Patients Before Middlemen Act

Summary

Patients Before Middlemen Act This bill establishes certain standards and reporting requirements for prescription drug plan (PDP) sponsors, pharmacy benefit managers (PBMs), and pharmacies under the Medicare prescription drug benefit and Medicare Advantage. Specifically, the Centers for Medicare & Medicaid Services (CMS) must develop reasonable and relevant standards for contracts between PDP sponsors and pharmacies. The CMS must seek input from interested stakeholders when developing these standards. PDP sponsors are subject to civil penalties for violating these standards; PBMs must reimburse PDP sponsors for civil penalties that result from their responsibilities. The bill also requires the CMS to report periodically on essential retail pharmacies (i.e., pharmacies that serve as the only pharmacy within a certain radius) with respect to costs, contracts, and other specified information, particularly in relation to other types of pharmacies. Additionally, PBMs may not receive any income other than flat, bona fide service fees. PBMs must turn over any excess amounts they receive to PDP sponsors; PDP sponsors must turn over these amounts to the CMS. In addition, PBMs must report to PDP sponsors and to the CMS an itemized list of prescription drugs that were dispensed during the previous year and related data about costs, claims, affiliated pharmacies, and other specified information. PDP sponsors may audit PBMs to ensure compliance with these requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations. The bill's changes generally apply beginning in 2028.

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Timeline

1. 6 March 2025

   Introduced

   Read twice and referred to the Committee on Finance.

   Source: IntroReferral

2. 6 March 2025

   Introduced

   Introduced in Senate

   Source: IntroReferral

Votes

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Versions

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Documents

2 official files

• Introduced in Senate

  Introduced in Senate · EN · 6 March 2025

  ViewDownloadOpen at official source

• Introduced in Senate

  summary · EN · 6 March 2025

  Open at official source

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Sponsors

• Sen. Blackburn, Marsha [R-TN] · R · Sponsor
• Sen. Hassan, Margaret Wood [D-NH] · D · Sponsor
• Sen. Lankford, James [R-OK] · R · Sponsor
• Sen. Warner, Mark R. [D-VA] · D · Sponsor
• Sen. Marshall, Roger [R-KS] · R · Sponsor
• Sen. Welch, Peter [D-VT] · D · Sponsor
• Sen. Cortez Masto, Catherine [D-NV] · D · Cosponsor
• Sen. Cassidy, Bill [R-LA] · R · Cosponsor
• · ssfi00 · Standing

Related records

• related to → Bipartisan Health Care Act
• related to → Lower Costs for Everyday Americans Act