Sponsor
Frank Pallone
Representative · D-NJ
Representative · D-NJ
Introduced March 3, 2025 by Frank Pallone · Last progress March 3, 2025
The bill advances drug and PBM transparency, expands telehealth and home-based care, and strengthens public-health preparedness and targeted social supports, but does so by adding substantial new reporting requirements, federal spending, privacy risks, and compliance costs that may fall hardest on small providers, plans, and taxpayers.
Patients, plan participants, employers, and large group health plans gain substantially more transparency into drug prices, PBM receipts/rebates/fees, and claims-level flows, plus rules requiring some rebate remittances to plans, enabling better oversight, audits, and the potential to lower premiums or out-of-pocket costs.
People who rely on telehealth, home-based acute care, cross-state Medicaid coverage, and home infusion (including Medicare and Medicaid beneficiaries, children in Medicaid, and rural patients) will have expanded access and retained flexibilities that make remote and home care easier to use.
Hospitals, public health systems, and communities get strengthened preparedness: larger, multi-year funding for medical countermeasures, regional biocontainment labs, diagnostics preparedness, cyber resilience, and clearer national strategies to respond to public-health emergencies.
State and local governments, Tribes, health providers, PBMs, plans, pharmacies, and other regulated entities face major new administrative, reporting, and compliance burdens (frequent machine-readable reports, expanded audits, new sampling/reporting regimes, and federal data requirements) that will consume staff time and operational resources.
The bill authorizes substantial new appropriations and program spending across health, preparedness, spectrum, and recycling programs, increasing federal outlays that will be borne by taxpayers and could crowd out other priorities absent offsets.
Detailed, frequent claims-level and manufacturer/copay assistance reporting raises risks to patient privacy and PHI if de-identification or HIPAA safeguards fail or if business associates mishandle sensitive information.
Based on analysis of 37 sections of legislative text.
Mandates PBM and plan drug‑price transparency, updates Medicare/Medicaid access and payment rules, bans certain consumer products, and creates tech, telecom, and public‑health reporting and program changes.
Imposes broad consumer safety, health-care, and technology reforms focused on price transparency, patient access, and standards. The bill requires detailed reporting and disclosure from pharmacy benefit managers (PBMs) and related entities, changes Medicare and Medicaid rules on telehealth, home infusion, hospital payments, and out‑of‑state provider enrollment for children, sets product safety rules and a ban on high‑concentration sodium nitrite consumer products, and creates or updates programs for recycling, blockchain coordination, telecommunications administration, public‑health preparedness, and medical research. Implements enforceable deadlines, new reporting formats and civil penalties, new or increased funding for selected public‑health countermeasure efforts and NTIA, and multiple agency rulemakings and studies (GAO, MedPAC, HHS, HHS/OCR, DOL, IRS/HHS rulemaking). Many health‑care transparency rules take effect for plan years beginning 30 months after enactment; other provisions have discrete dates (e.g., CPSC ban effective 90 days, telehealth coding by Jan 1, 2026, Medicaid enrollment changes in 3 years).