Sponsors (7)
Want to know what is actually in this bill?
This is not an official government website.
Copyright © 2026 PLEJ LC. All rights reserved.
Stops pharmacy benefit managers from taking any payments tied to prescription drug benefits in group or individual health coverage. Starting January 1, 2027, PBMs may only collect clearly defined “bona fide service fees” as allowed under the bill. The bill orders federal regulators to enforce these rules, claw back improper payments, and fine violators $10,000 per day. Agencies must issue interim final regulations to put the rules in place and define terms needed for compliance.
Beginning January 1, 2027, a pharmacy benefit manager (PBM) shall derive no remuneration from any entity for services, benefit administration, or any other activities related to prescription drug benefits under a group health plan or group or individual health insurance coverage.
Adds a substantially identical prohibition on PBM remuneration beginning January 1, 2027, to ERISA by inserting a new section 726 after section 725.
Adds a substantially identical prohibition on PBM remuneration beginning January 1, 2027, to the Internal Revenue Code as a new section 9826 in Subchapter B (chapter 100).
Permits PBMs to charge only bona fide service fees if the fee is set forth in an agreement and the fee is a flat dollar amount that is not directly or indirectly based on or contingent upon a drug price, drug benchmark price, the amount of discounts/rebates/fees/other remuneration related to prescription drugs for plan participants, or any other amounts specified by the relevant Secretaries.
Defines “bona fide service fee” as a fee equal to the fair market value of a bona fide, itemized service actually performed on behalf of an entity, that the entity would otherwise perform or contract for, and that is not passed on in whole or in part to a client or customer (whether or not the entity takes title to the drug).
PBMs must overhaul their payment models, moving away from rebates or other remuneration tied to drug benefits and toward clearly defined service fees. Health insurers and group health plans will need to revise contracts and payment structures with PBMs, and strengthen compliance systems to avoid penalties. Employers that sponsor health plans will likely renegotiate PBM arrangements and may see changes in the transparency and predictability of PBM costs. Pharmacies and wholesalers could see adjustments in fee structures and chargebacks as PBM compensation changes. Enrollees in private health plans may experience downstream effects on premiums, cost-sharing, and formulary design; the direction and size of those impacts will depend on how plans and PBMs restructure contracts and how regulators define bona fide service fees. Federal regulators will take on enforcement, define key terms, and manage rulemaking and oversight.
Expand sections to see detailed analysis
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced March 18, 2025 by Mariannette Miller-Meeks · Last progress March 18, 2025
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House