Pharmacy Benefit Manager Transparency Act of 2025

This bill prohibits unfair or deceptive practices by pharmacy benefit managers (PBMs) related to prescription drug pricing, requires transparency reporting, protects whistleblowers, and allows enforcement by the Federal Trade Commission (FTC) and state attorneys general.

Sec. 2, Prohibition on unfair or deceptive prescription drug pricing practices: It is unlawful for a PBM to charge a health plan more for a drug than it reimburses a pharmacy and keep the difference, to arbitrarily claw back pharmacy payments, or to arbitrarily increase fees or lower reimbursement to offset federal reimbursement changes. Exceptions apply if the PBM passes 100% of price concessions to the health plan and fully discloses costs, fees, and manufacturer remuneration.

Sec. 3, Prohibition on false information: It is unlawful to knowingly report false or misleading information about PBM services to a federal agency if the information was required by law and would affect the agency's statistical or analytical data on the PBM market.

Sec. 4, Transparency: PBMs must annually report to the FTC and the Secretary of Health and Human Services the aggregate difference between what they are paid by health plans and what they pay pharmacies, fees and clawbacks, reasons for moving drugs to higher-cost formulary tiers, and any reimbursement differences between affiliated and unaffiliated pharmacies. The FTC must submit reports to Congress on enforcement actions, complaints, and merger impacts, and a separate report on formulary design practices. The Government Accountability Office must study PBM roles, competition, rebates, and pricing practices.

Sec. 5, Whistleblower protections: PBMs, health plans, manufacturers, and pharmacies cannot discharge, demote, or discriminate against a covered individual for reporting a violation of this Act to Congress, federal agencies, state regulators, or law enforcement, or for participating in investigations. Violators may face jury trials and remedies including reinstatement, double back pay, and damages. Predispute arbitration agreements are invalid for disputes under this section.

Sec. 6, Enforcement: Violations are treated as unfair or deceptive acts under the FTC Act. The FTC can enforce against nonprofits and insurers. Civil penalties up to $1,000,000 per violation, with each day a separate violation. State attorneys general can bring civil actions on behalf of residents, with notice to the FTC. An affirmative defense exists if conduct was nonpretextual and necessary to comply with law, protect patient safety, or access.

Sec. 7, Protection of personal health information: Disclosures required by this Act must not include patient or prescriber identifying information.

Sec. 8, Effect on state laws: This Act does not preempt state laws.

Sec. 9, Definitions: Defines key terms including 'Commission' (FTC), 'covered individual', 'health plan', 'pharmacy benefit manager', 'pharmacy benefit management services', and 'prescription drug'.