Pharmacy Benefit Manager Transparency Act of 2025

Protection against unfair pricing: The bill prohibits pharmacy benefit managers from charging a health plan a different amount for a drug's cost than what they reimburse the pharmacy while keeping the difference (Section 2(a)(1)).

Prevention of arbitrary reimbursement changes: It stops pharmacy benefit managers from arbitrarily or deceptively reducing or clawing back reimbursement payments to pharmacies (Section 2(a)(2)).

Increased transparency for consumers and payers: The Act requires pharmacy benefit managers to disclose costs, prices, and all fees or discounts to health plans and pharmacies (Section 2(b)(2)).

Enhanced accountability through reporting: Pharmacy benefit managers must report aggregate amounts regarding price differences, fees, and any drug movements to higher-cost formulary tiers (Section 4(a)).

Protection for whistleblowers: Individuals who report suspected violations are protected from being fired, demoted, or harassed (Section 5(a)).

Legal recourse for employees: Employees facing retaliation can bring actions for reinstatement, back pay, and damages (Section 5(b)).

Empowerment of State officials: State attorneys general are authorized to bring civil actions on behalf of their residents if their interests are threatened by these practices (Section 6(b)(1)).

Exceptions to pricing prohibitions: Pharmacy benefit managers are not in violation of certain pricing rules if they pass along 100 percent of price concessions or rebates to the health plan or payer (Section 2(b)(1)).

Potential for industry mergers: The bill requires the Commission to analyze whether its requirements might lead to mergers among pharmacy benefit managers or pharmacies, which could impact competition (Section 4(b)(1)(E)).

Privacy of information: The Commission is prohibited from disclosing information that constitutes a trade secret or confidential information, except when necessary for enforcement (Section 4(b)(3)).