# 119-hr-4317: PBM Reform Act of 2025

119-hr-4317, PBM Reform Act of 2025, is a 119th Congress bill sponsored by Rep. Carter, Earl L. "Buddy" [R-GA-1] (R-GA); status introduced; PRIA reads it as touching household money (as of 2026-09-30).

- Canonical: https://policyrisk.com/legislation/119-hr-4317
- As of: 2026-09-30
- Plain-text twin of the page above; the HTML and this file carry the same facts.

## Facts
- Bill: 119-hr-4317
- Congress: 119
- Title: PBM Reform Act of 2025
- Status: introduced
- Introduced: 2025-07-10
- Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] (R-GA)
- Cosponsors: 71
- Policy area: Health
- Touches household money: yes
- Last recorded action: 2026-09-30

## Summary

**Greater PBM transparency and tighter contract rules** would require pharmacy benefit managers (PBMs) to disclose detailed per‑drug revenues and rebates, protect small "essential" retail pharmacies, and change Medicaid and group plan payment rules across the drug supply chain. The bill would layer reporting, audit rights, pass‑through pricing, and enforcement across Medicare Part D, ERISA/group plans, and Medicaid to spotlight hidden payments and affiliate flows. - Patients and community pharmacies: Would create an "essential retail pharmacy" label for pharmacies in underserved areas and require network access standards and biennial public data starting in 2028, helping small pharmacies show reimbursement and cost differences to plans. - PBMs, plans, and auditors: Would force PBMs to adopt flat bona fide service fees, disclose per‑drug claims, rebates, retained revenue, and affiliate dispensing shares, and give sponsors audit rights and remedies for improper remuneration. - States and Medicaid programs: Would require monthly national acquisition‑cost surveys, ban spread pricing in State Medicaid contracts, and mandate pass‑through pricing with itemized reporting and penalties for false data. *Would increase federal spending for implementation by about $336 million in FY2025 and fund ongoing oversight including a $9 million annual IG appropriation.*

## Cosponsors (71)

- Rep. Fitzpatrick, Brian K. [R-PA-1] (R-PA), 2026-09-28T00:00:00.000Z
- Rep. Dingell, Debbie [D-MI-6] (D-MI), 2025-07-10T00:00:00.000Z
- Rep. Murphy, Gregory F. [R-NC-3] (R-NC), 2025-07-10T00:00:00.000Z
- Rep. Ross, Deborah K. [D-NC-2] (D-NC), 2025-07-10T00:00:00.000Z
- Rep. Arrington, Jodey C. [R-TX-19] (R-TX), 2025-07-10T00:00:00.000Z
- Rep. Harshbarger, Diana [R-TN-1] (R-TN), 2025-07-10T00:00:00.000Z
- Rep. Gonzalez, Vicente [D-TX-34] (D-TX), 2025-07-10T00:00:00.000Z
- Rep. Allen, Rick W. [R-GA-12] (R-GA), 2025-07-10T00:00:00.000Z
- Rep. Krishnamoorthi, Raja [D-IL-8] (D-IL), 2025-07-10T00:00:00.000Z
- Rep. Rose, John W. [R-TN-6] (R-TN), 2025-07-10T00:00:00.000Z
- Rep. Tran, Derek [D-CA-45] (D-CA), 2025-07-10T00:00:00.000Z
- Rep. Malliotakis, Nicole [R-NY-11] (R-NY), 2025-07-10T00:00:00.000Z
- Rep. Khanna, Ro [D-CA-17] (D-CA), 2025-07-14T00:00:00.000Z
- Rep. Landsman, Greg [D-OH-1] (D-OH), 2025-07-15T00:00:00.000Z
- Rep. Correa, J. Luis [D-CA-46] (D-CA), 2025-07-16T00:00:00.000Z
- Rep. Fleischmann, Charles J. "Chuck" [R-TN-3] (R-TN), 2025-07-16T00:00:00.000Z
- Rep. Auchincloss, Jake [D-MA-4] (D-MA), 2025-07-21T00:00:00.000Z
- Rep. Bishop, Sanford D. [D-GA-2] (D-GA), 2025-07-21T00:00:00.000Z
- Rep. Harris, Andy [R-MD-1] (R-MD), 2025-07-25T00:00:00.000Z
- Rep. Norman, Ralph [R-SC-5] (R-SC), 2025-07-25T00:00:00.000Z
- Rep. Subramanyam, Suhas [D-VA-10] (D-VA), 2025-07-25T00:00:00.000Z
- Rep. McCormick, Richard [R-GA-7] (R-GA), 2025-07-29T00:00:00.000Z
- Rep. Weber, Randy K. Sr. [R-TX-14] (R-TX), 2025-08-12T00:00:00.000Z
- Rep. Miller-Meeks, Mariannette [R-IA-1] (R-IA), 2025-08-15T00:00:00.000Z
- Rep. Tokuda, Jill N. [D-HI-2] (D-HI), 2025-08-26T00:00:00.000Z
- Rep. Budzinski, Nikki [D-IL-13] (D-IL), 2025-09-02T00:00:00.000Z
- Rep. Perez, Marie Gluesenkamp [D-WA-3] (D-WA), 2025-09-02T00:00:00.000Z
- Rep. Flood, Mike [R-NE-1] (R-NE), 2025-09-03T00:00:00.000Z
- Rep. Moore, Tim [R-NC-14] (R-NC), 2025-09-08T00:00:00.000Z
- Rep. Mann, Tracey [R-KS-1] (R-KS), 2025-09-08T00:00:00.000Z
- Rep. Bresnahan, Robert P. [R-PA-8] (R-PA), 2025-09-08T00:00:00.000Z
- Rep. Comer, James [R-KY-1] (R-KY), 2025-09-09T00:00:00.000Z
- Rep. McBride, Sarah [D-DE-At Large] (D-DE), 2025-09-18T00:00:00.000Z
- Rep. Langworthy, Nicholas A. [R-NY-23] (R-NY), 2025-09-30T00:00:00.000Z
- Rep. Franklin, Scott [R-FL-18] (R-FL), 2025-09-30T00:00:00.000Z
- Rep. Goldman, Craig A. [R-TX-12] (R-TX), 2025-10-03T00:00:00.000Z
- Rep. Johnson, Julie [D-TX-32] (D-TX), 2025-10-03T00:00:00.000Z
- Rep. Cammack, Kat [R-FL-3] (R-FL), 2025-10-08T00:00:00.000Z
- Rep. Tlaib, Rashida [D-MI-12] (D-MI), 2025-10-10T00:00:00.000Z
- Rep. Craig, Angie [D-MN-2] (D-MN), 2025-10-17T00:00:00.000Z
- Rep. Cloud, Michael [R-TX-27] (R-TX), 2025-10-21T00:00:00.000Z
- Rep. Calvert, Ken [R-CA-41] (R-CA), 2025-10-21T00:00:00.000Z
- Rep. Harder, Josh [D-CA-9] (D-CA), 2025-10-24T00:00:00.000Z
- Rep. Mfume, Kweisi [D-MD-7] (D-MD), 2025-10-28T00:00:00.000Z
- Rep. Owens, Burgess [R-UT-4] (R-UT), 2025-10-31T00:00:00.000Z
- Rep. Kiggans, Jennifer A. [R-VA-2] (R-VA), 2025-10-31T00:00:00.000Z
- Rep. Houlahan, Chrissy [D-PA-6] (D-PA), 2025-11-04T00:00:00.000Z
- Rep. Peters, Scott H. [D-CA-50] (D-CA), 2025-11-07T00:00:00.000Z
- Rep. Sessions, Pete [R-TX-17] (R-TX), 2025-11-12T00:00:00.000Z
- Rep. Messmer, Mark B. [R-IN-8] (R-IN), 2025-11-12T00:00:00.000Z
- Rep. Scholten, Hillary J. [D-MI-3] (D-MI), 2025-11-12T00:00:00.000Z
- Rep. Sewell, Terri A. [D-AL-7] (D-AL), 2025-11-17T00:00:00.000Z
- Rep. Goodlander, Maggie [D-NH-2] (D-NH), 2025-11-17T00:00:00.000Z
- Rep. Barrett, Tom [R-MI-7] (R-MI), 2025-11-20T00:00:00.000Z
- Rep. Biggs, Sheri [R-SC-3] (R-SC), 2025-11-21T00:00:00.000Z
- Rep. Clarke, Yvette D. [D-NY-9] (D-NY), 2025-11-28T00:00:00.000Z
- Rep. Davids, Sharice [D-KS-3] (D-KS), 2025-12-01T00:00:00.000Z
- Rep. Rogers, Harold [R-KY-5] (R-KY), 2025-12-03T00:00:00.000Z
- Rep. Mackenzie, Ryan [R-PA-7] (R-PA), 2025-12-09T00:00:00.000Z
- Rep. Wilson, Joe [R-SC-2] (R-SC), 2025-12-09T00:00:00.000Z
- Rep. Vasquez, Gabe [D-NM-2] (D-NM), 2025-12-09T00:00:00.000Z
- Rep. Bentz, Cliff [R-OR-2] (R-OR), 2025-12-09T00:00:00.000Z
- Rep. Joyce, John [R-PA-13] (R-PA), 2025-12-16T00:00:00.000Z
- Rep. Babin, Brian [R-TX-36] (R-TX), 2025-12-16T00:00:00.000Z
- Rep. Davis, Donald G. [D-NC-1] (D-NC), 2025-12-16T00:00:00.000Z
- Rep. Dunn, Neal P. [R-FL-2] (R-FL), 2025-12-19T00:00:00.000Z
- Rep. Van Drew, Jefferson [R-NJ-2] (R-NJ), 2026-01-08T00:00:00.000Z
- Rep. Lawler, Michael [R-NY-17] (R-NY), 2026-01-12T00:00:00.000Z
- Rep. Olszewski, Johnny [D-MD-2] (D-MD), 2026-01-20T00:00:00.000Z
- Rep. Van Orden, Derrick [R-WI-3] (R-WI), 2026-01-21T00:00:00.000Z
- Rep. Menendez, Robert [D-NJ-8] (D-NJ), 2026-04-16T00:00:00.000Z

## Provisions PRIA read

- More pharmacy choice in Medicare: benefit, high. If enacted, Medicare drug plans would have to let any pharmacy join the network if it meets standard terms, starting in 2029. HHS would set what counts as reasonable contract terms after an information request by April 1, 2027 and final standards by April 2028. Starting in 2028, HHS would list "ess…
- Funding to enforce PBM transparency: benefit, high. If enacted, Congress would provide $188 million to CMS in fiscal year 2025 to carry out pharmacy access, standards, enforcement, and PBM oversight, available until spent. It would also provide $113 million to CMS and $20 million to the HHS Inspector General in fiscal year 2025 for PBM transparency…
- Limits on PBM profits in Medicare: benefit, high. If enacted, starting in 2028 PBMs in Part D could be paid only flat, fair‑market‑value service fees, not other revenue, with narrow exceptions. PBMs would have to return any prohibited payments and ensure affiliates do the same. Contracts would have to make PBMs repay a plan for fines tied to dutie…
- More Medicare PBM reporting and audits: benefit, high. If enacted, PBMs would have to send a free, machine‑readable report to the Part D plan and HHS each year by July 1 starting in 2028. Reports would show per‑drug prices, rebates, pharmacy payments, and totals, plus extra details when the PBM has pharmacy affiliates. PBMs would have to report when a…
- Medicaid PBM pass‑through pricing rules: benefit, medium. If enacted, states would have to use pass‑through pricing in Medicaid PBM and managed‑care contracts starting 18 months after enactment. Payments would be limited to ingredient cost plus a professional dispensing fee at least equal to the State plan fee, and passed through to the dispensing pharmac…
- New PBM transparency for employer plans: benefit, medium. If enacted, PBMs that serve employer health plans would have to send plans plain, machine‑readable drug reports at least every 6 months. Plans could ask for quarterly reports at the same cost. HHS would set standard forms within 18 months and machine‑readable formats by June 1, 2027. Starting with…
- Confidential tips and oversight on PBMs: benefit, medium. If enacted, HHS would run a confidential tip line to report PBM violations, with anti‑retaliation protections. HHS could share reports with oversight bodies but could not publicly reveal who the parties are or specific contract prices. HHS would publish an enforcement report within 2 years and at l…
- Tax enforcement could extend to PBMs: benefit, low. If enacted, tax penalty rules would also apply to PBMs when employer‑plan PBM reporting rules apply. The bill would also clarify a tax‑code section so these PBM rules are not exempted. This aims to back up the employer plan transparency rules with tax enforcement.

## Related bills

- 119-hr-3514: Improving Seniors’ Timely Access to Care Act of 2025
- 119-hr-842: Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act
- 119-hr-1262: Mikaela Naylon Give Kids a Chance Act
- 119-hr-979: AM Radio for Every Vehicle Act of 2025
- 119-hr-909: Crime Victims Fund Stabilization Act of 2025
- 119-hr-2102: Major Richard Star Act

## Sources
- [119-hr-4317 on Congress.gov](https://www.congress.gov/bill/119th-congress/house-bill/4317)

## Related
- [119-hr-3514: Improving Seniors’ Timely Access to Care Act of 2025](https://policyrisk.com/legislation/119-hr-3514)
- [119-hr-842: Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage A…](https://policyrisk.com/legislation/119-hr-842)
- [119-hr-1262: Mikaela Naylon Give Kids a Chance Act](https://policyrisk.com/legislation/119-hr-1262)
- [119-hr-979: AM Radio for Every Vehicle Act of 2025](https://policyrisk.com/legislation/119-hr-979)
- [119-hr-909: Crime Victims Fund Stabilization Act of 2025](https://policyrisk.com/legislation/119-hr-909)
- [119-hr-2102: Major Richard Star Act](https://policyrisk.com/legislation/119-hr-2102)
- [All bills in Congress](https://policyrisk.com/legislation)

Source: PRIA, https://policyrisk.com/legislation/119-hr-4317 (as of 2026-09-30).