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119-hr-2450119th CongressWALLET

Prescription Drug Transparency and Affordability Act

Sponsored By: Representative McDonald Rivet, Kristen [D-MI-8]

Introduced

Summary

PBM transparency and reporting. This bill would require pharmacy benefit managers (PBMs) to produce detailed, machine‑readable drug and claim reports for group health plans and to give accessible summaries to participants and plan selectors.

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  • Families and patients would get plain-language summaries and can request claim-level information. Reports must show participant out-of-pocket spending, copayment assistance where feasible, and net price information for drugs.
  • Employers and plan sponsors would receive standardized data at least every 6 months and can demand quarterly reports at the same cost. Contracts between plans and PBMs would have to include data-sharing and nondisclosure limits and the rules would start for plan years beginning 30 months after enactment.
  • PBMs and affiliated pharmacies would have to disclose detailed payment and remuneration flows, formulary rationales, affiliated‑pharmacy dispensing shares, and top-drug details for drugs exceeding $10,000 in plan spending or the plan's top 50 drugs. The Department of Health and Human Services would enforce the rules and could levy penalties of $10,000 per day for failures and up to $100,000 for each item of knowingly false information.

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 3 benefits, 0 costs, 1 mixed.

Fines and enforcement for PBM reporting

If enacted, the government could fine plans, issuers, PBMs, and others $10,000 for each day required information is missing. It could also fine up to $100,000 for each item of knowingly false information. Officials could waive penalties or give more time for good‑faith efforts. The bill would add ERISA and tax‑code tools so federal agencies can enforce these reporting rules against PBMs.

Drug cost reports to your plan

This bill would require your health plan’s PBM to send clear drug cost reports at least every 6 months. Upon request, the plan could get quarterly reports at the same price and terms. Reports would show what the plan paid the PBM and pharmacies, rebates and net prices, and what you paid out of pocket. They would include totals by drug and by drug class, plus summaries for the plan and a simple participant summary on request. If your plan or PBM uses affiliated pharmacies, the report would compare their prices to other pharmacies. Contracts would need to allow data sharing so PBMs can report. These duties would start for plan years that begin 30 months after enactment.

Privacy rules for PBM drug reports

PBM reports would have to follow HIPAA and HITECH privacy rules. Plans would give a yearly notice telling participants about these reports. Reports could be kept from the public, but plans could not block sharing with HHS, Labor, or Treasury, or stop you from getting information you are allowed to see. These rules would apply for plan years starting 30 months after enactment.

Standard report format and definitions

The Secretary would set a standard PBM report format and finalize rules within 18 months of enactment. The bill would define who is covered (like manufacturers, wholesalers, rebate aggregators, and PBM affiliates) and key terms like contracted compensation, gross and net spending, and wholesale acquisition cost. The Secretary would define “remuneration” by rule and update it at least every 5 years. These definitions would guide who must report and what amounts are measured.

Sponsors & CoSponsors

Sponsor

McDonald Rivet, Kristen [D-MI-8]

MI • D

Cosponsors

  • Rep. Carter, Earl L. "Buddy" [R-GA-1]

    GA • R

    Sponsored 3/27/2025

  • Rep. Menendez, Robert [D-NJ-8]

    NJ • D

    Sponsored 3/27/2025

  • Rep. James, John [R-MI-10]

    MI • R

    Sponsored 3/27/2025

Roll Call Votes

No roll call votes available for this bill.

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