PBMs must reveal hidden drug markups and rebate flows to health plans

What it does

This bill requires pharmacy benefit managers (PBMs) to provide detailed, transparent reports to health plans about drug pricing, rebates, and fees at least every six months. Plans and their participants can request specific information about what PBMs are paid, what pharmacies receive, and the markup between the two. The bill aims to expose hidden PBM profits and conflicts of interest, particularly when PBMs own affiliated pharmacies.

Why we flagged it

The bill's core mechanism is a mandatory disclosure regime for PBMs, requiring them to report detailed pricing, rebate, and fee data to health plans and participants. This is a transparency and accountability measure, not a price-control or subsidy mechanism.

What the text implies

• PBMs with affiliated pharmacies face heightened scrutiny and must disclose comparative pricing, potentially exposing conflicts of interest and steering practices that inflate costs for non-affiliated pharmacies.
• The 30-month implementation delay gives PBMs time to restructure contracts and reporting systems, but also delays transparency benefits to consumers.
• Disclosure of rebate flows to PBMs (separate from flows to plans) may reveal that PBMs retain significant portions of manufacturer rebates, a practice that has driven drug cost inflation.
• Plans and brokers receiving detailed PBM data may use it to switch vendors or renegotiate terms, creating competitive pressure on PBM margins and potentially lowering plan costs.
• The bill applies only to group health plans and health insurance issuers; individual/ACA marketplace plans are not covered, leaving a significant population without these transparency protections.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Ordinary people gain transparency into drug pricing and PBM markups that have historically been hidden, enabling plans to negotiate better rates and participants to understand their costs. The bill does not restrict access to drugs or impose new costs on consumers; it only requires disclosure of existing financial flows.

Who stands to gain

• Large employers and health plans (gain negotiating leverage through transparency)
• Participants and beneficiaries (gain visibility into pricing and can request claims-level data)

Named in the bill

Pharmacy Benefit Managers (PBMs), Health plans, Health insurance issuers, Drug manufacturers, Pharmacies (retail, mail order, specialty), Department of Health and Human Services, Department of Labor, Department of the Treasury

Where it stands

3 cosponsors: 2 Republicans, 1 Democrats.

• Mar 27, 2025 — Introduced · Congress.gov: “Introduced in House”
• Mar 27, 2025 — Referred to House Committee on Ways and Means and House Committee on Education and Workforce · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

7 lobbying clients named this bill on 10 disclosure filings across 3 quarters, Dec 2025 to Jun 2026. Those filings disclosed $10,030,000 in lobbying spend. A filing names 16 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 86% of bills with at least one filing.

Kristen McDonald Rivet, the sponsor, reported $1,610,092 in PAC receipts in the 2026 cycle. $12,000 of that came from 2 PACs tied to these lobbying clients.

• Elevance Health, Inc. — $4,010,000 on 2 filings
• America's Health Insurance Plans Inc (ahip) — $3,010,000 on 1 filing
• Boeing Company — $2,770,000 on 1 filing
• Society for Human Resource Management — $190,000 on 1 filing
• Soleno Therapeutics, Inc. — $50,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.