
H.R. 1, or the Big Beautiful Bill, has brought substantial change to the managed care pharmacy landscape, particularly for managed care organizations (MCOs) with managed Medicaid lines of business.
The Protecting Pharmacies in Medicaid Act would prohibit the use of spread pricing arrangements in Medicaid programs. Pharmacy benefit managers (PBMs) would be required to pass through to pharmacies the full amount of the money paid to the PBMs by Medicaid programs, except for a fixed administrative fee. The total reimbursement amount will be determined by a survey of national average drug acquisition costs administered by the Department of Health & Human Services.
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