PBM Price Transparency and Accountability Act
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
This bill expands PBM and pharmacy price-transparency rules in Medicaid and Medicare by requiring broader drug-acquisition-cost surveys, pharmacy participation and public reporting, civil penalties, and any-willing-pharmacy and contract-standard rules in Medicare Part D.
Who Benefits and How
Retail and non-retail pharmacies and their patients could gain more transparent reimbursement benchmarks, less abusive spread pricing, stronger any-willing-pharmacy protections, and clearer standards for Part D contracting.
Who Bears the Burden and How
PBMs, PDP sponsors, pharmacies, and HHS would face new survey participation, reporting, public-disclosure, penalty, contracting, and rulemaking requirements.
Key Provisions
- Requires Medicaid drug-acquisition-cost surveys to include non-retail pharmacies, public reporting, and civil penalties for noncompliance.
- Requires states to compel pharmacy participation in the surveys and publish monthly response and pricing information.
- Requires Medicare Part D sponsors to admit any willing pharmacy meeting plan terms and directs HHS to define reasonable and relevant contract standards after a request for information.
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
This bill expands PBM and pharmacy price-transparency rules in Medicaid and Medicare by requiring broader drug-acquisition-cost surveys, pharmacy participation and public reporting, civil penalties, and any-willing-pharmacy and contract-standard rules in Medicare Part D.
Key Policy Areas
Healthcare, Government Administration, Consumer Protection
Primary Purpose
This bill expands PBM and pharmacy price-transparency rules in Medicaid and Medicare by requiring broader drug-acquisition-cost surveys, pharmacy participation and public reporting, civil penalties, and any-willing-pharmacy and contract-standard rules in Medicare Part D.
Policy Domains
Main Provisions
Identified Gains
Contextual inference, no direct clause citation- Pharmacies and patients benefiting from more transparent PBM pricing and broader network access
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- PBMs, PDP sponsors, pharmacies, and HHS officials subject to new survey, contracting, and enforcement rules
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
In CommitteeMr. Crapo (for himself, Mr. Wyden, Mr. Grassley, Mr. Bennet, …
Read twice and referred to the Committee on Finance.
Introduced in Senate
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Network and out-of-network pharmacies seeking fairer access and more reasonable contract terms in Medicare Part D, PDP sponsors and PBM-linked Part D plan networks subject to any-willing-pharmacy access and contract-standard rules, Pharmacy benefit managers and pharmacies subject to new survey participation, pricing disclosure, and penalty rules in Medicaid
Positive-direction: Network and out-of-network pharmacies seeking fairer access and more reasonable contract terms in Medicare Part D, Retail and non-retail pharmacies that may benefit from more accurate acquisition-cost benchmarks and reduced spread pricing
Negative-direction: PDP sponsors and PBM-linked Part D plan networks subject to any-willing-pharmacy access and contract-standard rules, Pharmacy benefit managers and pharmacies subject to new survey participation, pricing disclosure, and penalty rules in Medicaid
HHS officials responsible for surveys, public reporting, and civil-money-penalty enforcement
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
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