Sponsors (7)
The bill forces PBMs to pass through rebates and limits undisclosed fees to lower drug spending and improve transparency, but it risks higher administrative fees, narrower drug coverage, and increased compliance costs that could be shifted onto employers, taxpayers, and patients.
Employers, health plans, and plan sponsors will receive rebates/discounts passed through to them, lowering net prescription drug costs for sponsors and potentially reducing premiums for consumers.
Patients with chronic conditions may face lower out-of-pocket costs if plan savings are used to reduce premiums or patient cost-sharing.
Increases transparency by limiting PBM revenue to itemized, fair-market-value fees, making pharmacy benefit costs easier for plans, hospitals, and state governments to audit and control.
Insurers or employers might narrow drug formularies or restrict coverage if PBM services become more expensive, reducing access to needed medicines for some patients.
PBMs and pharmacies may raise administrative or itemized fees to replace lost rebate revenue, which could increase plan costs and be passed on to employers, taxpayers, and families through higher premiums or contributions.
High civil penalties and strict enforcement (e.g., large per‑day fines) could increase legal and compliance costs for PBMs and plans, with those costs potentially passed through to consumers or reducing plan offerings.
Based on analysis of 2 sections of legislative text.
PBMs are barred from receiving remuneration tied to administering prescription drug benefits, permitting only narrow flat service fees; enforcement and penalties are added across health, ERISA, and tax law.
Official title: To improve services provided by pharmacy benefit managers.
Introduced March 18, 2025 by Mariannette Miller-Meeks · Last progress March 18, 2025
This bill prohibits pharmacy benefit managers (PBMs) from receiving any remuneration tied to prescription drug benefit administration for group or individual health coverage beginning January 1, 2027, while allowing narrowly defined flat, itemized service fees that equal fair market value. It adds parallel prohibitions and enforcement authorities across the Public Health Service Act, ERISA, and the Internal Revenue Code, requires interim final regulations, and authorizes remedies including disgorgement, daily civil penalties, and enforcement procedures under existing Social Security Act authorities. The law preserves payment for drug ingredient costs and dispensing fees and allows full pass-through of rebates/discounts to plans or issuers to lower net costs.