Drug Price Transparency in Medicaid Act of 2023
If passed, HB1613 will have significant implications for how state Medicaid programs interact with PBMs and how prices for outpatient drug prescriptions are structured. By mandating pass-through pricing, the bill seeks to prevent PBMs from charging additional fees on top of the actual drug cost, potentially reducing the overall expenditure for Medicaid programs and, by extension, taxpayers. Moreover, the bill requires states to collect data on pharmacy prices to establish a national average drug acquisition cost, increasing the accountability in drug pricing and making this information publicly available.
House Bill 1613, titled the 'Drug Price Transparency in Medicaid Act of 2023', aims to amend Title XIX of the Social Security Act with a focus on increasing transparency in drug pricing within the Medicaid program. The bill targets the practices of pharmacy benefit managers (PBMs) and seeks to enforce that drug payments made through these entities are based on a pass-through pricing model. This means that the payments will only cover the ingredient costs of drugs, along with a professional dispensing fee, and any additional fees or profits from spread pricing will not be permitted. This legislation is designed to curb abuses that have led to inflated drug prices in the Medicaid system.
Despite its aims at transparency, HB1613 is not without controversy. Supporters argue that it will lower drug costs for Medicaid recipients and prevent exploitative pricing practices by PBMs. Opponents, however, argue that such regulations may stifle the financial viability of local pharmacies and impede their ability to provide services. Additionally, there is a concern that while trying to save costs, the bill might inadvertently hinder access or availability of necessary medications for vulnerable populations, raising important considerations about balancing cost control with healthcare access.