S3345119th CongressWALLET

PBM Price Transparency and Accountability Act

Sponsored By: Senator Mike Crapo

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.

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

Mike Crapo

ID • R

Cosponsors

  • Ron Wyden

    OR • D

    Sponsored 12/4/2025

  • Chuck Grassley

    IA • R

    Sponsored 12/4/2025

  • Michael Bennet

    CO • D

    Sponsored 12/4/2025

  • John Cornyn

    TX • R

    Sponsored 12/4/2025

  • Mark Warner

    VA • D

    Sponsored 12/4/2025

  • John Thune

    SD • R

    Sponsored 12/4/2025

  • Sheldon Whitehouse

    RI • D

    Sponsored 12/4/2025

  • Bill Cassidy

    LA • R

    Sponsored 12/4/2025

  • Maggie Hassan

    NH • D

    Sponsored 12/4/2025

  • James Lankford

    OK • R

    Sponsored 12/4/2025

  • Catherine Cortez Masto

    NV • D

    Sponsored 12/4/2025

  • Steve Daines

    MT • R

    Sponsored 12/4/2025

  • Tina Smith

    MN • D

    Sponsored 12/4/2025

  • John Barrasso

    WY • R

    Sponsored 12/4/2025

  • Sen. Luján, Ben Ray [D-NM]

    NM • D

    Sponsored 12/4/2025

  • Thomas Tillis

    NC • R

    Sponsored 12/4/2025

  • Raphael Warnock

    GA • D

    Sponsored 12/4/2025

  • Marsha Blackburn

    TN • R

    Sponsored 12/4/2025

  • Peter Welch

    VT • D

    Sponsored 12/4/2025

  • Roger Marshall

    KS • R

    Sponsored 12/4/2025

  • Tim Scott

    SC • R

    Sponsored 12/16/2025

  • Shelley Capito

    WV • R

    Sponsored 12/16/2025

  • Lisa Blunt Rochester

    DE • D

    Sponsored 12/16/2025

  • Todd Young

    IN • R

    Sponsored 12/16/2025

  • James Risch

    ID • R

    Sponsored 1/5/2026

  • Martin Heinrich

    NM • D

    Sponsored 1/28/2026

Roll Call Votes

No roll call votes available for this bill.

View on Congress.gov

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