Sponsors (70)
Introduced July 10, 2025 by Buddy Carter · Last progress July 10, 2025
The bill greatly increases transparency, reporting, enforcement, and certain patient access protections—aiming to reduce opaque PBM revenue and lower net drug spending—while imposing substantial reporting burdens, privacy risks, new penalties, and potential market responses that may shift costs or harm smaller market participants.
Plan sponsors, taxpayers, and beneficiaries will get far more transparent PBM and drug-pricing information (rebates, fees, WAC equivalents, contract terms), enabling stronger oversight and potential reductions in net drug spending.
Patients and plan enrollees will be able to request participant-facing summaries and claims-level information so individuals can see how much their plan paid versus the pharmacy and better understand out-of-pocket costs.
Medicare Part D plans and State Medicaid programs will receive a greater share of discounts and face limits on opaque PBM 'spread' or rebate retention, increasing the funds available to plans and potentially lowering program costs.
Medicare beneficiaries, Medicaid enrollees, employees, and taxpayers may face higher premiums or drug costs because PBMs, plans, and sponsors will incur substantial new administrative and compliance costs that are likely to be passed on.
Patients' sensitive health and prescription data could be exposed or re‑identified because frequent, detailed machine-readable, claims-level reporting increases privacy and data‑security risks despite HIPAA-aligned safeguards.
Small and independent pharmacies, small PBMs, and smaller plan sponsors will face disproportionate technical and reporting burdens (and risk heavy penalties), which could force market exits or reduce competition.
Based on analysis of 8 sections of legislative text.
Sets strict new rules for pharmacy benefit managers (PBMs) and transparency across Medicare Part D, Medicaid, and employer group plans: PBMs must disclose detailed, drug-level pricing and payment data, accept any willing pharmacy in Part D, limit spread pricing, pass payments through to dispensing pharmacies in Medicaid, and face civil monetary penalties and enforcement. The bill creates reporting templates, audit and certification requirements for plan sponsors, inspection and survey duties for HHS, multiple appropriations for implementation, and phased implementation dates (mostly 18–30 months or plan years beginning 2028). Creates machine-readable, standardized reports for PBM activity to plan sponsors and federal agencies (with HIPAA protections), requires monthly national pharmacy acquisition-cost surveys, authorizes penalties for noncompliance or false reporting, and funds HHS/CMS, HHS OIG, and MedPAC/GAO studies and enforcement resources to implement and monitor these requirements.