To prevent unfair and deceptive acts or practices and the dissemination of false information related to pharmacy benefit management services for prescription drugs, and for other purposes.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
Prohibits pharmacy benefit managers from spread pricing (charging plans more than reimbursing pharmacies) and arbitrary clawbacks of pharmacy payments. Increases prescription drug pricing transparency.
Who Benefits and How
Pharmacies protected from unfair PBM practices. Health plans know true drug costs. Consumers benefit from transparent pricing.
Who Bears the Burden and How
PBMs lose spread pricing revenue. PBM business model disrupted. Compliance requirements increased.
Key Provisions
- Bans spread pricing by PBMs
- Prohibits arbitrary clawbacks of pharmacy reimbursements
- Prevents fee increases to offset federal program changes
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Prohibits unfair PBM practices including spread pricing and clawbacks
Who Benefits
- Pharmacies
- Health plans
- Consumers
Who Bears Costs
- PBMs
- PBM business model
Key Policy Areas
Healthcare, Pharmacy, PBM Regulation
Primary Purpose
Prohibits unfair PBM practices including spread pricing and clawbacks
Policy Domains
Legislative Strategy
"Eliminate unfair PBM practices through prohibition"
Sponsors
Legislative Progress
ReportedReported by Ms. Cantwell, with an amendment
Ms. Cantwell (for herself, Mr. Grassley, Mrs. Hyde-Smith, Mr. Braun, …
Ms. Cantwell (for herself, Mr. Grassley, Mrs. Hyde-Smith, Mr. Braun, …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Pharmacy Benefit Managers, Pharmacy Benefit Managers (CVS Caremark, Express Scripts, OptumRx)
Independent pharmacies, PBM and health plan employees (whistleblowers)
State Attorneys General, States with PBM regulations
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology