Pharmacy Benefit Manager Transparency Act of 2025

Key Points

• This bill targets pharmacy benefit managers (PBMs), the middlemen between drug makers, insurance companies, and pharmacies. It bans deceptive pricing practices, requires financial transparency, and gives the FTC new enforcement power over these companies.
• The bill bans "spread pricing," where a PBM charges an insurance plan more for a drug than it pays the pharmacy, then pockets the difference. PBMs can avoid this rule only if they pass 100% of all rebates and price concessions back to the health plan.
• PBMs would be blocked from clawing back payments they already made to pharmacies, unless the original claim was fraudulent, inconsistent with the contract, or the services were never actually provided. This protects pharmacies from unexpected revenue losses.
• PBMs must file annual reports with the FTC and HHS showing the difference between what they charge health plans and what they pay pharmacies, all fees charged to pharmacies, and explanations for moving drugs to more expensive formulary tiers.
• The FTC can fine violators up to $1 million per violation, with each day of a continuing violation counting separately. State attorneys general can also bring their own lawsuits to enforce the law on behalf of their residents.
• The bill includes strong whistleblower protections. Employees who report violations cannot be fired, demoted, or harassed, and they can sue for double back pay, reinstatement, and legal fees. Pre-dispute arbitration agreements cannot block these claims.

Votes

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Related Bills

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