WASHINGTON, D.C.— U.S. Senate Finance Committee Chairman Mike Crapo (R-Idaho) and Ranking Member Ron Wyden (D-Oregon) have introduced bipartisan legislation aimed at increasing transparency and oversight of pharmacy benefit managers (PBMs) in federal prescription drug programs. The measure, titled the Pharmacy Benefit Manager (PBM) Price Transparency and Accountability Act, is designed to reduce out-of-pocket costs for patients while strengthening protections for independent pharmacies, particularly in rural communities.
Crapo said the legislation is intended to curb practices that allow PBMs to profit by overcharging patients, adding that the reforms are a significant step toward making the prescription drug market more transparent and easier to navigate. Wyden described the proposal as a comprehensive effort to limit business practices that he says are driving up prices for seniors and taxpayers who rely on Medicare.
The bill seeks to restructure how PBMs are compensated by eliminating financial incentives tied to higher-priced medications. It also expands reporting requirements for PBMs to Medicare Part D plan sponsors and the U.S. Department of Health and Human Services, while giving plan sponsors more authority to audit PBM compliance. In addition, the proposal reinforces existing rules requiring plan sponsors to contract with any pharmacy willing to meet standard terms, a provision aimed at helping small and independent pharmacies stay competitive. The legislation further requires retail community pharmacies to participate in the National Average Drug Acquisition Cost survey so Medicaid payments more accurately reflect real drug acquisition costs. It also mandates that PBMs pass Medicaid payments directly to pharmacies to ensure states and taxpayers have a clearer view of drug pricing structures.
More than 20 senators from both parties have signed on as co-sponsors, including lawmakers from Wyoming, Colorado, Tennessee, Nevada, Louisiana, New Hampshire, Texas, New Mexico, Montana, Minnesota, Iowa, Virginia, Oklahoma, Georgia, Kansas, Vermont, South Dakota, Rhode Island and North Carolina. The broad support underscores a growing bipartisan push to increase transparency in the pharmaceutical supply chain and address concerns about rising drug costs.
