Sponsors (4)
Official title: To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1984 to increase oversight of pharmacy benefit management services, and for other purposes.
Introduced March 27, 2025 by Kristen McDonald Rivet · Last progress March 27, 2025
The bill substantially increases PBM and drug‑price transparency and regulatory oversight—giving consumers, employers, and regulators better tools to reduce drug spending—at the cost of significant compliance burdens, privacy risks, and uneven impacts that may fall hardest on small providers and plan sponsors.
Patients and health‑plan enrollees nationwide gain far greater drug‑price transparency — PBMs and plans must disclose rebates, net prices, spread pricing, and regular drug‑level reports so plans can identify overpayments and redesign benefits to lower net costs and patient out‑of‑pocket spending.
Individual participants (especially people with chronic conditions) can obtain standardized, machine‑readable participant summaries and request claims‑level information about their own prescriptions, enabling them to verify charges and understand cost‑sharing.
Plan sponsors, large employers, and regulators receive standardized, machine‑readable summaries and datasets (estimated net prices, fee structures, NDC‑level reports) that improve contract oversight, bargaining power, and benefit design, helping sponsors negotiate better PBM contracts.
Plans, PBMs, and insurers face substantial new administrative and compliance costs to collect, process, and report frequent drug‑ and claim‑level data, which could raise premiums and administrative expenses for employers, employees, and taxpayers.
Extensive claims‑ and drug‑level reporting increases privacy and re‑identification risks for participants, requiring costly safeguards and creating potential exposure of sensitive health information.
Smaller PBMs, independent pharmacies, small employers, and less‑resourced plan sponsors will face disproportionate burdens and competitive pressure—risking consolidation, reduced competition, and that the practical benefits of the data accrue mainly to large, well‑resourced entities.
Based on analysis of 4 sections of legislative text.
Imposes federal PBM oversight and requires machine‑readable, drug‑level reporting by PBMs, plans, and issuers and bans contract clauses that block disclosure, effective 30 months after enactment.
Creates a new federal regulatory framework requiring pharmacy benefit managers (PBMs), group health plans, and group health insurance issuers to disclose detailed, drug‑level pricing, payment, and utilization data to plan sponsors and to federal regulators. It bans PBM contractual practices that limit transparency, extends federal nondiscrimination protections to covered health programs, and gives HHS authority to issue rules and enforce compliance. Most disclosure and contract restrictions take effect for plan years beginning 30 months after enactment.