Saving Seniors Money on Prescriptions Act

This bill would require the companies that run Medicare’s drug benefits (pharmacy benefit managers, or PBMs) to share much more information about drug prices and fees. PBMs must give plans—and, if asked, Medicare—a yearly, detailed report and clearly explain how they define key terms and what they leave out of price promises . Plans can audit PBMs at least once a year to verify the data, and PBMs would be responsible for fines if they cause violations.

The reports must also shine a light on steering and savings options. PBMs with their own pharmacy affiliates must show how often those pharmacies fill prescriptions and how the costs compare to other pharmacies. They must flag when a plan favors a brand‑name drug over a generic, or a reference biologic over a biosimilar, and explain why and what patients would pay in each case. These rules cover both stand‑alone Medicare drug plans and Medicare Advantage plans with drug coverage . A federal study would also review overlapping state and federal reporting rules and suggest ways to simplify them.

• Who is affected
  • People with Medicare drug coverage, plus the plans and PBMs that serve them.
• What changes
  • PBMs must submit a detailed annual report to plans (and to Medicare on request) by July 1 each year; the report includes itemized drug lists, what patients paid, rebates from drugmakers, and any PBM revenue kept. Data is kept confidential and can be shared only for oversight .
  • Plans can audit PBMs at least once a year; PBMs must provide records—including from affiliates—and are on the hook for penalties if they break the rules.
• When
  • Applies starting with the 2028 plan year.
  • Standard report formats must be set by June 1, 2025.
  • The federal study is due within two years after enactment.