This bill would require pharmacy benefit managers (PBMs) that work with Medicare drug plans to report more detailed information about the costs and prices of prescription drugs. This is intended to make the drug pricing process more transparent and hold PBMs accountable for the prices they negotiate.
Latest Action
Referred to the Subcommittee on Health.
AI Summary
Plain-English explanation of this bill
This bill would require pharmacy benefit managers (PBMs) that work with Medicare drug plans to report more detailed information about the costs and prices of prescription drugs. This is intended to make the drug pricing process more transparent and hold PBMs accountable for the prices they negotiate.
Last updated: 12/29/2025
Official Summary
Congressional Research Service summary
<p><strong>Medicare PBM Accountability Act</strong></p><p>This bill establishes reporting requirements for pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit and Medicare Advantage, particularly relating to the prices of prescription drugs.</p><p>Specifically, PBMs must (1) disclose certain information underlying cost performance measurements (e.g., exclusions and terms), and (2) report to prescription drug plan (PDP) sponsors (and to the Centers for Medicare & Medicaid Services upon request) an itemized list of prescription drugs that were dispensed during the previous year and related data about costs, claims, affiliated pharmacies, and other specified information. PDP sponsors may audit PBMs to ensure compliance with this bill's requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations.</p><p>In addition, the Government Accountability Office must study federal and state reporting requirements for health plans and PBMs with respect to prescription drug price transparency and recommend ways to streamline these requirements.</p>
Key Points
Main provisions of the bill
PBMs must disclose information about how they calculate drug costs and performance measures for Medicare drug plans.
PBMs must provide an itemized list of all prescription drugs dispensed, including information about costs, claims, and affiliated pharmacies.
Medicare drug plan sponsors can audit PBMs to ensure they are complying with the new reporting requirements.
The Government Accountability Office must study ways to streamline reporting requirements for health plans and PBMs related to drug price transparency.
How This Impacts Americans
Potential effects on citizens and communities
If this bill becomes law, it would primarily impact Medicare beneficiaries and taxpayers by increasing transparency around prescription drug pricing and the role of PBMs in the Medicare drug benefit program. This could lead to lower drug prices and out-of-pocket costs for seniors and people with disabilities enrolled in Medicare.
Policy Areas
Primary Policy Area
Health
Related Subjects
Accounting and auditing
Congressional oversight
Contracts and agency
Drug safety, medical device, and laboratory regulation
Government information and archives
Government studies and investigations
Health care costs and insurance
Prescription drugs
Retail and wholesale trades
Scope & Jurisdiction
Jurisdiction Level
federal
Congressional Session
119th Congress
Citation Reference
5385, 119th Congress (2025). "Health Providers Training Act". Source: Voter's Right Platform. https://votersright.org/bills/118-hr-5385
