To amend titles XVIII and XIX of the Social Security Act to establish requirements relating to pharmacy benefit managers under the Medicare and Medicaid programs, and for other purposes.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
This bill, To amend titles XVIII and XIX of the Social Security Act to establish requirements relating to pharmacy benefit managers under the Medicare and Medicaid programs, and for other purposes., changes federal law or congressional policy affecting health care providers and patients. The main policy domain is Healthcare, Government Operations, Finance.
Who Benefits and How
health care providers and patients may benefit from new authority, funding, eligibility, regulatory clarity, or reduced risk created by the bill.
Who Bears the Burden and How
federal implementing agencies, health care providers and patients may take on implementation duties, reporting obligations, compliance costs, or oversight responsibilities.
Key Provisions
- Section S1: 1. Short title; table of contents This Act may be cited as the Modernizing and Ensuring PBM Accountability Act. The table of contents of this Act is as follows:
- Section idedb726e1f1344d6d805e8b02fd5ac73d: 2. Arrangements with pharmacy benefit managers with respect to prescription drug plans and MA–PD plans Section 1860D–12 of the Social Security Act (42 U.S.C....
- Section idc51c2d08dff5417a98bfc7fa447e9e67: 3. Ensuring fair assessment of pharmacy performance and quality under Medicare part D Section 1860D–2 of the Social Security Act (42 U.S.C. 1395w–102) is...
- Section id819ae9f304564637b1311e9d9dbbdd81: 4. Promoting transparency for pharmacies under Medicare part D Section 1860D–2(f) of the Social Security Act (42 U.S.C. 1395w–102(f)), as added by section 3,...
- Section id5EFE4125CB9243B58574C30488F48333: 5. Preventing the use of abusive spread pricing in Medicaid Section 1927(e) of the Social Security Act (42 U.S.C. 1396r–8(e)) is amended by adding at the end...
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
This bill, To amend titles XVIII and XIX of the Social Security Act to establish requirements relating to pharmacy benefit managers under the Medicare and Medicaid programs, and for other purposes., changes federal law or congressional policy affecting health care providers and patients.
Key Policy Areas
Healthcare, Government Operations, Finance
Primary Purpose
This bill, To amend titles XVIII and XIX of the Social Security Act to establish requirements relating to pharmacy benefit managers under the Medicare and Medicaid programs, and for other purposes., changes federal law or congressional policy affecting health care providers and patients.
Policy Domains
Whole bill
Identified Gains
Contextual inference, no direct clause citation- health care providers and patients
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- federal implementing agencies
- health care providers and patients
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
ReportedReported by Mr. Wyden, with an amendment
Mr. Wyden introduced the following bill; which was read twice …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Health benefits plans, MA organizations, Medicaid managed care organizations
PDP sponsors faces effects in multiple directions
Positive-direction: Health benefits plans, Prescription drug plan sponsors
Negative-direction: MA organizations, Medicaid managed care organizations, PBM affiliates, PBM-affiliated specialty pharmacies, PDP sponsors and MA organizations, Pharmacy benefit managers, Pharmacy benefit managers (Medicaid), Pharmacy benefit managers (Medicare Part D), Vertically integrated health companies
Independent retail pharmacies, Pharmacies serving Medicaid patients, Retail community pharmacies
Positive-direction: Independent retail pharmacies, Pharmacies serving Medicaid patients, Retail pharmacies dispensing Part D drugs
Negative-direction: Retail community pharmacies
Medicare Part D beneficiaries, Medicare beneficiaries, Medicare seniors
Centers for Medicare & Medicaid Services, HHS Office of Inspector General, HHS/CMS
Positive-direction: Centers for Medicare & Medicaid Services
Negative-direction: HHS/CMS
Biosimilar drug manufacturers, Reference biologic manufacturers
Positive-direction: Biosimilar drug manufacturers
Negative-direction: Reference biologic manufacturers
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_commission"
- → The commission identified in the operative section
- "secretary_of_health_and_human_services"
- → Secretary of Health and Human Services
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology