
H.R. 6609, the "Pharmacists Fight Back in Medicare and Medicaid Act," aims to amend the Social Security Act to regulate pharmacy benefit managers (PBMs) under Medicare and Medicaid. The bill introduces requirements related to prescription drug benefits, pharmacy payments, rebate pass-throughs, and transparency. It seeks to prevent PBM practices like steering and ensure fair reimbursement to pharmacies.
Expected Effects
The bill would change how PBMs operate within Medicare and Medicaid, impacting drug pricing and pharmacy reimbursements. It mandates specific payment structures and rebate handling, potentially lowering costs for patients. These changes are set to take effect for plan years beginning on or after January 1, 2027.
Potential Benefits
- Increased transparency in drug pricing and PBM operations.
- Reduced out-of-pocket costs for Medicare and Medicaid beneficiaries through rebate pass-throughs.
- Fairer reimbursement rates for pharmacies, ensuring their financial viability.
- Prevention of PBM steering practices, allowing patients more choice in pharmacies.
- Potential for lower overall drug costs due to increased regulation of PBMs.
Potential Disadvantages
- Potential for increased administrative burden on PBMs and pharmacies.
- Possible unintended consequences on drug pricing and availability.
- Risk of higher premiums if PBMs pass compliance costs onto consumers.
- Complexity in implementation and enforcement of the new regulations.
- Potential legal challenges from PBMs regarding the new requirements.
Constitutional Alignment
The bill aligns with the Constitution's general welfare clause (Preamble) by aiming to improve healthcare access and affordability. Congress's power to regulate interstate commerce (Article I, Section 8) provides a basis for regulating PBMs, which operate across state lines. The bill does not appear to infringe on individual rights or state powers, thus aligning with constitutional principles.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).