Ensuring Accurate Payments to Specialty Pharmacies Act
Sponsored By: Senator Warner, Mark R. [D-VA]
Introduced
Summary
Creates a national monthly price survey (a NADAC) for non-retail pharmacies, like mail-order and specialty shops, to build public acquisition-cost benchmarks and strengthen payment oversight.
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- Non-retail pharmacies would have to report monthly prices and price concessions and could face civil monetary penalties for non-response or misreporting. Public data would include response rates and lists of non-compliant pharmacies.
- Contracts and reports must identify pharmacy types and whether a pharmacy is owned or affiliated with a pharmacy benefit manager. The HHS Inspector General would study how related-party deals and PBM affiliations affect reported costs.
- The survey would produce NADAC benchmarks to inform Medicaid payment policy for non-retail dispensing, with a rule that States may not use this non-retail data to set retail community pharmacy rates. The bill also funds oversight with a one-time $5 million appropriation for FY2027 and an added $9 million each year thereafter.
*Would increase federal spending by about $5 million in FY2027 and roughly $9 million annually thereafter.*
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 0 benefits, 0 costs, 1 mixed.
New rules for specialty and mail-order pharmacies
If enacted, HHS would run monthly surveys of state-licensed non-retail pharmacies (for example, specialty and mail-order) to produce national average drug acquisition cost benchmarks. States would have to require qualifying non-retail pharmacies that receive payments or discounts tied to Medicaid drug dispensing to respond. The Secretary would publish guidance by January 1, 2028 and make survey outputs public, including monthly response rates, sampled counts, and lists of noncompliant pharmacies to the extent allowed. The Secretary could impose civil monetary penalties for violations or nonresponse, including penalties per noncompliant location. States could not use the non-retail survey pricing data to set retail community pharmacy reimbursement. The HHS Inspector General would study the survey data and report to Congress without revealing trade secrets. The bill would appropriate $5 million for the IG for fiscal year 2027 and add $9 million each year starting in fiscal year 2027 for related IG funding. The rules would start the first day of the first fiscal quarter beginning 18 months after enactment.
Sponsors & CoSponsors
Sponsor
Warner, Mark R. [D-VA]
VA • D
Cosponsors
Sen. Cassidy, Bill [R-LA]
LA • R
Sponsored 9/29/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov