Bipartisan Health Care Act
Updated 49 minutes ago
Last progress March 6, 2025 (11 months ago)
Lower Costs for Everyday Americans Act
Updated 26 minutes ago
Last progress March 3, 2025 (11 months ago)
Read twice and referred to the Committee on Finance.
Consolidated Appropriations Act, 2026
Updated 1 day ago
Last progress January 30, 2026 (6 days ago)
Last progress March 6, 2025 (11 months ago)
Introduced on March 6, 2025 by Marsha Blackburn
Requires Medicare Part D and MA–PD drug plans to let any pharmacy join their networks if the pharmacy accepts the plan’s contract terms, and directs the Secretary to set standards for those terms. It defines and tracks “essential retail pharmacies,” creates a process for pharmacies to allege plan violations, assigns PBMs financial responsibility for some violations, and mandates Secretary reports on pharmacy access and enforcement. Also tightens rules for pharmacy benefit managers (PBMs) that work with Part D plans: written contracts, regular transparent reporting and audits, limits on certain PBM revenue retention, confidentiality and enforcement rules for data, and timelines for implementing the required standards and reports (with plan‑year effects beginning in 2027–2028).
Amend Section 1860D–4(b)(1) to require that a PDP sponsor offering a prescription drug plan permit any pharmacy that meets the plan’s standard contract terms and conditions to participate as a network pharmacy.
For plan years beginning on or after January 1, 2028, contract terms and conditions offered by PDP sponsors must be reasonable and relevant according to standards the Secretary will establish.
Secretary must issue a request for information by April 1, 2026 to gather input on contracting practices, reimbursement, dispensing fees, quality measures, auditing, and other contracting issues to inform standards.
Secretary must establish standards for reasonable and relevant contract terms and conditions not later than the first Monday in April of 2027.
Adds a new subsection requiring the Secretary to publish reports about trends (ingredient cost reimbursement, dispensing fees, incentive payments, amounts paid to PDP sponsors, participation in networks, number of essential retail pharmacies, cost‑sharing comparisons, dispensing volumes, and comparisons between PDP and MA–PD contexts) at least once every 2 years until 2034 and periodically thereafter for plan years beginning on or after January 1, 2028.
Who is affected and how:
Medicare beneficiaries: Likely improved access to local, independent, or small chain pharmacies because plans must accept any pharmacy that agrees to contract terms; could reduce travel or delivery delays for some enrollees.
Retail pharmacies (independent, chain, and rural pharmacies): Directly affected—gain stronger rights to join Part D/MA–PD networks and new mechanisms to challenge denials or network exclusion; they may benefit from increased participation but may also face standardized contract terms set by plans and the Secretary.
Pharmacy Benefit Managers (PBMs): Direct targets of new transparency, audit, and financial‑accountability rules; will need to deliver detailed reports, submit to audits, and may lose or be required to pass through some revenue streams—raising compliance, reporting, and possibly operational costs.
Part D plan sponsors and Medicare Advantage organizations offering MA–PD plans: Must permit willing pharmacies (subject to contract terms), implement the Secretary’s standards, respond to pharmacy allegations, and integrate new contract, reporting, and audit requirements into operations—possible administrative and network‑management costs.
Federal agencies (CMS / HHS): Increased administrative workload to develop standards, review PBM and plan submissions, run audits or authorize them, adjudicate allegations, and produce periodic public reports.
Likely downstream effects and tradeoffs:
Patient access improvements are likely where pharmacies previously were excluded from networks, especially in underserved areas.
Plans and PBMs may respond by adjusting network design, reimbursement rates, or other commercial terms; costs of compliance could be passed to plans, potentially affecting premiums or formulary designs.
Increased transparency and enforcement could reduce some practices that limited pharmacy participation, but litigation or administrative disputes are possible as stakeholders adapt to new standards.
Smaller pharmacies may still face practical challenges (e.g., negotiating terms, meeting administrative requirements) even with a statutory right to join networks, so outcomes will depend on how detailed standards and enforcement are applied.