PBM Price Transparency and Accountability Act
Sponsored By: Senator Mike Crapo
Introduced
Summary
Holds pharmacy benefit managers to new accountability standards and forces drug price transparency across Medicaid and Medicare Part D. The bill would set national monthly benchmarks for pharmacy acquisition costs, ban spread pricing for federal Medicaid matching, and impose broad PBM reporting, audit, disgorgement, and governance rules.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 1 benefits, 0 costs, 2 mixed.
Medicaid pharmacy pay and surveys
If enacted, State Medicaid contracts would have to pay outpatient drug claims as pass-through ingredient cost plus a dispensing fee, and those payments would be passed in full to the pharmacy except for fraud or abuse reductions. The bill would ban spread pricing when states claim Federal Medicaid matching funds. HHS would run monthly drug acquisition surveys (NADAC) by vendor, and states must require pharmacies that receive drug-related payments to respond. Pharmacies that refuse or give false data could face civil penalties up to $100,000 per violation, and HHS could implement the survey and reporting rules by program instruction without normal notice-and-comment or some paperwork rules.
New PBM reporting and audits
If enacted, PBMs would have to send detailed, drug-level annual reports to Part D plan sponsors and HHS starting in 2028. The bill would require PBMs to allow plan-selected audits at least once a year and to provide affiliate records and written CEO-level certifications. PBMs would generally not be allowed to get pay tied to drug use or price except for flat, fair-market-value service fees, and they would have to return (disgorge) improper payments. Reports and audit results would be confidential for oversight but would be used by HHS, GAO, MedPAC, and the OIG.
Funds and studies for PBM oversight
If enacted, the bill would provide FY2026 funding to support PBM and Part D oversight: $113 million to CMS, $20 million to the HHS Inspector General, and $5 million for IG studies. It would also give $1 million to MedPAC for reporting. The bill would require the Government Accountability Office to report on price-related compensation in Part D within two years and would require MedPAC reports analyzing PBM agreements and effects on out-of-pocket costs.
Sponsors & CoSponsors
Sponsor
Mike Crapo
ID • R
Cosponsors
Ron Wyden
OR • D
Sponsored 12/4/2025
Chuck Grassley
IA • R
Sponsored 12/4/2025
Michael Bennet
CO • D
Sponsored 12/4/2025
John Cornyn
TX • R
Sponsored 12/4/2025
Mark Warner
VA • D
Sponsored 12/4/2025
John Thune
SD • R
Sponsored 12/4/2025
Sheldon Whitehouse
RI • D
Sponsored 12/4/2025
Bill Cassidy
LA • R
Sponsored 12/4/2025
Maggie Hassan
NH • D
Sponsored 12/4/2025
James Lankford
OK • R
Sponsored 12/4/2025
Catherine Cortez Masto
NV • D
Sponsored 12/4/2025
Steve Daines
MT • R
Sponsored 12/4/2025
Tina Smith
MN • D
Sponsored 12/4/2025
John Barrasso
WY • R
Sponsored 12/4/2025
Sen. Luján, Ben Ray [D-NM]
NM • D
Sponsored 12/4/2025
Thomas Tillis
NC • R
Sponsored 12/4/2025
Raphael Warnock
GA • D
Sponsored 12/4/2025
Marsha Blackburn
TN • R
Sponsored 12/4/2025
Peter Welch
VT • D
Sponsored 12/4/2025
Roger Marshall
KS • R
Sponsored 12/4/2025
Tim Scott
SC • R
Sponsored 12/16/2025
Shelley Capito
WV • R
Sponsored 12/16/2025
Lisa Blunt Rochester
DE • D
Sponsored 12/16/2025
Todd Young
IN • R
Sponsored 12/16/2025
James Risch
ID • R
Sponsored 1/5/2026
Martin Heinrich
NM • D
Sponsored 1/28/2026
Roll Call Votes
No roll call votes available for this bill.
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