Patients Before Middlemen Act
Sponsored By: Senator Marsha Blackburn
Introduced
Summary
Make PBMs more transparent and open Medicare Part D networks to willing pharmacies. This bill would require pharmacy benefit managers and Prescription Drug Plan sponsors to report detailed drug price and payment data and would create rules to let willing and qualifying independent pharmacies join networks.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 4 benefits, 0 costs, 0 mixed.
Limit PBM pay and require refunds
If enacted, PBMs and affiliates could not get payments tied to drug use except flat, bona fide service fees that reflect fair market value. Incentive or volume payments would count only if flat and tied to real services. Rebates and discounts would be allowed only if fully passed through to the Part D plan sponsor and compliant with DIR rules. HHS (with OIG input) could review deals, require illegal payments to be returned to sponsors, and require PBMs to reimburse sponsors for penalties. The same PBM rules would apply to Medicare Advantage drug plans for plan years beginning January 1, 2028.
Protect local and essential pharmacies
If enacted, HHS would create an “essential retail pharmacy” list starting for plan year 2028. Pharmacies would qualify when they are non‑affiliate and are in medically underserved or isolated areas (examples: rural with no other pharmacy within 10 miles, suburban within 2 miles, urban within 1 mile). Part D plans would have to let any willing pharmacy that meets HHS standards join their networks starting in plan years beginning January 1, 2028. The Secretary would also seek public input by April 1, 2026 on contract terms to set the standards.
Yearly PBM transparency reports
If enacted, PBMs would have to give each Part D plan and HHS a yearly, no-cost, machine-readable report. Reports would be due by July 1 each year starting in 2028, with formats set by the Secretary by June 1, 2027. Reports must list drug names and NDCs, counts of enrollees and claims, dispensing channel breakdowns, WAC/AWP per unit and per typical course, enrollee out-of-pocket totals, total rebates and other remuneration, and how much the PBM or affiliates retained. PBMs with pharmacy affiliates would also report affiliate dispensing shares, cost ranges, and 340B drug lists. HHS would limit public release of nonpublic data to specific oversight uses.
Stronger audits and enforcement tools
If enacted, Part D plans could audit their PBMs at least once per year and pick the auditor. PBMs would have to provide records, including affiliate data, within six months and answer follow-ups within 30 days. HHS would require plans to certify yearly that they follow PBM rules and would keep a confidential complaint channel for manufacturers, pharmacies, and others. HHS must also create a pharmacy allegation process by January 1, 2028 and can investigate and fine sponsors or take other sanctions.
Sponsors & CoSponsors
Sponsor
Marsha Blackburn
TN • R
Cosponsors
Maggie Hassan
NH • D
Sponsored 3/6/2025
James Lankford
OK • R
Sponsored 3/6/2025
Mark Warner
VA • D
Sponsored 3/6/2025
Roger Marshall
KS • R
Sponsored 3/6/2025
Peter Welch
VT • D
Sponsored 3/6/2025
Catherine Cortez Masto
NV • D
Sponsored 3/10/2025
Bill Cassidy
LA • R
Sponsored 3/10/2025
Roll Call Votes
No roll call votes available for this bill.
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