Pharmacists Fight Back in Medicare and Medicaid Act

Lower out-of-pocket costs for enrollees: The bill requires that manufacturer rebates be applied at the point of sale to reduce the coinsurance or copayment an individual owes for covered drugs (Section 2(a)(1)(A)(ii)(A)).

Standardized pharmacy reimbursement: It mandates that pharmacies be reimbursed for the ingredient cost of a drug plus a specific small fee, ensuring more predictable payments (Section 2(a)(1)(A)(i) and Section 2(a)(1)(2)(A)).

Protection against forced pharmacy choices: By prohibiting "steering," the bill prevents entities from forcing or requiring enrollees to use specific pharmacies or affiliate pharmacies (Section 2(a)(1)(A)(iv) and Section 2(b)(1)(A)).

Increased price transparency: The bill requires pharmacies to report drug acquisition prices, and the Secretary must make this information, including information on price concessions, publicly available (Section 3(1)(A)(F) and Section 3(1)(A)(G)).

Fairer dispensing fees: It requires the payment of a dispensing fee equal to what is paid under the State plan in the pharmacy's location (Section 2(a)(1)(2)(B)(i)).

Strict penalties for non-compliance: Pharmacy benefit managers who willfully fail to follow payment, steering, or rebate requirements face felony charges, including up to 10 years in prison and fines up to $1,000,000 (Section 2(c)(1)).

Civil monetary burdens: Entities can be hit with civil penalties of $1,000,000 for specific prohibited acts (Section 2(c)(2)(C)(ii)).