PBM Transparency Act of 2025

Summary#

This bill, the Pharmacy Benefit Manager Transparency Act of 2025, sets rules for pharmacy benefit managers (PBMs). It makes certain PBM actions illegal, requires regular public-interest reporting to federal agencies, bans knowingly reporting false information to agencies, and gives whistleblowers protections. The Federal Trade Commission (FTC) enforces the law, and the Government Accountability Office (GAO) must study PBM market practices. The bill also protects patient privacy in reports and does not override state laws.

What it means for you#

  • If you work for or run a PBM: the bill bans keeping the difference when a PBM charges a health plan more than it reimburses a pharmacy; bans arbitrary "clawbacks" that reduce pharmacist payments; and bans raising fees to offset federal reimbursement changes unless specific conditions are met. PBMs must annually report detailed payment and fee information to the FTC and HHS and explain certain formulary changes.
  • If you are a pharmacist or pharmacy: the bill limits some ways PBMs can reduce or rescind reimbursements and requires PBMs to report clawbacks and fees affecting pharmacies.
  • If you are a health plan or payer: PBMs must disclose the amounts they were paid and what they paid pharmacies, and must pass through 100% of price concessions to avoid some prohibitions.
  • If you are a patient: the bill requires PBMs to report when drugs move to higher-cost formulary tiers and why, but it does not directly change benefits or set prices in the text of the bill.

Expenses#

  • The bill creates reporting and study requirements for PBMs, the FTC, HHS, and the GAO. No line-item budget or cost estimates are included in the bill text.
  • The bill authorizes civil penalties of up to $1,000,000 for violations. No other implementation cost figures or funding amounts are provided in the bill text.

Proponents' View#

  • The bill states its purpose is "to prevent unfair and deceptive acts or practices and the dissemination of false information" about PBM services. Sponsors built rules to increase disclosure of PBM costs, fees, rebates, and reimbursements; to stop certain pricing practices; to require explanations for formulary changes; and to protect employees who report violations. The bill also directs studies and reports intended to inform Congress about PBM market structure and practices.

Opponents' View#

No publicly available information.