Bill · S. 5586· Senate(119-S-5586)
Ensuring Accurate Payments to Specialty Pharmacies Act
- Introduced
- 9/29/2026
- Last activity
- 9/29/2026 — Read twice and referred to the Committee on Finance.
- Sponsored by
- Mark Warner
- Cosponsors
- - 0 - 1
- Introduced
- In Committee
What this bill would do
This bill requires the Secretary of Health and Human Services to conduct monthly surveys of non-retail pharmacy drug prices under Medicaid. It sets up national average drug acquisition cost benchmarks specifically for these non-retail pharmacies, including mail-order and specialty pharmacies. States must require applicable non-retail pharmacies to respond to these surveys or face civil monetary penalties. The bill also directs the Inspector General of the Department of Health and Human Services to conduct periodic studies on the reported survey data. Finally, it ensures that pricing information from non-retail pharmacies cannot be used to set reimbursement rates for retail community pharmacies.
Yes
Does this make what the government does easier for the public to see?+4
The bill mandates public availability of non-retail pharmacy survey response rates, methodologies, and price concessions.
Does this make it easier to run a small business?+3
The bill protects retail community pharmacies by prohibiting states from using non-retail pricing data to set their reimbursement rates.
Does this put more money into Medicaid, the health coverage for people on low incomes?+2
The bill improves pricing accuracy and oversight for prescription drugs under Medicaid.
The opposite
Would business owners be better off under this?-2
The bill imposes survey compliance requirements and civil monetary penalties on applicable non-retail pharmacies.
Who it would affect, and how
Potential Positive Impacts for People
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Public Transparency: Under Section 2(a), adding section 1927(f)(2)(E) to the Social Security Act, information on national drug acquisition prices obtained from the surveys must be made publicly available. This includes monthly response rates, sampling methodology, and information on price concessions like discounts and rebates, which helps hold officials and companies accountable.
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Protection for Retail Pharmacies: Under Section 2(a), adding section 1927(f)(2)(G) to the Social Security Act, no State is allowed to use pricing information reported by non-retail pharmacies to develop or inform reimbursement rates for retail community pharmacies. This safeguards retail community pharmacies from having their rates improperly influenced by non-retail pricing data.
Potential Negative Impacts for People
- Survey Compliance Burdens and Penalties: Under Section 2(a), adding sections 1927(f)(2)(D) and 1927(f)(2)(F) to the Social Security Act, applicable non-retail pharmacies are forced to respond to the monthly surveys or face civil monetary penalties for non-response or violations. This creates a regulatory burden and financial risk for these businesses.
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Hover a score for the reason it gave.
- Governance And Ideology
- Improves Government Transparency+4
- Economy And Finance
- Improves Small Business Support+3
- Demographic And Interest Groups
- Good For Business Owners-2
- Healthcare
- Increases Medicaid Funding+2
- 9/29/2026
- Read twice and referred to the Committee on Finance.
- 1 Cosponsor added.
- Introduced in Senate
Bill CassidyRepublican · Louisiana