Senate Bill Would Ban PBM "Spread Pricing" in Medicaid, Open Medicare Drug Networks

New pharmacy survey and Medicaid pass-through pricing rules begin to take effect

Retail pharmacies must respond to monthly drug cost surveys, and states must start requiring PBMs to pass through full drug payments to pharmacies instead of keeping a hidden "spread." This is the first concrete step toward lowering Medicaid drug costs.

Medicare Part D any-willing-pharmacy and PBM transparency rules take effect for plan year 2028

Starting January 1, 2028, Medicare drug plans must let any pharmacy join their network if it meets standard terms, PBMs must file detailed annual cost reports, and pharmacies gain a formal complaint process. Seniors and people with disabilities should have more choices about where to fill prescriptions.

HHS publishes standards for 'reasonable and relevant' pharmacy contract terms

By April 2027, HHS must set standards defining what contract terms PBMs and drug plans can require of pharmacies. This will determine how much real-world protection pharmacies — especially small and rural ones — actually get under the new law.