S. 3345 — PBM Price Transparency and Accountability Act

This section revises the survey requirements under the Medicaid drug rebate program (SSA §1927(f)) for determining national average drug acquisition cost benchmarks (NADAC) for covered outpatient drugs, which states use to reimburse pharmacies, as follows: (1) requires the Secretary to survey both retail community pharmacy prices and applicable non-retail pharmacy prices (potentially by type), conducted monthly by a vendor net of discounts, rebates, and price concessions; (2) mandates monthly vendor updates to the Secretary and differentiation of data by pharmacy type (including affiliates); (3) requires states to ensure that pharmacies receiving Medicaid-related payments respond to surveys; (4) requires public disclosure of survey information, including response rates, non-compliant pharmacies, sampling methodology, and price concessions; and (5) authorizes civil money penalties against non-compliant pharmacies for failing to respond, providing false information, or other violations. (Thus, the changes expand the NADAC survey beyond retail community pharmacies, improve data timeliness and granularity, and strengthen enforcement to promote accurate Medicaid drug reimbursements.)

This section requires prescription drug plan (PDP) sponsors to permit any willing pharmacy meeting standard contract terms and conditions to participate as a network pharmacy and directs the Secretary to establish, by the first Monday in April 2027, standards for reasonable and relevant such terms (following a request for information issued by April 1, 2026), effective for plan years beginning on or after January 1, 2028. This section further requires the Secretary to publish reports at least every two years until 2034 (and periodically thereafter) on trends in payments to and from, network participation of, and dispensing volumes by essential retail pharmacies (i.e., non-affiliate retail pharmacies located in rural areas with no other pharmacy within 10 miles, suburban areas with no other within 2 miles, or urban areas with no other within 1 mile), including geographic and plan-type comparisons with non-essential pharmacies.