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PBM Reform Act of 2025

H.R. 4317 Rep. Earl Carter (R-GA-1) In committee
Bill text PDF
  1. Introduced Jul 10
  2. Committee Jul 10
  3. Passed House Next
  4. Passed Senate Not yet
  5. To President Not yet
  6. Law Not yet
Where it stands
In committee, Jul 10, 2025Next: House vote
475d ago Jul 10, 2025: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Final votes
No roll callsNo recorded vote on this bill yet
Lobbying
10companies, 27 filings
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21trades in the last 90 days
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Companies lobbying on this bill

10 companies
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Biotech & Pharma 5Financials 2Consumer & Retail 1Industrials 1Mining & Materials 1
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Summary

This bill aims to reform pharmacy benefit manager (PBM) practices to assure pharmacy access and choice for Medicare beneficiaries and improve transparency and accountability in drug pricing. It amends the Social Security Act and the Public Health Service Act to impose new requirements on PBMs, prescription drug plans, and state Medicaid programs.

Sec. 2, Assuring pharmacy access and choice for Medicare beneficiaries: This section requires Medicare Part D prescription drug plan sponsors to permit any willing pharmacy that meets standard contract terms to participate as a network pharmacy. The Secretary of Health and Human Services must establish standards for reasonable and relevant contract terms by April 2028, after issuing a request for information by April 2027. It also requires the Secretary to publish reports every two years until 2034 on trends in payments, pharmacy participation, and cost-sharing for essential retail pharmacies.

Sec. 3, Modernizing and ensuring PBM accountability: For plan years starting on or after January 1, 2028, this section requires that contracts between Part D plan sponsors and PBMs include provisions barring PBMs from deriving income other than bona fide service fees, with certain exceptions for incentive payments and rebates passed through to sponsors. It also mandates transparency in guarantees and cost performance evaluations.

Sec. 4, Oversight of pharmacy benefit management services: For plan years beginning 30 months after enactment, this section applies to group health plans and health insurance issuers. It prohibits contracts with entities that limit disclosure of information needed for reports. It requires PBMs to submit reports every six months (or quarterly upon request) to the group health plan, including detailed drug-level data on compensation paid and received.

Sec. 5, Ensuring accurate payments to pharmacies under Medicaid: This section amends Medicaid drug pricing surveys. It requires the Secretary to conduct surveys of retail and non-retail pharmacies to determine national average drug acquisition cost benchmarks, net of discounts and rebates. It mandates that pharmacies respond to such surveys and that survey information be made publicly available, including response rates and sampling methodology.

Sec. 6, Preventing the use of abusive spread pricing in Medicaid: This section requires that contracts between states and PBMs or managed care entities for Medicaid drug coverage use a transparent pass-through pricing model. Payments to pharmacies must be limited to ingredient cost plus a professional dispensing fee, with no spread pricing allowed. It also requires disclosure of all costs and payments to the state and Secretary, and annual publication of aggregated information.

Summary of the bill text as introduced in House (Jul 10, 2025), generated by SecBot from the official bill text; the Library of Congress summary is not yet published.

Official record from Congress.gov, the House Clerk and the Senate; lobbying from Lobbying Disclosure Act filings. Updated Oct 27, 2026.