Sponsors
The bill increases PBM and drug‑price transparency and expands association/custom plan options—giving employers, plans, patients, and regulators tools to reduce net drug spending and design benefits—while creating new compliance costs, privacy risks, weakened state oversight, and market‑stability risks that could shift costs to consumers and erode protections for some groups.
Millions of patients and enrollees (including middle-class and low-income families) gain standardized, machine-readable PBM and drug-price reporting (net prices, rebates, per-claim payments) that can expose excess markups and enable plans to negotiate lower net drug spending and reduce out-of-pocket costs over time.
Employers and plan sponsors get standardized summaries and disclosure (including estimated net price summaries) that make it easier to compare PBMs and select better contracts, potentially lowering employer health spending and premiums.
Individual participants and patients can request claims‑level and aggregate drug‑cost information, improving transparency so people can make more informed prescription and coverage decisions.
PBMs, plans, and vendors will face substantial new data‑collection and reporting costs that are likely to be passed, at least initially, to employers and enrollees as higher premiums or administrative fees.
Extensive machine‑readable and claims‑level reporting raises privacy and re‑identification risks for enrollees despite HIPAA safeguards, potentially exposing sensitive health information if breaches or misuse occur.
A federal preemption provision limits state authority over association plans' ability to insure against excess claims, weakening state consumer protections and oversight in important parts of the insurance market.
Based on analysis of 5 sections of legislative text.
Allows associations to sponsor group health plans if they meet governance tests and requires PBMs, plans, and issuers to provide detailed machine-readable drug- and claim-level reporting.
Creates a path for employer associations to sponsor group health plans if they meet new organizational, membership, and governance tests, and imposes comprehensive transparency and reporting requirements on pharmacy benefit managers (PBMs), group health plans, and issuers. Reports must be machine-readable, delivered at least semiannually (or quarterly on request), and include per-drug, per-claim data on prices, rebates, payments, dispensing channel, and participant out-of-pocket costs; the rules take effect for plan years beginning 30 months after enactment.
Introduced December 15, 2025 by Mariannette Miller-Meeks · Last progress December 18, 2025