CONGRESSMAN GONZALEZ CO-LEADS BIPARTISAN BILL TO BAN PREDATORY PRICING TACTICS FOR MEDICAID REIMBURSEMENTS 

WASHINGTON – On Friday, March 17, 2023, Congressmen Vicente Gonzalez (TX-34) and, Earl L. "Buddy" Carter (GA-1), introduced H.R. 1613, the Drug Price Transparency in Medicaid Act. This bipartisan legislation would end spread pricing in Medicaid programs, leading to low reimbursement rates for pharmacies, and lower health care costs artificially raised by Pharmacy Benefit Managers (PBMs).

"Patients should not have to decide between buying life-saving medicine or groceries. Prescription drug prices have become so high that patients are having to make these difficult and dangerous choices," stated Congressman Gonzalez. "I am proud to re-introduce this bipartisan bill with Congressman Carter to put patients first, hold industry accountable, and bring down the price of life saving medicine."

"PBMs have been allowed to rob patients, small businesses, and taxpayers blind for decades. As a pharmacist, I've seen firsthand how patients have been forced to stay sick and forgo medication due to the broken process. With this bill, we can hold PBMs accountable for their role in increasing the cost of health care and pocketing taxpayer money. I am proud to have bipartisan support and commitment to protecting the lives, health, and pocketbooks of patients across America," stated Congressman Carter.

Spread pricing occurs when a PBM, a middle man in the Medicaid managed care chain, charges health plans for prescription drugs more than they pay the pharmacy, which often is even below the cost for a pharmacy to acquire the drugs they are dispensing. Instead of passing the full payment on to pharmacies, PBMs keep the "spread" as profit while the pharmacies are reimbursed below their costs, which is an unsustainable situation for community pharmacies trying to keep their doors open to take care of patients. 

H.R. 1613 is a bipartisan piece of legislation cosponsored by Republican Congressman Rick Allen (GA-12) and Congresswoman Elise Stefanik (NY-21), Democratic Congresswoman Deborah Ross (NC-2) and Congressman Jake Auchincloss (MA-4).

The full text of the bill can be found here.

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