Sponsors (8)
The bill increases pharmacy network access and PBM transparency to lower patient drug costs and protect local pharmacies, but it also raises compliance, administrative, and liability costs for plans, PBMs, and CMS that could translate into higher premiums, narrower benefits, or implementation delays.
Medicare Part D enrollees (seniors and people with chronic conditions) are likely to face lower out-of-pocket drug costs because PBMs are barred from retaining undisclosed remuneration and rebates must be passed through to plan sponsors.
Local and essential pharmacies — including those in rural and urban pharmacy deserts — are more likely to remain in or join Part D networks because plans must allow pharmacies that meet reasonable contract terms to participate, preserving local access to dispensed medications.
Greater transparency and standardized, machine-readable PBM reporting will give PDP sponsors and CMS better oversight to compare pricing, detect abuses, and improve market accountability.
PDP sponsors and Medicare Advantage organizations will face higher costs and potential liabilities from expanded network participation, rebate pass-through oversight, and new certification/penalty regimes, which can lead to higher Part D premiums or reduced plan benefits for enrollees.
PBMs and smaller plans face increased administrative burdens and compliance costs; PBMs may shift these costs to plan sponsors or limit services, which can raise premiums or narrow benefits for enrollees.
Requiring plans to accept any pharmacy that meets 'reasonable' terms risks that lower-quality or noncompliant pharmacies could gain network access if standards are weak or slow to be issued, potentially harming patient safety and dispensing quality.
Based on analysis of 3 sections of legislative text.
Requires Part D and MA–PD plans to accept any pharmacy meeting reasonable contract terms and imposes PBM transparency and remuneration limits, with HHS rulemaking and reporting; effective 2028.
Official title: Amend title XVIII of the Social Security Act to assure pharmacy access and choice for beneficiaries under prescription drug plans and MA-PD plans and to establish requirements of pharmacy benefit managers under Medicare part D.
Introduced March 6, 2025 by Marsha Blackburn · Last progress March 6, 2025
Requires Medicare Part D plans and MA–PD plans to allow any pharmacy that accepts plan standard contract terms to join networks beginning in plan years starting Jan 1, 2028, subject to HHS-established "reasonableness and relevance" standards. Imposes detailed limits and transparency requirements on pharmacy benefit managers (PBMs) serving Part D and MA–PD plans, including prohibition on non-service remuneration (with narrow exceptions), machine-readable disclosures and annual reporting, contractual and audit rules, and regular HHS reporting on payments and participation by designated "essential retail pharmacies." The bill sets deadlines for HHS rulemaking and reporting beginning with an RFI in April 2026 and standards by April 2027.