This bill, introduced in September 2026, creates new requirements for pharmacy benefit managers and prescription drug plans under Medicare Part D and commercial health insurance to increase transparency and control drug costs. Starting January 2028, pharmacy benefit managers must use a standardized bidding format that discloses all costs including service fees, rebates, and discounts, with commercial health plans required to report "net effective costs" beginning in 2028. The legislation establishes strict federal oversight through annual audits of at least one-third of Medicare plans, real-time cost-sharing tools for enrollees, and quarterly monitoring to ensure actual drug costs match projections within a 10 percent tolerance. Plans that exceed cost projections must provide explanations and corrective action plans, while those submitting false information face civil penalties up to $100,000, with additional penalties up to $25,000 per day for failing to provide data and up to $10,000 per violation for cost overruns. The bill empowers the Secretary of Health and Human Services to investigate pricing patterns, require restitution to enrollees when costs materially exceed projections, and terminate contracts with pharmacy benefit managers that cannot guarantee costs will not exceed what they promised.