The proposed rule would:

Establish a Medicaid drug price verification survey, which would require manufacturers of some high-cost drugs to submit detailed pricing information to CMS. Non-proprietary data would be made publicly available and would help state agencies negotiate Medicaid drug prices with manufacturers.
Require PBMs to report the cost of dispensing and administering drugs to managed care plans separately from any additional costs charged by the PBM. The agency said this would cut down on inflated medical loss ratios and bring down capitation rates, which pay a set amount for each enrolled person assigned to them per period of time, whether or not that person seeks care.
Give CMS increased oversight of drug classifications in Medicaid and the ability to require corrective actions from manufacturers if a drug is incorrectly classified as brand name rather than generic. The proposed rule also would ensure that states get the appropriate rebates from manufacturers.

Related: Biden's drug price reform rollout: What to expect in 2023 and 2024

"With today's proposed rule, we are advancing unprecedented efforts to increase transparency in prescription drug costs, being good stewards of the Medicaid program and protecting its financial integrity," said Xavier Becerra, secretary of the U.S. Department of Health and Human Services. "This proposed rule will save both states and the federal government money."

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CMS proposes price transparency rule that targets PBMs

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