Sponsors (15)
Introduced February 11, 2025 by Charles Ernest Grassley · Last progress February 11, 2025
The bill increases PBM transparency, regulatory enforcement, and whistleblower protections to curb abusive PBM practices and help pharmacies and patients, but it also raises compliance, enforcement, and litigation costs and creates regulatory and privacy uncertainties that could be passed on to consumers and complicate operations for businesses and government programs.
Patients, plan sponsors, pharmacies, and taxpayers would gain much greater PBM price-and-fee transparency (disclosure of costs, markups, rebates and per-drug/per-PBM data), making it easier for plans, regulators, and pharmacies to detect unfair practices and explain price gaps.
Consumers and patients would get stronger enforcement tools because the FTC (and state attorneys general) can pursue unlawful PBM practices with civil penalties and injunctive relief, increasing deterrence of harmful conduct.
Independent pharmacies and pharmacists (and hospital pharmacies) would face fewer surprise clawbacks and have better access to data exposing fees and DIR charges, improving cash flow, financial predictability, and ability to seek enforcement or remedies.
Employers, plans, and consumers could bear higher costs because PBMs and pharmacies will incur significant new compliance, reporting, and administrative expenses that are likely to be passed on as higher premiums, administrative fees, or drug prices.
PBMs may respond to limits on retained spread by raising administrative fees or negotiating higher prices with manufacturers, which could offset intended savings and raise costs for plans and beneficiaries.
The bill substantially raises litigation and enforcement risk for firms (larger civil fines, private suits, state interventions, and barred arbitration), increasing legal costs, duplicative enforcement exposure, and the chance of defensive or disruptive litigation against providers and insurers.
Based on analysis of 9 sections of legislative text.
Prohibits certain pharmacy benefit manager (PBM) practices that hide or retain money between what health plans pay and what pharmacies receive, bans arbitrary clawbacks or fee increases tied to federal policy changes, and creates civil and criminal rules against false reporting to federal agencies. Requires yearly, aggregated PBM transparency reports to the FTC and HHS, mandates FTC and GAO studies and reports about PBM markets and formularies, strengthens whistleblower protections with a private right of action, and makes the FTC the primary federal enforcer with additional civil penalties. The law also requires PBMs to protect patient/provider identifying data and preserves state law authority.