Sponsor
Mariannette Miller-Meeks
Representative · R-IA
Representative · R-IA
The bill increases PBM and drug‑price transparency and expands access to association health plans—potentially lowering drug spending and improving employer bargaining—but does so at the cost of higher administrative and compliance burdens, privacy and enforcement risks, and possible reductions in plan quality and state consumer protections.
Patients and plan participants (especially people with chronic conditions and lower‑income enrollees) will get clearer, participant‑facing drug price and claim‑level cost information so they can see what drugs actually cost and make lower‑cost choices.
Employers and plan sponsors (including small businesses) will receive standardized, machine‑readable PBM and rebate/net‑price reports enabling better negotiation of PBM contracts and stronger control over prescription drug spending, with potential to reduce premiums or employer costs.
Federal oversight, standardized reporting formats, and enforcement authority will increase transparency of PBM practices and enable regulators (HHS, GAO, Congress) to identify and act on opaque pricing practices that drive premiums and out‑of‑pocket costs.
Preparing and delivering frequent, claims‑level, machine‑readable reports will raise administrative and compliance costs for PBMs, plans, and employers, costs that are likely to be passed to employers and consumers via higher premiums or fees.
Detailed drug‑ and claim‑level reporting increases the risk that sensitive health information could be exposed or reidentified despite HIPAA/HITECH protections, posing privacy risks for patients.
Large civil money penalties and enforcement provisions (including per‑item penalties) create substantial litigation and financial risk for PBMs and plans, which could drive conservative reporting, higher legal/compliance costs, or cause smaller PBMs to exit the market.
Based on analysis of 5 sections of legislative text.
Broadens association health plans under ERISA and imposes federal PBM registration, reporting, and transparency rules with detailed drug‑level disclosures to plans.
Allows broader association health plans (AHPs) by changing ERISA’s definition of a group or association of employers and setting formation, governance, membership, and fiduciary rules so more employer associations can offer group health coverage. Creates a comprehensive federal transparency and reporting regime for pharmacy benefit managers (PBMs), requiring registration, semiannual (or quarterly) plain-language and machine‑readable reports to group health plans, detailed drug‑level claims and financial disclosures, prohibiting certain PBM practices (e.g., gag clauses, steering, discriminatory formulary actions), and directing HHS and Treasury/IRS rulemaking and enforcement. Most PBM and reporting requirements become effective for plan years beginning 30 months after enactment; the AHP changes take effect on enactment.
Official title: To ensure access to affordable health insurance.
Introduced December 15, 2025 by Mariannette Miller-Meeks · Last progress December 18, 2025