S.882 - Patients Before Middlemen Act (119th Congress)
Summary
S.882, the "Patients Before Middlemen Act," aims to amend Title XVIII of the Social Security Act, focusing on pharmacy access and choice for Medicare beneficiaries under prescription drug plans (PDPs) and MA-PD plans. It seeks to regulate pharmacy benefit managers (PBMs) under Medicare Part D. The bill introduces measures to ensure that any willing pharmacy can participate in prescription drug plans, establishes standards for reasonable contract terms, and requires transparency from PBMs regarding pricing and cost information.
Expected Effects
The bill's passage would likely lead to increased pharmacy participation in Medicare Part D networks. It would also increase oversight and accountability of PBMs. Beneficiaries might see more choices in pharmacies and potentially fairer drug pricing, although the full impact will depend on the Secretary's standards and enforcement.
Potential Benefits
- Increased pharmacy access for Medicare beneficiaries, especially in underserved areas.
- Greater transparency in PBM practices, potentially leading to lower drug costs.
- Standardized contract terms between PDP sponsors and pharmacies, promoting fairness.
- Enhanced enforcement mechanisms to address violations of contract terms.
- Improved reporting on drug pricing and PBM revenue, providing valuable data for oversight.
Potential Disadvantages
- Potential for increased administrative burden on the Secretary to establish and enforce new standards.
- Possible unintended consequences from restricting PBM practices, such as reduced negotiation power with drug manufacturers.
- The definition of 'essential retail pharmacy' may be too restrictive or too broad, leading to unintended consequences.
- The implementation timeline, with many provisions taking effect in 2028, delays immediate benefits.
- The complexity of the reporting requirements for PBMs could lead to compliance challenges.
Constitutional Alignment
The bill aligns with the general welfare clause (Article I, Section 8) by aiming to improve healthcare access and affordability for Medicare beneficiaries. Congress has the power to legislate on matters related to Medicare under this clause. The bill does not appear to infringe upon any specific constitutional rights or freedoms.
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).