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119-s-3345119th CongressWALLET

PBM Price Transparency and Accountability Act

Sponsored By: Senator Crapo, Mike [R-ID]

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

Crapo, Mike [R-ID]

ID • R

Cosponsors

  • Sen. Wyden, Ron [D-OR]

    OR • D

    Sponsored 12/4/2025

  • Sen. Grassley, Chuck [R-IA]

    IA • R

    Sponsored 12/4/2025

  • Sen. Bennet, Michael F. [D-CO]

    CO • D

    Sponsored 12/4/2025

  • Sen. Cornyn, John [R-TX]

    TX • R

    Sponsored 12/4/2025

  • Sen. Warner, Mark R. [D-VA]

    VA • D

    Sponsored 12/4/2025

  • Sen. Thune, John [R-SD]

    SD • R

    Sponsored 12/4/2025

  • Sen. Whitehouse, Sheldon [D-RI]

    RI • D

    Sponsored 12/4/2025

  • Sen. Cassidy, Bill [R-LA]

    LA • R

    Sponsored 12/4/2025

  • Sen. Hassan, Margaret Wood [D-NH]

    NH • D

    Sponsored 12/4/2025

  • Sen. Lankford, James [R-OK]

    OK • R

    Sponsored 12/4/2025

  • Sen. Cortez Masto, Catherine [D-NV]

    NV • D

    Sponsored 12/4/2025

  • Sen. Daines, Steve [R-MT]

    MT • R

    Sponsored 12/4/2025

  • Sen. Smith, Tina [D-MN]

    MN • D

    Sponsored 12/4/2025

  • Sen. Barrasso, John [R-WY]

    WY • R

    Sponsored 12/4/2025

  • Sen. Luján, Ben Ray [D-NM]

    NM • D

    Sponsored 12/4/2025

  • Sen. Tillis, Thomas [R-NC]

    NC • R

    Sponsored 12/4/2025

  • Sen. Warnock, Raphael G. [D-GA]

    GA • D

    Sponsored 12/4/2025

  • Sen. Blackburn, Marsha [R-TN]

    TN • R

    Sponsored 12/4/2025

  • Sen. Welch, Peter [D-VT]

    VT • D

    Sponsored 12/4/2025

  • Sen. Marshall, Roger [R-KS]

    KS • R

    Sponsored 12/4/2025

  • Sen. Scott, Tim [R-SC]

    SC • R

    Sponsored 12/16/2025

  • Sen. Capito, Shelley Moore [R-WV]

    WV • R

    Sponsored 12/16/2025

  • Sen. Blunt Rochester, Lisa [D-DE]

    DE • D

    Sponsored 12/16/2025

  • Sen. Young, Todd [R-IN]

    IN • R

    Sponsored 12/16/2025

  • Sen. Risch, James E. [R-ID]

    ID • R

    Sponsored 1/5/2026

  • Sen. Heinrich, Martin [D-NM]

    NM • D

    Sponsored 1/28/2026

  • Sen. McCormick, David [R-PA]

    PA • R

    Sponsored 8/7/2026

Roll Call Votes

No roll call votes available for this bill.

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