Sponsors (7)
The bill aims to lower prescription drug costs and increase PBM transparency and enforcement by requiring rebate pass‑through and bona fide fees, but it may raise administrative costs, leave room for plans to retain savings instead of benefiting patients, disadvantage smaller PBMs, and create significant enforcement/liability risks.
Middle‑class families, employers, and enrollees (including patients with chronic conditions and Medicare/Medicaid beneficiaries) will receive fuller pass‑through of manufacturer rebates and discounts, which can lower net drug costs and reduce out‑of‑pocket spending for many plan members.
Group health plans and insurers must use bona fide, itemized service fees that reflect fair market value and be agreed in writing, increasing contract transparency and giving plans clearer visibility into PBM remuneration.
Plans, insurers, and taxpayers gain stronger enforcement tools (disgorgement, civil penalties, interim final regulations) to deter improper PBM practices and encourage compliance.
Patients (including those with chronic conditions) and other enrollees may see little or no reduction in copays or premiums if plans retain rebate savings instead of passing them through to beneficiaries, undermining the law’s intent to lower consumer costs.
Middle‑class families, employers, and taxpayers could face higher premiums or administrative charges because PBMs and plan sponsors will incur one‑time and ongoing costs to re-contract, document, and administer flat, itemized fees.
Smaller PBMs and third‑party administrators may be disadvantaged if they cannot retain revenue streams previously used for services, reducing competition in PBM services and potentially raising costs or narrowing options for employers and consumers.
Based on analysis of 2 sections of legislative text.
Starting Jan 1, 2027, PBMs may not earn remuneration tied to drug prices, rebates, or discounts and may only charge flat, non-contingent service fees at fair market value.
Prohibits pharmacy benefit managers (PBMs) from earning any remuneration tied to prescription drug prices, rebates, discounts, or other price-contingent amounts for group health plans, group health insurance, and specified individual coverage beginning January 1, 2027. PBMs may only collect flat, prearranged "bona fide service fees" that reflect fair market value for specific, itemized services actually performed; regulators will enforce the rule, require disgorgement of prohibited amounts, and impose civil penalties for violations.
Introduced March 18, 2025 by Mariannette Miller-Meeks · Last progress March 18, 2025