Sponsors (15)
The bill increases transparency, enforcement, and whistleblower protections to curb PBM abuses and improve oversight, but it creates significant new compliance, litigation, and penalty risks that could be passed to consumers and complicate operations across states.
Patients, employers, and taxpayers will get clearer drug-pricing information because PBMs must disclose spreads, rebates, and markups, enabling plans to negotiate better prices and potentially lowering premiums and out-of-pocket costs.
Community pharmacies and pharmacists will face fewer unexpected clawbacks and payment reversals, improving cash flow and financial stability for local and hospital pharmacies.
Federal and state enforcement capacity will be strengthened because the FTC is given clear authority, state attorneys general can sue, and the FTC/GAO will study and report on PBM practices, increasing the chance of regulatory fixes.
Middle-class families, taxpayers, and plan sponsors may face higher premiums or out-of-pocket costs because PBMs could raise administrative fees or negotiate higher list prices to offset lost retained margins.
PBMs, insurers, pharmacies, and vendors will incur substantial new compliance and administrative costs (data reporting, de-identification, legal exposure), which are likely to be passed to consumers and burden smaller firms.
Organizations (including nonprofits and insurers) face large civil penalties and expanded federal enforcement exposure (up to high per-violation fines and continuing daily penalties), creating financial risk that could increase consumer costs.
Based on analysis of 9 sections of legislative text.
Stops undisclosed PBM spreads and clawbacks, mandates annual PBM transparency reports, protects whistleblowers, and empowers the FTC with penalties and state enforcement.
Introduced February 11, 2025 by Charles Ernest Grassley · Last progress February 11, 2025
Prohibits pharmacy benefit managers (PBMs) from keeping undisclosed differences between what they charge health plans and what they reimburse pharmacies, from unfairly rescinding or clawing back payments, and from raising fees to offset federal reimbursement changes. Requires annual, detailed transparency reports from PBMs to the Federal Trade Commission and HHS, strengthens whistleblower protections with a federal private right of action, makes violations enforceable by the FTC with sizable civil penalties, allows state enforcement, and requires privacy protections for patient and prescriber data in required disclosures.