To amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes.
Impact
By enforcing standardized pharmacy performance measures, HB 5393 seeks to enhance the consistency and fairness of how pharmacies are evaluated and compensated under Medicare Part D. The legislation highlights the need for pharmacies to receive complete and timely information on payments and pricing related to their claims, which is intended to promote transparency within the pharmaceutical service sector. Additionally, $4 million is appropriated for the fiscal year 2025 to assist in the implementation of these measures, indicating a substantial federal investment in reforming the Medicare drug program.
Summary
House Bill 5393 aims to amend title XVIII of the Social Security Act concerning Medicare Part D, focusing on the fair assessment of pharmacy performance and quality. It establishes requirements for standardized performance measures that must be applied across various types of pharmacies, including retail, mail order, and specialty pharmacies. The bill mandates that any incentive payments, price concessions, or fees based on performance measures must utilize standards set or adopted by the Secretary of Health and Human Services. This is set to take effect for plan years starting January 1, 2025.
Contention
While the bill seeks to improve the regulatory framework surrounding pharmacies, there may be points of contention. Stakeholders might express concerns regarding the feasibility of implementing standardized measures and how they may affect small or independent pharmacies compared to larger chains. Additionally, the role of the Centers for Medicare & Medicaid Services in maintaining these measures and ensuring compliance may raise questions about oversight and accountability within the drug pricing structure, leading to debates on how these changes could impact pharmacy operations and patient care.
To amend title XVIII of the Social Security Act to provide for enforcement of standards for reasonable and relevant contract terms and conditions and essential retail pharmacy protections under the Medicare program.
To amend title XVIII of the Social Security Act to provide coverage for wigs as durable medical equipment under the Medicare program, and for other purposes.
Saving Seniors Money on Prescriptions ActThis bill establishes reporting requirements for pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit and Medicare Advantage, particularly relating to the prices of prescription drugs.Specifically, PBMs must (1) disclose certain information underlying cost performance measurements (e.g., exclusions and terms), and (2) report to prescription drug plan (PDP) sponsors (and to the Centers for Medicare & Medicaid Services upon request) an itemized list of prescription drugs that were dispensed during the previous year and related data about costs, claims, affiliated pharmacies, and other specified information. PDP sponsors may audit PBMs to ensure compliance with this bill's requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations.In addition, the Government Accountability Office must study federal and state reporting requirements for health plans and PBMs with respect to prescription drug price transparency and recommend ways to streamline these requirements.