Sponsors (15)
The bill increases PBM transparency, regulatory oversight, and whistleblower protections to lower drug costs and curb abusive PBM practices, but it also raises compliance, litigation, and operational costs and could prompt PBM responses that unintentionally reduce patient access or complicate enforcement and competition.
Patients (including Medicare/Medicaid beneficiaries and people with chronic conditions) and other plan enrollees could pay less out‑of‑pocket for prescription drugs because greater PBM transparency and pass‑through rules reduce spreads, fees, and clawbacks.
Retail pharmacies, pharmacists, and hospital pharmacies will face fewer unexpected clawbacks and gain revenue predictability from required pass‑throughs and reporting.
Federal agencies, GAO/MACPAC/CBO, and state enforcers will have stronger, more accurate data and clearer authority to analyze PBM markets, detect anti‑competitive conduct, and make policy recommendations.
PBMs, insurers, pharmacies, and other covered entities will face significant new compliance, reporting, and IT costs that may be passed on to consumers through higher premiums, administrative fees, or drug prices.
Expanded criminal and civil liability (false‑reporting offenses, large per‑day penalties, broader private and state enforcement, and stronger whistleblower remedies) will increase litigation risk and enforcement costs for companies and could raise costs for taxpayers and employers.
PBMs may respond to greater scrutiny and reduced margins by narrowing pharmacy networks, cutting convenience services, or changing formulary management in ways that could reduce patient access—especially for people with chronic conditions and in rural areas.
Based on analysis of 9 sections of legislative text.
Prohibits PBM spread/abusive clawbacks, requires annual PBM disclosures to FTC/HHS, creates FTC enforcement and penalties, and adds whistleblower protections and market analyses.
Introduced February 11, 2025 by Charles Ernest Grassley · Last progress February 11, 2025
Prohibits pharmacy benefit managers (PBMs) from keeping differences between what they charge health plans and what they reimburse pharmacies (so-called "spread"), from arbitrary clawbacks or unexplained retroactive payment reductions, and from raising fees or lowering reimbursements to offset federal reimbursement changes unless all price concessions are fully passed through and disclosed. Requires PBMs to file annual transparency reports with the FTC and HHS, gives the FTC enforcement authority and new civil penalties, creates whistleblower protections and private rights to sue for retaliation, and orders independent analyses of market competition and formulary practices.