PBM Price Transparency and Accountability Act
Senate Bill Would Ban PBM "Spread Pricing" in Medicaid, Open Medicare Drug Networks
Stalled
No legislative action in over 90 days.
Legislative Progress
Key Points
- Medicaid: States would have to use a pass-through pricing model so PBMs can’t keep “spread” between what the state pays and what pharmacies get.
- Medicaid: HHS would run monthly surveys to set national drug cost benchmarks and publish results; pharmacies would have to respond or face penalties.
- Medicare drug plans: Starting in 2028, plans would have to let any pharmacy join the network if it accepts the plan’s standard terms, aiming to protect pharmacy choice.
- Medicare: HHS would set “reasonable” contract standards, create a complaint process for pharmacies, and allow penalties when plans break the rules.
- PBMs serving Medicare plans would have to file detailed annual reports on drug costs and payments, pass through certain price breaks, and allow audits; new federal funding supports oversight.
Impact Analysis
Personal Impact
Life & Work
The bill appropriates over $327 million to CMS, the HHS Inspector General, and other agencies to implement and oversee these new PBM transparency and accountability requirements. Federal employees at CMS and the OIG would take on significant new workload related to pharmacy surveys, PBM reporting, enforcement of contract standards, and investigation of complaints. This represents a substantial expansion of their regulatory responsibilities.
Programs
Disabilities
Milestones
Read twice and referred to the Committee on Finance.
Sent to a congressional committee for expert review. The committee decides whether this bill moves forward.
Introduced in Senate
The bill was officially filed and given a number. It now enters the legislative queue.
Votes
No votes have been recorded for this legislation yet.
Related News
3 articlesPBM Reforms, Restoration of Science Cuts Seen in $1.2T Spending Deal for 2026
The $1.2 trillion spending package passed in February 2026 includes PBM reforms that prohibit price-linked remuneration in Medicare Part D, ban spread pricing in Medicaid, and ensure reasonable pharmacy network contracting. The bill also expands HHS reporting and audit authority.
Senate leaders introduce bipartisan PBM reform bill
The bipartisan Senate bill aims to fix market distortions by mandating PBMs pass Medicaid payments directly to pharmacies and requiring participation in the NADAC survey. It also reinforces requirements for Medicare plans to contract with any pharmacy meeting standard terms.
Lawmakers introduce comprehensive PBM reform bill
A bipartisan group of House leaders introduced the Pharmacists Fight Back Act, which aligns with the Senate's PBM Price Transparency and Accountability Act. The legislation seeks to create a transparent reimbursement model using market-based pricing benchmarked to the NADAC.
Source Information
Document Type
Congressional Bill
Official Title
PBM Price Transparency and Accountability Act
Data Sources
Sponsor
Cosponsors
(26)Political Response
Analysis generated by AI. Always verify with official sources.