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HR10369119th CongressWALLET

Net Effective Cost Transparency and Prescription Drug Affordability Act of 2026

Sponsored By: Representative Mackenzie, Ryan [R-PA-7]

Introduced

Summary

This bill would require _PBM bid and net‑effective‑cost transparency_ across Medicare Part D, Medicare Advantage–Part D (MA‑PD), and ERISA commercial plans to make drug pricing auditable and comparable. It sets a standardized bidding system, requires audits and quarterly reconciliations, creates penalties and refunds, and adds a MA‑PD drug cost performance measure.

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 1 benefits, 0 costs, 1 mixed.

More transparency for Medicare drug costs

If enacted, plans that offer Medicare Part D and Medicare Advantage–Part D would use a standard PBM bidding process starting with plan years on or after January 1, 2028. Bids would list expected PBM fees, rebates and discounts, drug-level financial data, and a projected "net effective cost" for the year. PBMs would have to guarantee actual annual net cost will not exceed projections by more than the rulemaking percentage (not to exceed 10%) and must join periodic reconciliations. The Secretary would audit at least one-third of Part D sponsors each year, require written explanations and corrective-action plans within 30 days when quarterly costs exceed the rule threshold, and could order refunds to enrollees. The bill would also create a new drug-cost star measure (5-star scale with 2%, 5%, 10%, 15% thresholds) and phase in public ratings and quality-bonus effects over the next 2–3 plan years after initial data collection.

PBM fee disclosures for employer plans

If enacted, PBMs bidding for ERISA employer health plans would have to disclose projected "net effective cost" and itemize bona fide service fees in a uniform format for plan years beginning after calendar year 2027. The bill would define "bona fide service fees" as fair-market payments for itemized services not passed through to the plan. Employers and plan fiduciaries would get more detailed bid data to compare PBM offers and to document plan selections.

Sponsors & CoSponsors

Sponsor

Mackenzie, Ryan [R-PA-7]

PA • R

Cosponsors

  • Rep. Auchincloss, Jake [D-MA-4]

    MA • D

    Sponsored 9/14/2026

  • Rep. Allen, Rick W. [R-GA-12]

    GA • R

    Sponsored 9/14/2026

  • Rep. McBath, Lucy [D-GA-6]

    GA • D

    Sponsored 9/14/2026

  • Rep. Miller, Carol D. [R-WV-1]

    WV • R

    Sponsored 9/14/2026

Roll Call Votes

No roll call votes available for this bill.

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