Sponsors (2)
The bill strengthens transparency and fiduciary accountability for PBMs to protect plan participants, but risks higher plan costs, greater administrative burdens, and potential short-term disruptions to drug coverage as the market adjusts.
Patients in employer/group health plans (including those with chronic conditions) would face fewer conflicts of interest because PBMs and TPAs would be treated as ERISA fiduciaries required to act in plans' best interests.
Plan sponsors, beneficiaries, state governments, and small businesses would gain clearer disclosure and fiduciary-responsibility rules, improving transparency about PBM arrangements and price concessions.
Hospitals, health systems, and plan beneficiaries would have an easier path to hold PBMs and similar entities financially accountable because removing indemnification protections makes it simpler to recover losses from breaches of duty.
Small-business owners and middle-class families could face higher premiums or reduced benefits because PBMs and TPAs may incur greater litigation and liability costs as fiduciaries.
Patients with chronic conditions and Medicaid beneficiaries may see short-term disruptions in drug access or coverage (for example, formulary changes) if insurers or plan sponsors shift services, raise administrative fees, or terminate PBM contracts in response.
Small-business owners, state governments, and other plan sponsors may face increased paperwork, compliance burdens, and operational costs to implement and enforce fiduciary duties on PBMs and TPAs.
Based on analysis of 2 sections of legislative text.
Treats PBMs and certain third-party administrators as ERISA fiduciaries for specified pharmacy functions and bars indemnification, with a 12-month-plus phase-in for plan years.
Official title: To amend the Employee Retirement Income Security Act of 1974 to ensure that pharmacy benefit managers are considered fiduciaries, and for other purposes.
Introduced December 18, 2025 by Jake Auchincloss · Last progress December 18, 2025
Makes pharmacy benefit managers (PBMs) and certain third-party administrators fiduciaries under ERISA for group health plans when they perform core plan functions like maintaining formularies, negotiating rebates, processing claims, or managing utilization. It also amends ERISA disclosure and responsible-fiduciary rules, prohibits indemnification for these newly designated fiduciaries, and phases the changes in to apply to plan years starting at least 12 months after enactment.