Bill · H.R. 10369· House(119-HR-10369)
Net Effective Cost Transparency and Prescription Drug Affordability Act of 2026
- Introduced
- 9/14/2026
- Last activity
- 9/14/2026 — Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, 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.
- Sponsored by
- Ryan Mackenzie
- Cosponsors
- - 2 - 2
- Introduced
- In Committee
What this bill would do
This bill is called the Net Effective Cost Transparency and Prescription Drug Affordability Act of 2026. It sets up new rules for pharmacy benefit managers under Medicare Part D, Medicare Advantage plans, and commercial health plans governed by the Employee Retirement Income Security Act of 1974. The legislation requires prescription drug plan sponsors to use a standardized public bidding process when hiring pharmacy benefit managers. It also creates oversight tools, audits, cost-sharing comparisons, and performance ratings to monitor costs. Finally, the bill establishes civil monetary penalties and restitution requirements for plans or pharmacy benefit managers that fail to meet these cost and transparency rules.
Yes· 3 of 10
Does this make what the government does easier for the public to see?+7
The legislation mandates public reporting of pharmacy benefit manager bids, actual versus projected cost comparisons, and star ratings.
Would people over 65 be better off under this?+6
Seniors enrolled in Medicare Part D and Medicare Advantage benefit from clearer drug pricing, real-time cost tools, and protection against cost spikes.
Would retired people be better off under this?+6
Retirees experience enhanced financial protections and greater transparency regarding prescription drug pricing in their Medicare plans.
The opposite
No question was scored the opposite.
Who it would affect, and how
Potential Positive Impacts for People
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Better Cost Tracking for Medicare Enrollees: Section 2 requires plan sponsors to maintain a real-time cost-sharing tool. This tool shows the actual net cost of covered drugs for the sponsor, the Secretary, and the enrollee, helping people see clear pricing information.
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Protection Against Unexpected Cost Hikes: Section 2 creates guarantees on net effective costs and requires pharmacy benefit managers to pay penalties and allow contract terminations if actual costs exceed projections by more than an established percentage. This helps protect individuals from runaway expenses.
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Refunds for Incorrectly Collected Money: Section 2 mandates that plans maintain funds in an escrow account to refund enrollees for any amounts incorrectly collected during the plan year.
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Quality Ratings and Low-Performance Warnings: Section 3 establishes a 5-star rating scale for prescription drug cost performance in Medicare Advantage plans. Plans receiving 2 stars or below must notify enrollees of their performance and provide information on alternative plan options during the annual enrollment period.
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Commercial Plan Transparency: Section 4 amends the Employee Retirement Income Security Act of 1974 to require a description of projected net effective costs in uniform formats for commercial health plans, giving individuals and group health plans clearer visibility into pharmacy benefit management bids.
Potential Negative Impacts for People
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Potential Administrative Costs and Burdens: Section 2 imposes extensive bidding, auditing, quarterly reporting, and real-time tool maintenance requirements on plan sponsors and pharmacy benefit managers. These heavy administrative burdens could potentially lead to higher operational costs that might indirectly affect consumers or taxpayers.
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Risk of Plan Disruption from Corrective Actions: Section 2 and Section 3 allow for contracts to be terminated without penalty and require corrective action plans when costs deviate beyond acceptable thresholds. If a plan or pharmacy benefit manager fails to meet standards or terminates a contract, enrollees could face mid-year disruptions in their prescription drug management or coverage options.
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Hover a score for the reason it gave.
- Demographic And Interest Groups
- Good For Retirees+6Good For Seniors+6Good For Low Income Households+4Good For Middle Class Households+4
- Governance And Ideology
- Improves Government Transparency+7Increases Federal Power+4
- Economy And Finance
- Improves Consumer Protection+5Improves Fiscal Responsibility+4
- Healthcare
- Reduces Prescription Drug Costs+6Reduces Private Insurance Premiums+3
- 9/14/2026
- Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, 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.
- 4 Cosponsors added.
- Introduced in House
Jake AuchinclossDemocrat · Massachusetts
Rick AllenRepublican · Georgia
Carol MillerRepublican · West Virginia
Lucy McBathDemocrat · Georgia