Strikes existing subparagraph (A) and inserts a new subparagraph (A) that (1) requires PDP sponsors to permit any pharmacy meeting standard contract terms to participate as a network pharmacy, and (2) directs the Secretary to establish standards for 'reasonable and relevant' contract terms (with accompanying deadlines and processes).

Adds new subsections defining and addressing 'essential retail pharmacies' (reporting, definitions, publication of lists) and adds a biennial report on enforcement and oversight of pharmacy access requirements.

Adds a new subsection (h) establishing requirements relating to pharmacy benefit managers (PBMs) for plan years beginning on or after January 1, 2028, covering written agreements, prohibition on non–bona fide service income (with exceptions), transparency, reporting, audit rights, disgorgement, and other PBM obligations. Also adds paragraph (9) to 1860D–12(b) holding PBMs accountable for reimbursing PDP sponsors for amounts the sponsor must pay to the Secretary for certain violations.

Makes conforming amendments to section 1857(f)(3) to add references to the new PBM-related requirements and modifies 1857(g)(1) by inserting an additional subparagraph (K) (and redesignating others) to include failure to comply with the new standards for reasonable and relevant contract terms as a basis for sanctions.

Amends section 1927 of the Social Security Act to (a) require HHS to conduct monthly surveys of retail community and applicable non‑retail pharmacy drug prices to determine national average drug acquisition cost benchmarks and to publish survey information; (b) require vendors to provide monthly updates and to differentiate pharmacy types; (c) require States to mandate pharmacy response to surveys; (d) establish public reporting of survey results and sampling methodology; (e) authorize civil money penalties (up to $100,000 per violation) for pharmacies that refuse or fail to respond or provide false information; (f) add an OIG oversight paragraph including an appropriation of $5,000,000 for FY2026 for studies and periodic reports to Congress; and (g) add new definitions for "applicable non‑retail pharmacy," "affiliate," and "pharmacy benefit manager," and add requirements for transparent prescription drug pass‑through pricing in contracts involving PBMs and specified entities. See the amended text for the full list of additions and requirements.

Makes conforming amendments to section 1903(m) (42 U.S.C. 1396b(m)) to reflect the new contract and pricing requirements: adjusts paragraph (2)(A)(xiii) language as described and adds a new paragraph (10) providing that no Federal payment shall be made to a State with respect to expenditures for services provided by an "other specified entity" unless the services are provided under a contract that satisfies the requirements added to paragraph (2)(A)(xiii).