Protect Patient Access to Pharmacies Act

Protect Patient Access to Pharmacies Act

This bill establishes certain requirements with respect to payments to pharmacies by prescription drug plan (PDP) sponsors under the Medicare prescription drug benefit and Medicare Advantage.

Specifically, the Centers for Medicare & Medicaid Services (CMS) must ensure that payments sufficiently cover a pharmacy's costs to acquire and dispense covered drugs so as to enable the pharmacy to participate as a network provider. The CMS must (1) use relevant data from pharmacies with respect to acquisition and dispensing costs for covered drugs, (2) establish payment parameters, and (3) establish an appeal process for pharmacies about payments. The CMS must also evaluate the performance measures used by PDP sponsors for pharmacy price concessions or other performance fees and develop standardized performance measures.