Hidden Fee Disclosure Act of 2025
Sponsored By: Representative Courtney
Introduced
Summary
Per-service transparency of fees and payments by health-plan vendors would be required. The bill would amend the Employee Retirement Income Security Act of 1974 to force covered service providers to disclose compensation, rebates, and other remuneration by service rather than in aggregate.
Show full summary
- Families and plan participants would get clearer annual reports from pharmacy benefit managers showing total gross and net drug spending, spending at PBM-owned pharmacies, cost-sharing retained, and fees by source. Disclosures must be provided within 60 days after the start of each plan year.
- Employers and plan sponsors would receive per-service breakdowns for services like claims processing, network design, formulary maintenance, wellness programs, and stop-loss and would see what vendors pass through versus retain. Contracts entered into before Jan. 1, 2026 would not be covered by the new rules.
- Pharmacy benefit managers (PBMs) and third-party administrators (TPAs) would face expanded reporting requirements for fees, rebates, spread pricing, discounts, recoveries, and other remuneration, and new privacy requirements tied to HIPAA. The bill also broadens the list of services that must be disclosed and clarifies PBM arrangements as indirect contract relationships under ERISA.
- The Secretary of Labor must issue implementing regulations within 1 year to set standards for how expected compensation is disclosed and to account for varied compensation practices.
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
5 provisions identified: 1 benefits, 0 costs, 4 mixed.
Pharmacy benefit manager contracts face conflict rules
The bill would treat some pharmacy benefit manager contracts as deals with a party-in-interest to the plan. That would bring these arrangements under ERISA conflict-of-interest and prohibited-transaction rules. If you are in a group plan, this could help fiduciaries challenge self-dealing and push for better terms.
More health plan vendor fees disclosed
The bill would widen which health plan services must disclose their fees to plan fiduciaries. The list would include plan design, claim repricing, vision and dental selection, stop-loss, pharmacy benefit services, wellness tools, transparency tools, group purchasing deals, preferred vendor panels, disease management, compliance, employee assistance, third party administration, and related consulting. It would also align the legal meanings of health insurance coverage and issuers for these disclosure rules. If you are in a job-based plan, your plan leaders could see more fee details from more vendors.
New reporting for pharmacy benefit managers
Pharmacy benefit managers would have to give a detailed, written report each year to your plan’s fiduciary. It would be due within 60 days after the plan year starts and cover the prior year. It would list, by service, all direct and indirect pay and rebates from drug makers and other third parties, what is kept versus passed through, total gross and net drug spending, spending at PBM-owned pharmacies, and any cost-sharing the PBM kept. The report would also break out fees by source and add any details needed to judge if the contract is reasonable.
New reporting for third party administrators
Third party administrators would need to give an annual, written report to the plan fiduciary within 60 days after the plan year starts. It would show all direct and indirect pay they, affiliates, or subcontractors received, and estimate any participant cost-sharing caused by indirect pay. It would list total gross and net spending under the administrative services agreement and break out fees by source. It would also disclose expected fees from other vendors and expected recoveries, like overpayments, uncashed checks, subrogation, billing errors, or fraud.
Labor would set disclosure rules in a year
The Labor Department would have to write rules within one year of enactment. The rules would set how vendors report expected pay, rebates, and other compensation. They would cover pharmacy benefit managers, third party administrators, and other covered providers. Actual details would depend on the final rules.
Free Policy Watch
You just read the policy. Now see what it costs you.
Pick a topic. PRIA runs your household against live legislation and sends you a free personalized readout.
Pick a topic to get started
Sponsors & CoSponsors
Sponsor
Courtney
CT • D
Cosponsors
Houchin
IN • R
Sponsored 3/11/2025
Roll Call Votes
No roll call votes available for this bill.
View on Congress.govTake It Personal
Get Your Personalized Policy View
Start a Free Government Policy Watch to see how policy affects your household, then upgrade to PRIA Full Coverage for year-round monitoring.
Already have an account? Sign in