The PBM Price Transparency and Accountability Act addresses hidden markups and lack of transparency in how pharmacy benefit managers handle prescription drug payments in Medicaid and Medicare. The bill requires the federal government to set fair pharmacy reimbursement standards based on actual drug costs, eliminates "spread pricing" practices where intermediaries pocket the difference between what they pay pharmacies and what states pay them, and mandates comprehensive reporting by PBMs on their pricing, rebates, and affiliate pharmacy relationships starting in 2028. The legislation establishes enforcement mechanisms including penalties up to $100,000 for violations, whistleblower protections for pharmacies, and an "any willing pharmacy" rule to ensure prescription drug plans accept qualified pharmacies in underserved areas. Congress has allocated approximately $322 million for implementing and overseeing these transparency and accountability requirements.
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