Legislation Search

H.R. 4317: Pharmacy Benefit Manager Reform Act of 2025

The "Pharmacy Benefit Manager Reform Act of 2025" seeks to enhance access and choices for Medicare beneficiaries by allowing all willing pharmacies to take part in prescription drug plans. The legislation sets forth a series of regulations and requirements for pharmacy benefit managers (PBMs), which are entities that manage prescription drug benefits on behalf of health insurers.

Key Provisions of the Bill

Participation of Pharmacies: The bill ensures that any pharmacy that wishes to participate in prescription drug plans can do so, aimed at increasing accessibility for beneficiaries.
Transparency and Reporting Requirements: PBMs are required to disclose their compensation structures and report on the relationship between themselves and health plans. This is designed to foster transparency within the healthcare system.
Drug Pricing Oversight: PBMs must report detailed information on drug costs, including wholesale acquisition costs, average wholesale prices, the number of prescription claims processed, overall spending, and any rebates provided. This initiative aims to shed light on drug pricing and expenses associated with group health plans.
Standardized Reporting: The bill mandates the Secretary to develop standard reporting requirements and formats for group health plans and PBMs, targeting drug manufacturers, to help prevent anti-competitive practices in the market.
Dissemination of Information: Health plans will be required to provide relevant information to their participants, ensuring that beneficiaries are well-informed about their prescription drug benefits.
Compliance and Penalties: The legislation introduces enforcement mechanisms and sets penalties for non-compliance with the established regulations, intending to hold PBMs accountable for adhering to contract terms.

The overall goal of the Pharmacy Benefit Manager Reform Act of 2025 is to create a more transparent, competitive, and accessible prescription drug market for Medicare beneficiaries, ultimately aiming to promote better cost management within healthcare.

Relevant Companies

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Actions

2 actions

Date	Action
Jul. 10, 2025	Introduced in House
Jul. 10, 2025	Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

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