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Read. Follow. Verify.Proposed Changes to Medicare Pharmacy Performance Standards
Record date · December 17, 2024
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What This Bill Would Do
This bill requires the federal government to create standardized performance measures for pharmacies participating in Medicare Part D plans. It also mandates that health plans provide pharmacies with clear, standardized information about fees and payments for every drug claim processed.
If passed, this bill would change how pharmacies are evaluated and paid under Medicare Part D, potentially impacting the financial transparency and operational requirements for retail, mail-order, and specialty pharmacies starting in 2025.
- Mr. Griffith is a U.S. Representative for Virginia's 9th congressional district. context
- Mr. Carter of Georgia is a U.S. Representative for Georgia's 1st congressional district. context
Who It Would Affect
Groups the bill's text would affect if enacted, as described in the record. Being affected is not a position for or against it.
Network pharmacies
Pharmacies will be subject to standardized performance measures and will receive new, standardized payment and fee information for claims.
PDP sponsors
Prescription drug plan sponsors must adopt standardized performance measures and provide standardized claim information to pharmacies.
MA organizations
Medicare Advantage organizations offering MA-PD plans must adopt standardized performance measures and provide standardized claim information to pharmacies.
Pharmacy benefit managers
PBMs acting on behalf of plans will be subject to the new transparency and performance measure reporting requirements.
Key Facts
You don't have to trust us. Each fact below is taken straight from the official document - click any one to see the exact passage, highlighted in the original.
Frequently Asked Questions
How will this affect my pharmacy?
When do these changes take effect?
Who is responsible for checking if these measures are fair?
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News Coverage
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Votes, people, money & the original sourceWhere This Stands
Currently filed. The next step in the legislative lifecycle is Committee.
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
Discoveries
Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.
Standardization of Pharmacy Metrics
The bill represents a shift toward federal oversight of private pharmacy performance contracts, moving away from decentralized, plan-specific metrics.
Connected Entities
Sources
www.congress.gov
Analysis Score
0–100- Significance75How much this matters to a regular citizen
- Controversy40Intensity of disagreement among stakeholders
- Entertainment10Compellingness for a non-policy-wonk reader
- Buzz25Current news / social attention level
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