Bill > HR4317

This bill, titled the "Pharmacy Benefit Manager Reform Act of 2025," aims to enhance transparency, accountability, and fairness in pharmacy benefit management (PBM) services across Medicare, group health plans, and Medicaid. The bill introduces several key provisions designed to reform how pharmacy benefit managers operate and interact with pharmacies, health plans, and drug manufacturers. The bill focuses on several main areas of reform. For Medicare Part D, it requires prescription drug plans to permit any willing pharmacy that meets standard contract terms to participate in their network, and establishes standards for reasonable and relevant contract terms. It also introduces reporting requirements for essential retail pharmacies, particularly those in underserved or rural areas. For pharmacy benefit managers, the bill mandates significant transparency measures, including detailed reporting requirements about drug pricing, rebates, discounts, and administrative fees. PBMs will be required to provide comprehensive semi-annual reports to group health plans, covering information such as drug costs, rebates, out-of-pocket spending, and pharmacy network details. The bill also restricts PBMs from deriving income from sources other than bona fide service fees and requires them to pass through manufacturer rebates fully to health plans. In the Medicaid context, the bill aims to prevent spread pricing by requiring transparent prescription drug pass-through pricing models, where PBMs can only charge limited administrative fees and must pass through the full payment to pharmacies. It also establishes new survey mechanisms to track drug acquisition costs and imposes penalties for non-compliance. The legislation includes enforcement mechanisms, such as civil monetary penalties for violations, and requires regular reporting and oversight by various government agencies. Additionally, the bill appropriates funding to support the implementation of these new requirements across different healthcare programs.

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https://www.congress.gov/bill/119th-congress/house-bill/4317/all-info