Hidden Fee Disclosure Act of 2025

This bill strengthens and clarifies disclosure rules for employer health plans. It makes the companies that manage drug benefits and plan services—pharmacy benefit managers (PBMs) and third‑party administrators (TPAs)—spell out what they charge and what they get paid, broken out by each service. It also expands which services must be reported (for example, plan design, claims repricing, stop‑loss insurance, and PBM services) and adds privacy safeguards so only summary health information is shared. PBM arrangements made through a health insurer are covered too.

Key points

• Who is affected: Employers with group health plans, PBMs (companies that manage drug benefits), and TPAs (firms that run plan administration).
• What changes:
  • Fees must be itemized by service (not just lumped together), and the list of covered services is broadened.
  • PBMs must disclose all types of pay they expect to receive—fees, rebates, discounts, price concessions, and co‑pay offsets—including money made by charging the plan more than they pay the pharmacy (“spread pricing”). Each year they must also report totals like gross and net drug spending and how much was spent at PBM‑owned pharmacies, with a breakdown by location, plus any cost‑sharing they collected above the contracted rate.
  • TPAs must disclose what they collect and keep (for example, rebates or refunds from providers), and expected recoveries from things like overpayments or fraud. They must also give yearly reports on direct and indirect pay, plan spending on administrative costs, and total fees collected.
  • Privacy: Only summary health information can be shared, re‑disclosure is tightly limited, and plans/providers may restrict public release—but they cannot block sharing with the Department of Labor. HIPAA rules remain unchanged.
• When:
  • Applies to new or renewed contracts on or after January 1, 2026.
  • Annual disclosures are due within 60 days after each plan year begins.
  • The Department of Labor must issue rules within one year to implement these requirements.