Sponsors (2)
This bill increases federal funding, public‑health preparedness, Medicaid and primary‑care supports, and major transparency and oversight of drug pricing and PBM practices to improve access and accountability—at the tradeoff of substantial new reporting and compliance burdens, privacy and proprietary risks, possible market consolidation, and higher federal outlays that could raise costs for some providers, plans, and taxpayers.
Medicare, Medicaid beneficiaries, employer plan members, and patients with chronic conditions will get much more transparent drug pricing and PBM payment data (machine‑readable reports, rebate pass‑throughs, audited records), enabling plans and regulators to detect improper practices and potentially lower drug costs.
State, local, Tribal governments, hospitals, and communities will gain stronger public‑health preparedness, surveillance, and surge capacity (expanded Hospital Preparedness Program, antimicrobial resistance strategy, wastewater surveillance grants, regional biocontainment labs and related grants), improving detection and response to epidemics and other biological threats.
Low‑income, uninsured, and underserved patients and rural communities will see sustained and increased primary care and targeted program funding (community health centers, National Health Service Corps, teaching health center GME, diabetes and WTC health funding, expanded dental, sickle cell and cancer screening authorizations), supporting access to care and workforce expansion.
State Medicaid agencies, health systems, PBMs, pharmacies, plans, employers, and many providers will face substantial new administrative, reporting, auditing, and compliance burdens from machine‑readable claims reporting, PBM audits, DSH reallocations, HCBS reporting, preparedness plans, and other requirements—raising operating costs and staff workload.
The bill increases federal authorizations and new program spending (community health centers, preparedness programs, labs, disease programs, grants), which will raise federal outlays and could add to deficits or crowd other budget priorities absent offsets.
Extensive, detailed claims‑level and transaction reporting creates meaningful privacy and proprietary risks—patients face reidentification or data‑breach risk, while PBMs and manufacturers face exposure of sensitive commercial terms—despite HIPAA limits and nondisclosure protections.
Based on analysis of 36 sections of legislative text.
Imposes Medicaid and Medicare payment/enrollment changes, broad PBM and plan reporting/contract rules, MA directory accuracy scoring, public‑health funding increases, pediatric drug study rules, and biosimilar patent limits.
Introduced March 6, 2025 by Ronald Lee Wyden · Last progress March 6, 2025
Makes broad changes across federal health programs to increase provider access, transparency, funding, and program reporting. Key actions: require streamlined out‑of‑State Medicaid enrollment for children, tighten and expand reporting and contractual rules for pharmacy benefit managers (PBMs) and prescription drug plans, add Medicare Advantage provider‑directory accuracy scoring, adjust hospital payment/timing rules, extend and add targeted public‑health and workforce funding, and change pediatric drug study and biosimilar patent rules. The bill creates multiple new reporting and disclosure requirements (for PBMs, group plans, Medicare Advantage plans, and State HCBS waivers), provides specific appropriations/authorizations for community health centers, teaching health centers, and other public‑health programs, extends select temporary authorities (e.g., fentanyl analog scheduling), and phases in many provisions with staggered effective dates (ranging from immediate to multi‑year delays).