Sponsors (3)
The bill increases transparency and oversight of PBMs—helping Medicare beneficiaries, plan sponsors, and regulators understand drug pricing and conflicts—at the cost of added compliance burdens, potential competitive strain on smaller PBMs, and some risk to proprietary plan information.
Medicare Part D enrollees, PDP sponsors, and regulators will receive standardized, machine-readable PBM data (including gross/net drug spending and amounts retained), improving pricing transparency and enabling better assessment of drug prices, rebates, and plan performance.
PDP sponsors and health systems will be able to audit PBMs and obtain affiliate records, strengthening oversight and helping sponsors verify pricing guarantees, payments, and contractual performance.
Medicare enrollees will gain clearer visibility into conflicts of interest because PBMs must disclose affiliates, brokers, and incentive-linked benefit design that could influence where enrollees fill prescriptions.
PBMs, PDP sponsors, and ultimately taxpayers and plans will incur increased administrative and compliance costs to collect, standardize, certify, and submit detailed machine-readable data, which could raise plan costs or premiums.
Smaller PBMs and affiliated pharmacies may face disproportionately high compliance burdens and costs, risking market consolidation or reduced competition that could increase prices or reduce consumer choice.
Requiring sponsors to rely on PBM-provided data and certifications could shift liability and administrative burdens onto sponsors if PBMs fail to comply, complicating enforcement and beneficiary recourse.
Based on analysis of 2 sections of legislative text.
Requires PBMs for Medicare Part D and MA‑PD plans to adopt written transparency agreements and deliver annual machine‑readable reports to sponsors (and CMS on request) starting with 2028 plan years.
Introduced February 4, 2025 by Greg Landsman · Last progress February 4, 2025
Requires pharmacy benefit managers (PBMs) that serve Medicare prescription drug plans (Part D/PDP) and Medicare Advantage prescription drug plans (MA–PD) to enter written agreements imposing transparency and reporting duties and to provide annual machine‑readable reports to plan sponsors (and to the Secretary on request). The new requirements take effect for plan years beginning on or after January 1, 2028 and include rules for defining pricing terms, identifying excluded drugs/claims/concessions, converting benchmarks to a WAC equivalent, and delivering specified prior‑plan‑year data by July 1 each year.