Sponsors (71)
Introduced July 10, 2025 by Buddy Carter · Last progress July 10, 2025
The bill increases transparency, tightens PBM practices, and strengthens protections for pharmacies and government oversight—measures that could reduce hidden drug spending and preserve local pharmacy access—but it also imposes major reporting and compliance burdens, privacy risks, and market pressures that may raise administrative costs, prompt consolidation, or lead to cost‑shifting that limits near‑term savings for patients and taxpayers.
Millions of Medicare Part D enrollees, Medicaid recipients, and private plan participants gain far greater drug-price transparency (point-of-sale prices, negotiated reimbursements, rebates, and net/gross spending), enabling better price comparison and potentially reducing unexpected out-of-pocket costs.
Limits on PBM spread-pricing, required rebate pass-throughs, and caps/ties of administrative fees to fair‑market value reduce opaque PBM revenue streams and could lower program and plan drug spending, producing savings for taxpayers and plan enrollees over time.
Independent, rural, and other essential pharmacies get stronger payment protections (minimum reimbursement and dispensing fees) and network‑inclusion safeguards, helping preserve local pharmacy access for underserved communities.
Health plans, PBMs, pharmacies, and employers face substantial new compliance, reporting, and IT costs (machine‑readable, frequent reports and audits) that are likely to be passed through as higher premiums, administrative fees, or narrower plan offerings for beneficiaries and employers.
Smaller PBMs, independent pharmacies, and smaller plans may be unable to meet technical and reporting demands, creating pressure toward market consolidation and reduced vendor or pharmacy choices for consumers.
Detailed, claims‑level reporting increases risks to patient privacy and data security (even with HIPAA references), creating potential harms for patients if safeguards fail or if data are mishandled.
Based on analysis of 8 sections of legislative text.
Requires PBMs to use transparent pass‑through pricing, bans spread pricing and certain steering, and mandates detailed NDC‑level reporting across Medicare Part D, Medicaid, and group plans.
Requires pharmacy benefit managers (PBMs) to operate with far greater price and contract transparency across Medicare Part D, Medicaid, and group health plans, bans common spread-pricing and certain steering or retaliation practices, and forces pass-through drug payments to pharmacies with limited, fair‑market‑value administrative fees. It mandates detailed, machine‑readable, NDC‑level reporting to HHS and plan sponsors, creates new HHS enforcement authority (including civil penalties), and sets staggered effective dates for different programs (including 18 and 30 month rules and Part D plan‑year start dates in 2028–2029).