Sponsors (4)
Introduced March 27, 2025 by Kristen McDonald Rivet · Last progress March 27, 2025
The bill substantially increases PBM and drug‑level price transparency and regulatory oversight — likely helping patients and employers pay less for drugs — but does so at the cost of significant compliance burdens, privacy risks, and potential market disruption that may disproportionately burden smaller actors.
Millions of patients and plan enrollees gain much greater visibility into PBM pricing and drug-level net prices (rebates, spread, net price per NDC), enabling detection of overpayments and more informed contracting.
Patients (including those with chronic conditions and Medicaid/Medicare beneficiaries) could see lower out‑of‑pocket costs because plans can redesign benefits and negotiate based on true net drug spending.
Large employers, plan sponsors, and taxpayers receive standardized, machine‑readable summaries and aggregate reports that improve their ability to evaluate PBM contracts and negotiate lower costs or better benefit design.
Plans, PBMs, and insurers face substantial new compliance, reporting, and administrative costs to produce frequent, detailed, machine‑readable drug‑ and claims‑level data — costs that are likely to be passed on to consumers through higher premiums or reduced benefits.
Extensive claims‑level and drug‑level reporting increases privacy and reidentification risk for participants unless costly safeguards are implemented and maintained.
Smaller PBMs, independent pharmacies, and affiliated pharmacies may face competitive pressure or contractual disruption from licensure, reporting burdens, and disclosure requirements, which risks market consolidation and reduced competition.
Based on analysis of 4 sections of legislative text.
Requires PBMs, group plans, and issuers to disclose detailed drug-level pricing, payments, rebates, and contract information to plans and the federal government and bans contract terms that block those disclosures.
Requires pharmacy benefit managers (PBMs), group health plans, and group health insurance issuers to disclose detailed, drug-level pricing, payment, rebate, contract, and utilization data to plan sponsors and to the federal government, and sets federal oversight, nondiscrimination, licensure/registration, and enforcement rules for PBMs. Contracts entered or renewed on or after the effective date cannot block the flow of information needed for these reports; many disclosures must be machine-readable and produced at least semiannually (or quarterly if requested). Extends federal nondiscrimination protections to covered health programs and authorizes the Department of Health and Human Services to write rules and enforce compliance; similar reporting obligations are also added to the Internal Revenue Code. Most new requirements take effect for plan years beginning 30 months after enactment.