S. 3345: PBM Price Transparency and Accountability Act

S. 3345 is a broad transparency and accountability bill aimed at pharmacy benefit managers, or PBMs, in both Medicaid and Medicare. On the Medicaid side, it tells the HHS Secretary to run a monthly survey of retail community pharmacies and certain non-retail pharmacies to build national average drug acquisition cost benchmarks. Pharmacies that receive payments or fees tied to Medicaid covered outpatient drugs would have to answer the surveys, and failure to respond, false information, or other non-compliance could trigger civil money penalties of up to $100,000 per violation. The bill also requires public posting of monthly response rates, sampling methods, and releasable price concession information, while giving the HHS Office of Inspector General $5,000,000 in FY 2026 for studies and $9,000,000 in FY 2026 and each year after for survey administration.

The Medicaid section also takes direct aim at spread pricing. For contracts taking effect on or after 18 months after enactment, states and PBMs or managed care entities would have to use a transparent prescription drug pass-through pricing model. That means payments are limited to ingredient cost plus a professional dispensing fee, those payments must be passed through in full to the pharmacy that fills the prescription, administrative fees must reflect fair market value, and spread pricing would be barred for purposes of federal matching payments. Plans and PBMs would also have to report all costs and payments by drug, including ingredient costs, dispensing fees, and all other remuneration, to both the state and the Secretary.

On the Medicare side, the bill would strengthen pharmacy access rules in Part D. For plan years beginning January 1, 2028, prescription drug plan sponsors would have to let any pharmacy into the network if it meets the plan's standard contract terms, and those terms must be "reasonable and relevant" under standards the Secretary must set. HHS has to issue a request for information by April 1, 2026, then establish those standards by the first Monday in April 2027. The bill also creates a practical definition of an "essential retail pharmacy" using distance cutoffs: no other pharmacy within 10 miles in rural areas, 2 miles in suburban areas, or 1 mile in urban areas. The Secretary must publish biennial reports from 2028 through 2034, and pharmacies get an allegation process plus anti-retaliation protections if they report contract violations.

The bill's other major Medicare change is tighter control of PBM compensation and better access to data. PBMs and their affiliates could not keep remuneration other than bona fide service fees, defined to mean a flat dollar amount at fair market value that is not tied to a drug's price or rebates. If they collect prohibited remuneration, they must disgorge it to the prescription drug plan sponsor. Beginning July 1, 2028, PBMs must file annual reports to plan sponsors and the Secretary with drug-specific information such as claims, dosage units, acquisition costs, rebates, and the percentage dispensed by affiliates. Plan sponsors would get annual audit rights, and Congress backs enforcement with $188,000,000 to the CMS Program Management Account for FY 2026, $113,000,000 to CMS for PBM accountability work in FY 2026, $20,000,000 to OIG in FY 2026, and $1,000,000 to MedPAC in FY 2026. A GAO study on price-related compensation structures would be due 2 years after enactment.