Sponsors (4)
The bill substantially increases PBM and drug-price transparency—giving plans, participants, and regulators better data to negotiate costs and expose conflicts—but it also creates significant compliance costs, privacy risks, enforcement incentives to restrict data, and uneven disclosure that could blunt intended savings and public analysis.
Plan sponsors, employers, and participants (including middle-class families and patients with chronic conditions) will receive regular, standardized, machine-readable PBM and claims-level reports (net price, rebates, fees, cost-per-claim) enabling better plan selection, negotiation, and potential reductions in drug spending.
Patients and plan participants (including those with chronic conditions) will be able to obtain participant-facing summaries and request claim-level contracted payment differences for their own claims, giving clearer out-of-pocket cost information and helping individuals make more informed medication choices.
Federal and state regulators (and plan auditors) will gain standardized reporting formats and centralized HHS rulemaking, improving oversight, enforcement consistency, and the ability to compare plan and PBM behavior across markets.
PBMs, health plans, and employers (with costs ultimately borne by workers and beneficiaries) will face substantial compliance costs to collect, process, and produce frequent, claims-level machine-readable reports, likely increasing administrative expenses and potentially raising premiums or out-of-pocket costs.
Patients and plan participants (including people with disabilities and those with sensitive conditions) face privacy risks because detailed claims- and drug-level reporting and broad data-sharing obligations could expose sensitive health information if de-identification or summary safeguards fail.
Plan administrators, PBMs, and other entities will face high civil penalties (e.g., up to $10,000/day and large per-item fines), which could incentivize overly cautious data withholding, extensive redaction, slow compliance, or costly litigation that undermines transparency goals.
Based on analysis of 4 sections of legislative text.
Introduced March 27, 2025 by Kristen McDonald Rivet · Last progress March 27, 2025
Requires pharmacy benefit managers (PBMs) and related entities that serve group health plans to deliver standardized, machine‑readable, plain‑language reports about drug claims, payments, rebates, formularies, affiliated‑pharmacy activity, and other compensation. Reports must be provided to plans at least every six months (quarterly if requested) and participants can get summary information and claim‑level difference information for their own claims. The bill imposes privacy limits to comply with HIPAA/HITECH, sets civil monetary penalties for failures and false statements, and directs federal agencies to adopt standard reporting formats and implementing rules within set deadlines. Applies across three federal statutes (group health insurance statutes, ERISA, and the Internal Revenue Code) so the reporting and disclosure rules bind group health plans, issuers, PBMs, and certain plan sponsors for plan years beginning 30 months after enactment; the Secretary must issue detailed regulations and a standard report format within 18 months. The law also creates definitions, requires periodic re‑review of the term “remuneration,” and provides limited exceptions to avoid anti‑competitive disclosures for plans affiliated with drug supply‑chain participants.