Sponsors (7)
The bill increases PBM transparency and enforcement to try to direct drug pricing savings back to plans and patients, but it risks higher administrative costs, cost‑shifting, and punitive compliance consequences that could raise premiums or disrupt existing negotiations.
Patients (including those with chronic conditions), Medicare beneficiaries, and Medicaid beneficiaries could see lower net prescription drug costs if PBM rebates and discounts are fully passed through to plans or issuers.
Stronger enforcement tools (civil penalties, interim final regs) and increased transparency could deter improper PBM practices and make drug pricing and contracting more accountable.
Limiting PBM charges to transparent, flat-dollar bona fide service fees tied to specific services could simplify billing, improve oversight, and reduce opaque revenue streams.
Middle‑class families, small-business employers, and taxpayers may face higher premiums or employer health costs if PBMs raise administrative fees or shift costs to plans in response to limits on remuneration.
Patients (including those on Medicare and Medicaid) could lose some negotiated savings if PBMs stop negotiating certain price concessions because of remuneration limits and pass‑through is not fully enforced.
A narrow definition of permissible fees and a broad definition of PBMs could increase compliance costs and administrative burden for PBMs, plans, hospitals, and health system staff.
Based on analysis of 2 sections of legislative text.
Introduced March 18, 2025 by Mariannette Miller-Meeks · Last progress March 18, 2025
Prohibits pharmacy benefit managers (PBMs) from receiving payments tied to drug prices, rebates, or discounts for services related to prescription drug benefits for group or individual health coverage, starting January 1, 2027. PBMs may only receive narrowly defined flat-dollar fees that are contractually specified, equal fair market value for listed services actually performed, and not based on drug price-related amounts. Enforcement authority is given to federal agencies with disgorgement and monetary penalties for violations.