YourVoice.Now Summary
Transparency & AccountabilityCorporate BenefitsCivil LibertiesDrug middlemen would have to show your plan what they really paid pharmacies — and you could ask for your own numbers.
Transparency & Accountability
You could ask your plan for the difference between what it paid the drug middleman and what that middleman paid your pharmacy for your prescription. You could also request a plain summary of drug costs under the plan.
Firms that manage drug benefits would report drug-by-drug spending to plans with at least 100 members. A plan could ask for reports every three months instead, at the same cost.
Plans would learn what brokers, consultants, and advisors were paid for referring the plan's business to a drug benefit firm. The report names who got the money.
The penalty is $10,000 for each day a required report is late or withheld. Knowingly false information costs up to $100,000 for each false item.
Firms may place reasonable limits on sharing the reports publicly. They cannot block the reports from federal agencies, or from participants who ask for their own claim details.
Corporate Benefits
Health plans run by drug makers, wholesalers, or others in the drug supply chain would file a shorter report. The stated reason is to keep rivals from seeing each other's data.
For each drug, the report shows what the plan paid the middleman and what the pharmacy actually received. Today that gap is often invisible to the employer paying the bill.
If the firm owns pharmacies, it must report what share of prescriptions go there. It must also compare its own prices to other pharmacies in the same network.
Civil Liberties
The reports must follow federal health privacy rules and may carry only summary health information. Your plan would also have to tell you each year that these reports are being made.
More about this bill
Ask your health plan what it paid for your prescription, and it would have to tell you. You could see the price your plan paid the drug middleman, and the smaller price that middleman paid your pharmacy. The gap between those two numbers is money you never see today. Plans would also hand you a plain summary of drug costs, if you ask. Companies that manage drug benefits are called pharmacy benefit managers. Every six months, they would send a detailed drug spending report to plans with at least 100 members. It would list what the plan paid, what the pharmacy got, and what rebates drugmakers sent back. For any drug the plan spent more than $10,000 on, the report would explain why that drug is covered. Smaller plans would get a shorter summary. Many of these companies own pharmacies. The report would show how many of your plan's prescriptions go to those pharmacies. It would compare their prices to other pharmacies in the network. Plans would also learn what brokers were paid to steer their business. Prices are not capped here. What you pay at the counter would not change on its own. Firms that hide the data would owe $10,000 a day. False data would cost up to $100,000 per item. The reports would begin for plan years starting 30 months after passage.
Congressional Summary
Prescription Drug Transparency and Affordability ActThis bill requires pharmacy benefit managers (PBMs) to report, at least once every six months, prescription drug pricing, payment, and utilization data to the health insurance plans for which the PBM provides services.Specifically, a PBM contracted to provide services to an employer or sponsor offering a large group health insurance plan (i.e., a plan with at least 100 employees or participants) must report to the plan certain information for prescription drug claims under the plan. This includes, for each drug, the difference between the compensation paid by the plan to the PBM and the compensation paid by the PBM to the pharmacy.Further, for each therapeutic class of drugs under the plan, a PBM must report (1) the total amount it received in rebates, fees, and discounts; and (2) the net spending for each class after such rebates, fees, and discounts.Each PBM also must report certain information about (1) drugs for which total spending exceeded $10,000; and (2) drugs dispensed through pharmacies affiliated with the plan or PBM, such as the percentage of prescriptions dispensed by such affiliates.Finally, a PBM providing services to any group health insurance plan must provide the plan with a summary document that includes similar information for prescription drug claims under the plan, as determined by the Department of Health and Human Services. Plans must also make certain aggregate summary information available to plan participants.PBMs and plans that violate these requirements are subject to civil penalties.
Details
- Congress
- 119th
- Chamber
- House
- Status
- summarized
- Action
- Introduced in House
- Action Date
- 2025-03-27
- Date Added
- 2026-08-26
- Source
- Congress.gov →
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