By January 1, 2029 a pharmacy must be able to report a violation
What the document says“Not later than January 1, 2029, the Secretary shall establish a process through which a pharmacy may submit to the Secretary an allegation of a violation by a PDP sponsor offering a prescription drug plan of the standards for reasonable and relevant contract terms and conditions”
Subsection (c) of section 6223 adds a new subparagraph (F) to section 1860D-4(b)(1) of the Social Security Act. By January 1, 2029 the Secretary must set up a process for a pharmacy to allege that a sponsor broke the reasonable and relevant standards, or the anti-retaliation rule. A pharmacy may file once per plan year per contract, with an extra filing allowed where the contract is later modified. The Secretary must supply a standardized template requiring a certification of accuracy, and may temporarily bar a pharmacy that files frivolous allegations on a routine basis.
What the document actually says“Not later than January 1, 2029, the Secretary shall establish a process through which a pharmacy may submit to the Secretary an allegation of a violation by a PDP sponsor offering a prescription drug plan of the standards for reasonable and relevant contract terms and conditions”
By January 1, 2029 the health chief must set up a way for a pharmacy to report a plan. The report says the plan broke the fairness rule.
A pharmacy may file once a year for each deal it has. If the deal changes, it may file again. A set form must be used.
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