Sponsors (41)
Official title: To amend titles XI, XVIII, and XIX of the Social Security Act to establish certain requirements under Medicare and Medicaid with respect to prescription drug benefits and pharmacy benefit managers.
Introduced December 11, 2025 by Jake Auchincloss · Last progress December 11, 2025
The bill increases pricing transparency, applies rebates at point-of-sale, raises and stabilizes pharmacy reimbursements, and strengthens PBM enforcement — likely lowering out-of-pocket costs for many Medicare beneficiaries and protecting some pharmacies — but it also creates new reporting and compliance costs, confidentiality and market-response risks, and could shift costs onto premiums or reduce competition.
Medicare Part D enrollees (especially people with chronic conditions) will likely pay less at the pharmacy counter because manufacturer rebates must be applied to reduce coinsurance/copays at point of sale.
Patients and policymakers gain greater transparency and access to lower-cost options because gag clauses/steering are banned and PBMs must disclose rebate and pricing information, making it easier to detect abusive practices and compare costs.
In-network and community pharmacies (including hospitals and small independents) get more predictable and often higher reimbursements due to payment floors tied to NADAC/WAC plus an add-on and dispensing fees set to State Medicaid rates, and the law bars using non‑retail pricing to set retail rates.
PBMs and plan sponsors could pass compliance and operational costs onto beneficiaries by raising Part D premiums or narrowing plan offerings, increasing out-of-pocket costs for Medicare enrollees.
Drug manufacturers and PBMs may respond by changing rebate structures or list prices, which could shift costs elsewhere in the supply chain and blunt the intended savings for patients and state programs.
New reporting and transparency requirements impose significant administrative burdens and costs on pharmacies (especially small/independent ones), raise commercial confidentiality and competitive concerns, risk reputational harm from public noncompliance listings, and could be misinterpreted by states or the public.
Based on analysis of 3 sections of legislative text.
Imposes PBM transparency, anti-steering, rebate pass-through, pharmacy payment floors for Medicare Part D and requires Medicaid pharmacy acquisition-price surveys with public reporting.
Requires new rules and reporting for pharmacy benefit managers (PBMs) and pharmacies in Medicare Part D and Medicaid. For Medicare Part D, PBMs must follow transparency, anti-steering, rebate pass-through, audit, recordkeeping, pharmacy-payment, and fiduciary rules with civil penalties and contract-termination remedies; many Part D provisions phase in for plan years beginning January 1, 2027. For Medicaid, pharmacies must respond to monthly acquisition-price surveys and report net acquisition prices; the Secretary will publish national acquisition-price data and states may not use non-retail pricing to set retail reimbursement.