119th (2025–2027)
H.R. 4317
The PBM Reform Act of 2025 comprehensively regulates pharmacy benefit managers—the intermediaries that manage prescription drug benefits for insurance plans—by imposing strict transparency, accountability, and financial requirements across Medicare, group health plans, and Medicaid programs. The bill requires PBMs to open their pharmacy networks to qualified providers starting in 2029, restrict income to legitimate service fees only, submit detailed reports on drug costs and rebates to health plans and the government, and switch Medicaid to "pass-through pricing" that eliminates PBM profit margins on drug purchases. The legislation creates enforcement mechanisms with civil penalties up to $10,000 per day for non-compliance and $100,000 for knowingly providing false information, establishes reporting deadlines between 18 months and 30 months after enactment, and appropriates approximately $435 million for implementation and oversight by the Centers for Medicare & Medicaid Services, the HHS Inspector General, and other agencies. These reforms target both large employers and individual patients by requiring health plans to share detailed drug pricing information upon request while protecting patient privacy under HIPAA regulations.