PBM Price Transparency and Accountability Act

This bill changes how Medicaid and Medicare Part D pay for prescription drugs and oversee pharmacy benefit managers (PBMs). For Medicaid, it requires pharmacies to answer a monthly federal drug-cost survey, with fines up to $100,000 per violation, and requires state contracts with PBMs and managed care plans to pass drug payments through to pharmacies, with no 'spread pricing.' For Medicare Part D, it requires drug plans to let any pharmacy that accepts standard terms join their networks, sets up a process for pharmacies to report unreasonable contract terms, and limits PBM income to flat service fees. PBMs must also send yearly drug cost and rebate reports to plans and the government and allow yearly audits. The bill provides $188 million to the Centers for Medicare & Medicaid Services and $5 million to the HHS Inspector General for fiscal year 2026.

Full text and official record on Congress.gov

Sponsors

• Mike Crapo Republican sponsor
• 27 cosponsors