Net Effective Cost Transparency and Prescription Drug Affordability Act of 2026

This bill would require companies that run Medicare Part D drug plans, starting in 2028, to collect bids from pharmacy benefit managers (PBMs) in a standard format and to justify to the federal government any choice other than the lowest projected net drug cost. It would add federal audits of at least one-third of plan sponsors each year, require plans to keep escrow funds for enrollee refunds, and set civil fines for false bid information, missing information, and costs that exceed bid projections by more than a set percentage. It would add a drug cost performance measure to Medicare Advantage star ratings, with low-rated plans required to notify enrollees. It would also require employer health plan service providers to disclose the projected net effective cost of each PBM bid received.

Full text and official record on Congress.gov

Sponsors

• Ryan Mackenzie Republican sponsor
• 4 cosponsors