Sponsors (41)
Introduced December 11, 2025 by Jake Auchincloss · Last progress December 11, 2025
The bill aims to lower patients' point-of-sale drug costs and increase PBM/pharmacy transparency and protections, but it creates reporting and compliance burdens and risks cost-shifting or market responses that could raise premiums or disrupt competition.
Medicare Part D enrollees (especially people with chronic conditions) will pay lower out-of-pocket costs at the pharmacy because manufacturer rebates must be applied to reduce coinsurance/copays at the point of sale.
Patients gain clearer pricing and better access to lower-cost options because gag clauses and steering are prohibited and PBMs must disclose rebates and key financial information.
In‑network and community pharmacies receive more predictable and generally higher reimbursements (ingredient cost tied to NADAC/WAC plus an add-on, dispensing fees aligned with State Medicaid), and retail reimbursements are protected from being set by atypical non‑retail acquisition prices.
PBMs, insurers, or plan sponsors may pass compliance and program changes onto beneficiaries by raising Part D premiums or narrowing plan offerings, increasing costs for Medicare enrollees and taxpayers.
Drug manufacturers and PBMs may respond by changing rebate structures or raising list prices, shifting costs elsewhere in the supply chain and possibly raising overall drug spending for patients and public programs.
Pharmacies—especially small and independent ones—face new administrative burdens and compliance costs to collect and report net acquisition prices and concessions; states also face added administrative work to update managed care contracts and implement reporting regimes.
Based on analysis of 3 sections of legislative text.
Imposes PBM transparency, payment, reporting, and conduct limits in Medicare Part D and requires pharmacies to report net acquisition prices for Medicaid drug reimbursement policy.
Requires pharmacy benefit managers (PBMs) in Medicare Part D to follow new transparency, payment, reporting, and conduct rules and gives the Department of Health and Human Services tools to enforce penalties and contract terminations. It sets minimum pharmacy payment formulas for in‑network pharmacies, requires rebate pass‑through and reporting, bans certain PBM practices (like spread pricing, steering, gag clauses, forced acquisitions, and discriminatory reimbursements), and phases in compliance tied to plan years. Requires pharmacies that dispense covered outpatient drugs to Medicaid enrollees to report their net acquisition prices (or negotiated prices if net prices aren’t available) in response to state surveys; directs HHS to publish national acquisition price data and survey response rates and bars states from using non‑retail pharmacy pricing to set retail pharmacy reimbursement rates.