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119-s-3549119th CongressWALLET

PBM FAIR Act

Sponsored By: Senator Marshall, Roger [R-KS]

Introduced

Summary

Treats pharmacy benefit managers (PBMs) as ERISA fiduciaries for group health plans when they run networks, negotiate drug pricing, process claims, or perform utilization management. It would also expand disclosure rules for PBMs and third-party administrators and bar indemnifying certain fiduciary breaches.

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Bill Overview

Analyzed Economic Effects

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

Pharmacy Benefit Managers as Fiduciaries

If enacted, this bill would treat pharmacy benefit managers (PBMs) and similar entities as fiduciaries for group health plans when they run drug networks or formularies, buy drugs for a plan, negotiate or aggregate rebates or discounts, process and pay prescription drug claims, or perform drug utilization management. This would give plan members stronger legal protections and duties for those PBM actions. It would apply to plan years that begin at least 12 months after the date of enactment of this Act.

Required PBM and TPA Pay Disclosures

If enacted, this bill would require covered service providers, their affiliates, and subcontractors to disclose direct and indirect pay tied to PBM and third-party administrative (TPA) services. Disclosures would cover payments tied to drug networks, formularies, drug purchases from manufacturers or wholesalers, and TPA work like claims processing, record keeping, and negotiating reimbursement rates. The rule would apply to plan years that begin at least 12 months after the date of enactment of this Act.

No Indemnity for PBM Fiduciaries

If enacted, this bill would bar persons or entities deemed fiduciaries under the new PBM fiduciary rule from being indemnified or otherwise relieved from liability for fiduciary duties, except as the statute narrowly allows. Contract terms that try to indemnify such fiduciaries would be void as against public policy. The rule would take effect for plan years that begin at least 12 months after the date of enactment of this Act.

Responsible Plan Fiduciary Rules

If enacted, this bill would generally prevent a covered service provider from being the responsible plan fiduciary for certain required disclosures. An exception would allow a pharmacy benefit manager that sponsors a plan for its own employees to be the responsible fiduciary for that plan. This rule would apply to plan years that begin at least 12 months after the date of enactment of this Act.

Sponsors & CoSponsors

Sponsor

Marshall, Roger [R-KS]

KS • R

Cosponsors

  • Sen. Kaine, Tim [D-VA]

    VA • D

    Sponsored 12/17/2025

  • Sen. Grassley, Chuck [R-IA]

    IA • R

    Sponsored 12/17/2025

  • Sen. Hassan, Margaret Wood [D-NH]

    NH • D

    Sponsored 12/17/2025

Roll Call Votes

No roll call votes available for this bill.

View on Congress.gov
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