Pharmacy Benefit Manager Transparency Act of 2025
Sponsored By: Senator Chuck Grassley
Introduced
Summary
Ending hidden PBM markups and clawbacks is the bill's central goal. It would force pharmacy benefit managers to disclose fees, stop undisclosed price differences, and face federal oversight and penalties.
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- Patients and families: It would bar PBMs from keeping undisclosed differences between what a plan pays and what a pharmacy receives and limit arbitrary clawbacks that can raise out‑of‑pocket costs. It also protects patient and provider identity in reports.
- Pharmacies and pharmacists: The bill would curb sudden reimbursement clawbacks except for specific fraud or contract exceptions and would allow PBMs to retain concessions only if they pass them through 100 percent and make full disclosures.
- Health plans, payers, and regulators: PBMs would report within one year and then annually to the Federal Trade Commission and HHS on pass‑throughs, clawbacks, formulary moves, and affiliate reimbursements. The FTC would enforce the rules and could impose civil penalties up to $1,000,000 per violation.
- Workers and whistleblowers: Employees and contractors who report violations would get protection from retaliation and remedies like reinstatement and double back pay with interest.
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Bill Overview
Analyzed Economic Effects
6 provisions identified: 3 benefits, 0 costs, 3 mixed.
Stronger whistleblower protections
If enacted, workers and contractors who report PBM violations would be protected from retaliation. Covered individuals could get temporary relief, reinstatement, and twice their back pay with interest. They could also recover compensatory damages and attorneys' fees. Employers could not force these disputes into arbitration or make workers waive these rights.
Ban on hidden PBM billing spreads
If enacted, PBMs could not charge a health plan one price for a drug and pay a pharmacy a lower price while keeping the difference. PBMs could not arbitrarily cut pharmacy pay or raise fees to offset federal plan payment rules. Clawbacks would be barred except for fraud, contract inconsistency, or if services were not rendered. A PBM would avoid violation only if it returns 100% of price concessions and fully discloses costs, fees, and manufacturer payments.
PBMs must report money flows
If enacted, each pharmacy benefit manager would have to report to the FTC and HHS within one year and every year after. Reports would show aggregate gaps between what plans pay and what pharmacies receive, price concessions and clawbacks, and explanations for formulary moves that raised patient costs. The FTC would also deliver annual summaries to Congress and a study on formulary design within one year.
Enforcement powers, state lawsuits, defenses
If enacted, the FTC would enforce the Act like other unfair or deceptive practices and could seek civil penalties up to $1,000,000 per violation. State attorneys general could sue in federal court on behalf of residents, and the FTC could intervene. Defendants could raise an affirmative defense if their actions were needed to follow law or protect patient safety or access.
Protect trade secrets and data accuracy
If enacted, the FTC generally could not disclose trade secrets or confidential business information except as needed to enforce the law. The FTC could share anonymized data with GAO and CBO for review. It would also be illegal to knowingly file false PBM reports to federal agencies when those reports are legally required.
Who and what the bill covers
If enacted, the bill would define key terms used in the law. "Commission" means the FTC. "Covered individual" would include employees and contractors. "Health plan" would include group, individual, and government plans. It would also define PBM services and what counts as a prescription drug.
Sponsors & CoSponsors
Sponsor
Chuck Grassley
IA • R
Cosponsors
Maria Cantwell
WA • D
Sponsored 2/11/2025
Joni Ernst
IA • R
Sponsored 2/11/2025
Peter Welch
VT • D
Sponsored 2/11/2025
Shelley Capito
WV • R
Sponsored 2/11/2025
Jeanne Shaheen
NH • D
Sponsored 2/11/2025
Roger Marshall
KS • R
Sponsored 2/11/2025
Martin Heinrich
NM • D
Sponsored 2/11/2025
Jerry Moran
KS • R
Sponsored 2/11/2025
Cindy Hyde-Smith
MS • R
Sponsored 2/11/2025
Thomas Tillis
NC • R
Sponsored 2/11/2025
Mike Rounds
SD • R
Sponsored 2/11/2025
John Boozman
AR • R
Sponsored 2/18/2025
Ruben Gallego
AZ • D
Sponsored 9/15/2025
Roll Call Votes
No roll call votes available for this bill.
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