S.927 - Protecting Pharmacies in Medicaid Act (119th Congress)
Summary
S.927, the Protecting Pharmacies in Medicaid Act, aims to amend Title XIX of the Social Security Act to ensure accurate payments to pharmacies under Medicaid and prevent abusive spread pricing practices. The bill mandates surveys of pharmacy drug prices to determine national average drug acquisition cost benchmarks and requires transparent prescription drug pass-through pricing models. It also enhances oversight by the Inspector General of the Department of Health and Human Services.
Expected Effects
The bill will likely increase transparency in Medicaid pharmacy payments and reduce potential overcharging by pharmacy benefit managers (PBMs). This could lead to more efficient use of Medicaid funds and potentially lower drug costs for beneficiaries. The increased oversight and data collection may also reveal inefficiencies or fraudulent activities within the system.
Potential Benefits
- Increased transparency in drug pricing within the Medicaid system.
- Prevention of abusive spread pricing practices by PBMs.
- More accurate payments to pharmacies, ensuring their financial viability.
- Enhanced oversight by the Inspector General, potentially uncovering fraud and waste.
- Public availability of drug acquisition prices, promoting informed decision-making.
Potential Disadvantages
- Increased administrative burden on pharmacies due to survey requirements.
- Potential for increased costs associated with implementing and enforcing the new regulations.
- Delayed application to non-retail pharmacies may create temporary disparities.
- The definition of 'applicable non-retail pharmacy' may be subject to interpretation and potential loopholes.
- The exemption from the Administrative Procedure Act could limit public input on implementation.
Constitutional Alignment
The bill aligns with the General Welfare Clause (Article I, Section 8) of the Constitution, as it aims to improve the efficiency and effectiveness of the Medicaid program, which provides healthcare to vulnerable populations. By ensuring accurate payments to pharmacies and preventing abusive pricing practices, the bill seeks to promote the well-being of Medicaid beneficiaries. The bill does not appear to infringe upon any specific constitutional rights or limitations.
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).