Bills · S 526
IN COMMITTEE· 119TH CONGRESS
Senate BillS 526Civil actions and liabilitySupply chain
Pharmacy Benefit Manager Transparency Act of 2025
INTRO FEB 11· LAST ACTION FEB 11
READING
19MIN
COSPONSORS
14BIPARTISAN
READER REACTIONS0 TOTAL
NO VOTES YET · BE THE FIRST
- Introduced only
LEGISLATIVE PROGRESS
STEP 2 / 8Introduced
In Committee
Reported
Passed Senate
Passed House
Conference
To President
Became Law
WHAT THE BILL DOES
AI-writtenThis bill addresses a common frustration with the complex system of prescription drug pricing, where many feel prices are artificially inflated and opaque. By prohibiting certain PBM practices like "spread pricing" and limiting "clawbacks," the bill aims to ensure that more of the money spent on prescription drugs goes directly to paying for the drugs and pharmacy services, rather than being retained by intermediaries. This could lead to more stable finances for pharmacies, particularly independent ones, and potentially lower costs for health plans, which could then translate to lower premiums or out-of-pocket costs for patients.
If this bill becomes law, there would be greater transparency in the drug supply chain, allowing health plans, regulators, and the public to better understand how PBMs operate and profit. If it doesn't pass, the current practices that critics argue drive up drug costs and create financial instability for pharmacies could continue, leaving the prescription drug market less transparent and potentially more expensive for consumers. It is relevant in the ongoing debate about rising drug prices and the role of PBMs in the healthcare system.
KEY PROVISIONS
5AI-extractedPROVISION 01
Prohibits Pharmacy Benefit Managers (PBMs) from charging health plans more for a drug's ingredient cost or dispensing fee than they pay the pharmacy, and keeping the difference, unless they meet strict transparency requirements.
This provision aims to eliminate a practice known as "spread pricing" that critics say inflates drug costs without providing value.
PROVISION 02
Prevents PBMs from arbitrarily taking back money (clawbacks) from pharmacies for prescription drug reimbursements, with narrow exceptions for fraud or contract errors.
This protects pharmacies from unexpected financial losses and provides more stability in their reimbursement for services.
PROVISION 03
Requires PBMs to either pass on 100% of all rebates and discounts they receive from drug manufacturers to health plans, or fully disclose all their costs, prices, fees, and remuneration to health plans, payers, and pharmacies.
This ensures that health plans and consumers either benefit directly from manufacturer discounts or gain full insight into PBMs' financial arrangements.
PROVISION 04
Mandates annual reporting by PBMs to federal agencies, detailing financial differences between what they charge health plans and what they pay pharmacies, as well as fees, clawbacks, and reasons for changing drug formulary tiers.
This greatly increases federal oversight and public understanding of PBM financial practices, which are currently opaque.
PROVISION 05
Makes it illegal to knowingly report false or misleading information about pharmacy benefit management services to a federal agency.
This ensures the accuracy of data used by federal agencies to analyze the PBM market and inform policy decisions.
SPONSORSHIP
1 + 14
R· Iowa
YRS IN OFFICE
51
BILLS LED
92
COSPONSOR BREAKDOWNBIPARTISAN · 85%
DEM 6 REP 8 IND 0
ACTION TIMELINE
2 EVENTSFEB 11
Introduced in Senate
FEB 11
Read twice and referred to the Committee on Commerce, Science, and Transportation.
BILL INFO
TypeSenate Bill
NumberS 526
Congress119th
StatusIn Committee
IntroducedFeb 11, 2025
Last actionFeb 11, 2025
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IN COMMITTEE· 119TH CONGRESS · COMMERCE, SCIENCE, AND TRANSPORTATION COMMITTEE · INTRODUCED FEB 11, 2025
Senate BillS 526Civil actions and liabilitySupply chain
Pharmacy Benefit Manager Transparency Act of 2025
INTRODUCED FEB 11, 2025· LAST ACTION FEB 11, 2025
PASSAGE CHANCES
—%
READING
19 min
COSPONSORS
14
COMPLEXITY
Moderate
