PBM Price Transparency and Accountability Act
Sponsored By: Senator Crapo, Mike [R-ID]
Introduced
Summary
This bill would force sweeping PBM transparency and pass-through pricing to make prescription drug contracts, payments, and PBM revenue sources visible and to limit abusive spread pricing across Medicaid and Medicare. It would create national pharmacy price surveys, strict Part D PBM rules, audits, and penalties to boost accountability.
Show full summary
- Pharmacies and dispensing access: Would require recurring national surveys with monthly price updates to set acquisition-cost benchmarks and would force Medicaid contracts to use a pass-through model that pays ingredient cost plus a pharmacy dispensing fee. It bars spread pricing for Federal Medicaid matching and limits using non-retail prices to set retail payments.
- Medicare Part D plans and beneficiaries: Would require PBMs to use written agreements that limit income to flat bona fide service fees, disclose rebate and remuneration arrangements, deliver detailed annual drug- and plan-level reports to sponsors and HHS, and face sponsor audits and disgorgement powers starting in plan years beginning on or after 2028.
- States, oversight, and studies: States must share PBM cost data with HHS and the bill directs GAO and HHS Office of Inspector General studies on pricing and compensation structures. It provides about $139 million in specified FY2026 appropriations for CMS program management, OIG oversight, IG surveys, and MedPAC reporting.
*Would increase federal spending by about $139 million in FY2026 for implementation and oversight.*
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
5 provisions identified: 4 benefits, 1 costs, 0 mixed.
Medicaid pass-through drug payments
If enacted, State contracts signed 18 months or more after enactment would have to use pass-through pricing for Medicaid outpatient drugs. Payments would be limited to ingredient cost plus a professional dispensing fee at least as large as the fee the State would pay directly, and those payments would have to be passed through in full to dispensing pharmacies except for lawful reductions for waste, fraud, or abuse. The bill would bar spread pricing for Federal Medicaid matching and require drug-level reporting to States and HHS, with the Secretary publishing non‑identifying state-level summaries each year.
New Medicare PBM transparency rules
If enacted, PBMs serving Medicare Part D and MA-PD plans would face strict reporting, audit, and pay rules for plan years starting January 1, 2028. PBMs would generally be limited to bona fide flat-dollar service fees and must give machine-readable, drug-level reports to PDP sponsors and HHS starting by July 1, 2028. Reports would list rebates, gross and net spending, PBM retained revenue, affiliate dispensing metrics, and pricing definitions. PDP sponsors could audit PBMs, require disgorgement of prohibited payments, and recover penalties tied to PBM noncompliance. The Medicare Payment Advisory Commission would also report to Congress on PBM agreements and trends, with $1 million appropriated for that work.
Wider pharmacy access for Medicare
If enacted, Medicare Part D plans would have to let any pharmacy that meets Secretary-set contract standards join the plan network. The Secretary must set standards by the first Monday in April 2027. The bill would create an "essential retail pharmacy" list for plan years starting January 1, 2028, using distance rules (rural 10 miles, suburban 2 miles, urban 1 mile). Plans and MA organizations would report affiliate lists and incentive payments, and the Secretary would set a pharmacy allegation process by January 1, 2028, with protections and possible penalties.
Monthly pharmacy price surveys
If enacted, HHS would run recurring monthly surveys of drug purchase prices from retail and applicable non-retail pharmacies. Retail survey prices would start the first day of the first quarter at least 6 months after enactment; non-retail prices would start the first quarter at least 18 months after enactment. Pharmacies would have to report their type and any affiliation and could face civil fines up to $100,000 per violation for nonresponse or false reporting. The HHS Inspector General would get $5 million in FY2026 to study and oversee the surveys.
More funding for CMS oversight
If enacted, the bill would add $9,000,000 to CMS for fiscal year 2026 and each year after, and those funds would remain available until spent. The extra money is meant to support CMS activities tied to these oversight and reporting requirements.
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
Raphael Warnock
GA • D
Sponsored 12/4/2025
Sen. Blackburn, Marsha [R-TN]
TN • R
Sponsored 12/4/2025
Peter Welch
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
Shelley Capito
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
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov