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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.
article Official text account_balance Process page
Introduced
Citizen Poll
No votes cast
Additional Information
Print number: 119_HR_4317
Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1]
Process start date: 2025-07-10
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Summarized by: gemini-3-pro-preview
Source data: api.congress.gov
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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.

CATEGORIES

Health Economy