HR-4317 : Still Just a Bill

The Pharmacy Benefit Manager Reform Act of 2025 (H.R. 4317) aims to modify the role of Pharmacy Benefit Managers (PBMs) in federal healthcare programs. Key provisions include:

• Medicare Pharmacy Access: Requires Medicare prescription drug plans to allow participation from any pharmacy willing to meet standard contract terms and conditions. The Secretary must establish what the standard contract terms and conditions are.
• Essential Retail Pharmacy Protections: Mandates reports on reimbursement trends and pharmacy participation for "essential retail pharmacies" located in underserved areas, ensuring these pharmacies are sustained for beneficiaries.
• PBM Accountability: Holds PBMs accountable for contract violations and requires transparency in pricing and cost performance evaluations.
• Transparency and Oversight: Requires PBMs to disclose drug costs, rebates, and other financial arrangements to plan sponsors and the Secretary.
• GAO and MedPAC Studies: Directs the Comptroller General and the Medicare Payment Advisory Commission (MedPAC) to study and report on price-related compensation within the prescription drug supply chain.
• Group Health Plan Oversight: Requires entities providing pharmacy benefit management services on behalf of group health plans or health insurance issuers to submit reports on drug spending, rebates, and other remuneration.
• Medicaid Payment Accuracy: Directs the Secretary of Health and Human Services to survey retail community pharmacy drug prices and applicable non-retail pharmacy drug prices to determine national average drug acquisition cost benchmarks. This section also prevents states from using pricing information reported by applicable non-retail pharmacies to inform payment methodologies for retail community pharmacies.
• Medicaid Spread Pricing: Requires payment for drugs and related administrative services to be based on a transparent prescription drug pass-through pricing model.

The bill allocates funding for these initiatives to the Centers for Medicare & Medicaid Services Program Management Account, the Inspector General of the Department of Health and Human Services, and the Medicare Payment Advisory Commission.