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Pharmacy Benefit Manager Reform and Price Transparency Act

This bill reforms Pharmacy Benefit Manager (PBM) operations within Medicare, Medicaid, and group health plans. It ensures beneficiary access to pharmacies, mandates transparency regarding drug costs and rebates, and alters the compensation model for intermediaries to flat fees.
Key points
Bans 'spread pricing' in Medicaid, requiring a transparent pass-through pricing model instead.
Requires PBMs to disclose full data on drug costs, rebates, and fees to plan sponsors.
Ensures Medicare beneficiaries have access to 'any willing pharmacy' that meets contract terms and monitors access in rural areas.
Mandates that PBM fees be 'bona fide service fees' set as flat dollar amounts rather than percentages of drug prices.
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Status: Introduced
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Additional Information
Print number: 119_HR_4317
Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1]
Process start date: 2025-07-10
System Note: Lustra is free, publicly auditable civic infrastructure — full source code available on GitHub. You are reading sterilized legislative data, processed by our radical neutrality engine to strip political spin and retain factual mechanics. We process only official government data. Original documents remain the authoritative source—always verify them if you can.
Summarized by: gemini-3-pro-preview
Source data: api.congress.gov
AI work logs for this document launch

OFFICIAL LEGAL TITLE

PBM Reform Act of 2025

FREQUENTLY ASKED QUESTIONS

What is the official ID of this bill?

The official print number for this legislation is 119_HR_4317.

Which chamber initiated this legislation?

This legislation was initiated in the House of Representatives.

When did the legislative process begin?

The process officially started on 2025-07-10.

What are the main provisions?

Key points include:

  • Bans 'spread pricing' in Medicaid, requiring a transparent pass-through pricing model instead.
  • Requires PBMs to disclose full data on drug costs, rebates, and fees to plan sponsors.
  • Ensures Medicare beneficiaries have access to 'any willing pharmacy' that meets contract terms and monitors access in rural areas.
  • Mandates that PBM fees be 'bona fide service fees' set as flat dollar amounts rather than percentages of drug prices.
What is the specific legal status?

The current status is Introduced.

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 Rep. Carter, Earl L. "Buddy" [R-GA-1].

What is the latest detailed status?

The latest detailed status is: Introduced in House

Is this summary verified?

Yes. This content was analyzed by AI and verified by the Lustra Judge System on 2026-01-19.

What is the impact of this bill?

We don't know—that is up to you to decide. Summarizing raw data with AI is fundamentally different from predicting socio-economic outcomes. As of 2026, we believe impact assessment strictly requires a human in the loop to verify and judge.

CATEGORIES

Health Economy