Protecting Pharmacies in Medicaid Act Summary
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.
Related
In February 2026, Senators Elizabeth Warren (D-MA) and Josh Hawley (R-MO) introduced the Break Up Big Medicine Act (S. 3822). The bipartisan legislation, referred to the Senate Judiciary Committee, aims to prohibit pharmacy benefit managers (PBMs), health insurers, and prescription drug or medical device wholesalers from being under common ownership with certain medical service providers or provider groups, including in-patient or outpatient pharmacies.
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