Sponsors (7)
The bill forces PBM pass-through and fee limits to increase transparency and could lower costs for plan sponsors and some patients, but raises the risk that higher administrative or compliance costs and narrower drug coverage will offset those savings and reduce access for some people.
Employers and health plans will receive rebates and discounts fully passed through, lowering net prescription drug costs for plan sponsors and potentially reducing premiums for workers and families.
Patients with chronic conditions may face lower out-of-pocket costs if plan savings are used to reduce premiums or cost-sharing, improving medication affordability and adherence.
The bill increases transparency by limiting PBM revenue to itemized, fair-market-value fees, making pharmacy benefit costs easier for plans and governments to audit and control.
Insurers or employers might narrow drug formularies or restrict coverage if PBM services become more expensive, reducing access to some medicines for patients.
PBMs and pharmacies may raise administrative or service fees to replace lost revenue, which could increase plan costs for employers, taxpayers, and middle‑class families.
High civil penalties and strict enforcement could raise legal and compliance costs for PBMs and plans, costs that may be passed on to consumers and patients.
Based on analysis of 2 sections of legislative text.
Prohibits PBMs from receiving remuneration tied to drug prices or rebates for private health plans after Jan 1, 2027, allowing only certain flat, itemized service fees.
Introduced March 18, 2025 by Mariannette Miller-Meeks · Last progress March 18, 2025
Prohibits pharmacy benefit managers (PBMs) from receiving remuneration tied to drug prices, rebates, discounts, or other amounts for administering prescription drug benefits under group and individual private health plans beginning January 1, 2027. PBMs may instead receive narrowly defined, itemized flat fees that equal fair market value and are not contingent on drug-related payments; the law preserves payments for ingredient costs and dispensing fees and allows full pass-through of rebates to plans. The law adds parallel requirements to the Public Health Service Act, ERISA, and the Internal Revenue Code, directs agencies to adopt interim final regulations, and sets enforcement tools including disgorgement to affected plans/issuers, civil penalties of $10,000 per day per violation, and procedures modeled on existing Social Security Act enforcement authority with specified agency roles for HHS, Labor, and Treasury/IRS.