PBM Reform Back in Play: Senate Reintroduces Bipartisan Transparency Package
A major bipartisan push to overhaul pharmacy benefit managers (PBMs) is back on the Senate agenda. On Dec. 4, Senate Finance Committee Chair Mike Crapo (R-ID) and Ranking Member Ron Wyden (D-OR) reintroduced the Pharmacy Benefit Manager (PBM) Price Transparency and Accountability Act - a bill that revives core provisions from a bipartisan, bicameral health care package that came close to passing late last year.
At its center, the legislation aims to change how PBMs get paid and what they must disclose. Key provisions would:
- Delink PBM compensation from rebates tied to drug prices, separating rebate negotiations from the fees PBMs receive for benefit management services.
- Expand reporting requirements to ensure Medicare Part D plan sponsors and HHS receive clearer data on pricing, rebates, and related financial arrangements.
- Strengthen oversight by empowering plan sponsors to audit PBMs for contract compliance.
Supporters argue these changes would reduce incentives that can favor higher list prices and make it easier for plans—and regulators—to see how money moves through the prescription drug supply chain.
The bill also takes direct aim at spread pricing in Medicaid managed care—where a PBM may charge a payer more than it reimburses the pharmacy and keep the difference. The proposal would:
- Bar spread pricing in PBM contracts with Medicaid managed care organizations.
- Require PBMs to pass through the full cost of the drug and all associated rebates, discounts, and fees to the dispensing pharmacy or provider.
For states and Medicaid stakeholders, these provisions are framed as cost-containment tools and a step toward clearer, more predictable pharmacy reimbursement.
Another theme is protecting access—especially for independent and non-PBM-affiliated pharmacies. The bill would reinforce “any willing pharmacy” requirements in Medicare Part D, emphasizing that plans should allow any pharmacy meeting standard terms to participate in-network.
It also includes a Medicaid-focused provision that would require retail community pharmacies to participate in the National Average Drug Acquisition Cost (NADAC) survey, intended to support more accurate reimbursement benchmarks.
The reintroduction comes amid renewed pressure on Congress to enact the PBM reforms that were part of a broader December 2024 health care agreement that ultimately stalled. That earlier package paired PBM reforms with other policies—such as FDA ingredient assessment transparency (Q1/Q2) to streamline generic approvals and patent-related provisions aimed at preventing brand manufacturers from extending exclusivity through multiple patents.
While pieces of that broader package have moved independently in the House, PBM reform remains the focal point for many stakeholders—especially community pharmacy groups that warn of shrinking margins and growing “pharmacy deserts.”
The bill’s bipartisan sponsorship signals real momentum, but the path forward will depend on whether PBM reforms can advance on their own—or get pulled back into a larger year-end health or funding package. Either way, the Senate is again signaling that PBM practices, pharmacy access, and drug pricing transparency are front-and-center issues for the next round of health policy negotiations.
