Congress moves to ban hidden pharmacy middleman markups, forcing price transparency.
S. 3345 — PBM Price Transparency and Accountability Act · Filed by Mike Crapo (R-ID) · 27 cosponsors · Introduced Dec 4, 2025 · Referred to committee
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What it does
This bill requires pharmacy benefit managers (PBMs) and states to use transparent, pass-through pricing for prescription drugs under Medicaid and Medicare, banning 'spread pricing' (where PBMs pocket the difference between what they charge and what they pay pharmacies). It mandates detailed reporting on drug costs, rebates, and fees; establishes 'any willing pharmacy' participation rules for Medicare plans; and creates enforcement mechanisms with civil penalties for non-compliance. The bill aims to lower drug costs for beneficiaries and ensure independent pharmacies can participate in networks.
Why we flagged it
The bill's core mechanism is mandating transparent pass-through pricing for prescription drugs and eliminating hidden PBM markups, with extensive reporting and enforcement provisions. This is fundamentally a price-transparency and accountability measure targeting intermediary profit-taking.
What the text implies
- PBMs may respond by consolidating with pharmacy chains or manufacturers to maintain revenue, potentially reducing independent pharmacy participation despite 'any willing pharmacy' language.
- Detailed reporting requirements on rebates and manufacturer relationships may expose proprietary negotiating strategies, potentially shifting bargaining power toward large manufacturers.
- The 18-month implementation delay for non-retail pharmacies (mail, specialty) may create a two-tier system where mail-order and specialty drugs face different pricing rules than retail, complicating beneficiary navigation.
- Affiliate disclosure requirements may force PBMs to restructure ownership, but do not prevent them from operating as affiliates—only require transparency, leaving structural conflicts of interest intact.
- State Medicaid agencies will bear significant administrative burden to implement surveys and enforce penalties, potentially straining already-stretched state budgets despite federal appropriations.
Section numbers refer to the bill text the analysis read — linked under Primary records below.
Who it affects
Ordinary citizens benefit from lower out-of-pocket drug costs through transparent pricing, elimination of hidden spread pricing, and guaranteed access to independent pharmacies. However, implementation complexity and potential short-term disruption to pharmacy networks create modest offsetting costs.
Who stands to gain
- Independent retail pharmacies
- Medicare and Medicaid beneficiaries (lower out-of-pocket costs)
- State Medicaid programs (reduced spread pricing costs)
Named in the bill
Pharmacy Benefit Managers (PBMs), Medicare Part D plans, Medicaid programs, Centers for Medicare & Medicaid Services (CMS), Retail community pharmacies, Mail-order and specialty pharmacies, Drug manufacturers, Covered entities (340B program participants), PDP sponsors, MA organizations
Where it stands
27 cosponsors: 15 Republicans, 12 Democrats.
- Dec 4, 2025 — Introduced · Congress.gov: “Introduced in Senate”
- Dec 4, 2025 — Referred to Senate Committee on Finance · Congress.gov: “Read twice and referred to the Committee on Finance”
Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.
Money around this bill
22 lobbying clients named this bill on 28 disclosure filings across 2 quarters, Dec 2025 to Jun 2026. Those filings disclosed $40,474,656 in lobbying spend. A filing names 18 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 97% of bills with at least one filing.
Mike Crapo, the sponsor, reported $552,275 in PAC receipts in the 2026 cycle. $4,000 of that came from 1 PAC tied to these lobbying clients.
- Pharmaceutical Research and Manufacturers of America — $15,770,000 on 2 filings
- Pharmaceutical Care Management Association — $6,472,656 on 2 filings
- AARP — $5,300,000 on 1 filing
- CVS Health (and Subsidiaries) — $3,570,000 on 1 filing
- Amgen Inc — $2,440,000 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.
How this was measured
Analysis — Quorum's AI read the bill text published by Congress.gov (50,012 characters) on Aug 17, 2026. Section numbers in the findings refer to that text, linked below; transparency and hidden-provision scores are compared against the median of 16,222 analysed bills.
Status and sponsors — Congress.gov's bill record — actions, committee referrals and cosponsors — loaded nightly. The timeline shows status changes, not every procedural action.
Money — Senate Lobbying Disclosure Act filings whose specific-issue field names this bill for quarters ending Dec 2025 to Jun 2026. A filing's amount is reported whole beside the median number of bills a filing names; it is never divided across them. PAC receipts are FEC-reported contributions to the sponsor's candidate committee in the 2026 cycle.
As of — lobbying records through Jul 20, 2026 · page rendered 2026-10-20.
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