Sponsors (71)
Official title: To assure pharmacy access and choice for Medicare beneficiaries, and for other purposes.
Introduced July 10, 2025 by Buddy Carter · Last progress July 10, 2025
The bill increases transparency, oversight, and protections for beneficiaries and pharmacies—aiming to reduce hidden PBM profits and lower drug spending—but does so through broad new reporting and compliance requirements that could raise administrative costs, risk consolidation, and shift costs unless enforcement and privacy safeguards are effective.
Medicare Part D enrollees and other plan participants gain clearer, at-the-point-of-sale price transparency (negotiated price, adjustments, and expected out-of-pocket), helping patients avoid surprise costs and compare lower-cost options.
Independent, rural, and underserved local pharmacies are better protected and monitored (minimum reimbursements/dispensing fees, anti-discrimination, 'essential pharmacy' identification), which can preserve local access to pharmacy services and stabilize pharmacy revenues.
Federal oversight, enforcement, and funding increase (HHS/OIG authority, civil monetary penalties, audits, GAO/MedPAC/IG studies and $188M CMS implementation funding), strengthening the government's ability to detect, deter, and remediate improper PBM/plan practices.
PBMs, plan sponsors, health plans, and pharmacies face extensive new reporting, auditing, and compliance requirements that will impose administrative and IT costs likely to be passed to beneficiaries, employers, or taxpayers via higher premiums or fees.
Smaller PBMs, independent pharmacies, and small plans may struggle with technical and financial compliance burdens, risking market consolidation, reduced vendor options, or closures that could harm competition and local access.
Detailed, claims-level and machine-readable reporting increases risks of privacy breaches or inadvertent exposure of sensitive health information unless robust safeguards and enforcement are maintained.
Based on analysis of 8 sections of legislative text.
Imposes nationwide PBM transparency and anti‑spread‑pricing rules, requires passthrough pricing to pharmacies, and mandates detailed drug‑level reporting across Medicare, Medicaid, and group plans.
Creates comprehensive federal rules to regulate pharmacy benefit managers (PBMs) across Medicare Part D, Medicaid, and group health plans. The law bans spread pricing and certain steering/retaliation practices, requires detailed price and contract transparency, sets reimbursement and dispensing‑fee standards, authorizes HHS enforcement and penalties, and phases in reporting and contract requirements over 18–30 months with some Part D rules effective for plan years beginning 2028–2029. The bill forces PBMs and payers to pass through drug payments to pharmacies (subject to narrow administrative fees), deliver machine‑readable plain‑language reports on drug prices and payments, requires HHS to publish national acquisition benchmarks for Medicaid, and expands HHS rulemaking and enforcement authority to ensure compliance across federal programs and private group plans.