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New Rules for PBMs: Flat Fees Only, Ending Drug Price Gouging.

This law aims to lower prescription drug costs by fundamentally changing how Pharmacy Benefit Managers (PBMs) are paid. Starting in 2026, PBMs must switch to flat service fees, eliminating incentives to favor expensive drugs or engage in hidden price markups. This change is designed to ensure patients and health plans benefit directly from lower drug prices and have greater freedom in choosing pharmacies.
Key points
Flat Fee Requirement: PBMs must charge only fixed, flat service fees, disconnected from drug prices, rebates, or discounts.
Ban on Spread Pricing: PBMs are prohibited from charging health plans more for a drug than they reimburse the dispensing pharmacy.
Stopping Patient Steering: PBMs cannot steer patients toward pharmacies they own or control, especially if it results in higher out-of-pocket costs for the patient.
Fair Reimbursement for Pharmacies: PBMs must reimburse independent network pharmacies at the same rate they pay their own affiliated pharmacies for the same drug or service.
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Expired
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Additional Information
Print number: 118_S_1542
Sponsor: Sen. Marshall, Roger [R-KS]
Process start date: 2023-05-10
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Summarized by: gemini-2.5-flash-preview-09-2025
Source data: api.congress.gov
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OFFICIAL LEGAL TITLE

DRUG Act

FREQUENTLY ASKED QUESTIONS

What is the official ID of this bill?

The official print number for this legislation is 118_S_1542.

Which chamber initiated this legislation?

This legislation was initiated in the Senate.

When did the legislative process begin?

The process officially started on 2023-05-10.

What are the main provisions?

Key points include:

  • Flat Fee Requirement: PBMs must charge only fixed, flat service fees, disconnected from drug prices, rebates, or discounts.
  • Ban on Spread Pricing: PBMs are prohibited from charging health plans more for a drug than they reimburse the dispensing pharmacy.
  • Stopping Patient Steering: PBMs cannot steer patients toward pharmacies they own or control, especially if it results in higher out-of-pocket costs for the patient.
  • Fair Reimbursement for Pharmacies: PBMs must reimburse independent network pharmacies at the same rate they pay their own affiliated pharmacies for the same drug or service.
What is the specific legal status?

The current status is Expired.

Where can I read the full text of this legislation?

The full official text is available at: View full text

Who is the primary sponsor?

The primary sponsor is Sen. Marshall, Roger [R-KS].

What is the latest detailed status?

The latest detailed status is: Introduced in Senate

Is this summary verified?

Yes. This content was analyzed by AI and verified by the Lustra Judge System on 2025-12-26.

CATEGORIES

Health