PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Congressional Research Service
No official summary is available in the imported record yet.
People & committees
Rep. Mackenzie, Ryan [R-PA-7] · R–PA
Legislative record
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Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Sep 22, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2026-09-14 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
This bill would change how Medicare prescription drug plans hire and oversee pharmacy benefit managers—the businesses that manage drug benefits for plans. It would require standardized bidding, comparisons of promised and actual costs, and penalties for certain failures. It would also add drug-cost performance ratings and standardized projected-cost disclosures for benefit-manager bids received by covered service providers on covered commercial plans’ behalf. These are proposed requirements; the supplied record does not establish enactment.
Requiring standardized public bidding process for pharmacy benefit managers
The Secretary shall periodically compare actual costs incurred in connection with the plan to the projected costs included in the bid
A PDP sponsor that provides false or misleading information (including a material omission) in a bid submission under section 1860D–11(b) shall be subject to a civil monetary penalty
the Secretary shall establish a performance measure for MA–PD plans for purposes of evaluating prescription drug cost variations.
A description, in a uniform format, of the projected net effective cost for the applicable plan year for each bid received by the covered service provider on behalf of the covered plan from an entity providing pharmacy benefit management services.
2026-09-14: Introduced in House
For plan years beginning January 1, 2028, or later, Medicare Part D plan sponsors would have to solicit pharmacy benefit manager bids annually before contracting for those services. Sponsors would submit the bid information to the Secretary, demonstrate that they considered every qualifying bid, and justify selecting a bid other than the lowest projected-cost option.
For plan years beginning on or after January 1, 2028, each contract entered into with a PDP sponsor under this part with respect to a prescription drug plan offered by such sponsor shall provide that such sponsor may only enter into a contract with a pharmacy benefit manager to provide pharmacy benefit management services on behalf of such sponsor during such plan year if such sponsor— (A) solicits bids for such pharmacy benefit management services in accordance with the process under paragraph (2)
information sufficient to demonstrate that the sponsor accepted and considered all bids submitted by a pharmacy benefit manager containing the information described in paragraph (2)(B) in the uniform format specified by the Secretary
(ii) the information described in paragraph (2)(B) received from each such pharmacy benefit manager in connection with each such bid; and (iii) in the case that the bid selected at the conclusion of the process described in subparagraph (A) is not the bid with the lowest projected net effective cost, information sufficient to support a finding under paragraph (3)
Bids would use a uniform format and include a completeness and accuracy attestation from an officer of the plan sponsor. Sponsors would give bidders necessary enrollment, drug-use, covered-drug-list, and benefit-design information free of charge. They would accept all bids containing the required information without additional participation conditions.
(i) requires each bid to contain— (I) the information described in subparagraph (B) in a uniform format specified by the Secretary; and (II) an attestation of completeness and accuracy from an officer of the PDP sponsor
makes available at no cost to each pharmacy benefit manager submitting a bid such information, presented in a uniform format, as the Secretary determines necessary to enable the pharmacy benefit manager to submit a responsive bid, including— (I) projected enrollment; (II) historical utilization data; (III) formulary design parameters; and (IV) benefit design parameters
accepts all bids from pharmacy benefit managers containing the information described in paragraph (2)(B) in the uniform format specified by the Secretary, without imposing any additional conditions for participation in the bidding process
The bidding process would follow requirements consistent with specified federal purchasing rules, including seeking multiple qualified bidders, explaining limited competition or single-provider contracts, limiting contract duration, and keeping documentation. The Secretary could apply other relevant federal purchasing requirements.
requirements for solicitation of multiple qualified bidders, evaluation criteria, justification procedures for limited competition or sole-source contracting, contract duration limits, enforcement mechanisms, and minimum documentation standards consistent with part 15 of subchapter C of chapter 1 of title 48, Code of Federal Regulations
such other requirements from the relevant provisions of chapter 33 of subtitle C of subtitle I of title 41, United States Code, and the regulations under chapter 1 of title 48, Code of Federal Regulations, as the Secretary determines appropriate.
Bids would disclose expected service fees, incentive payments, rebates and other price reductions, drug use and costs, amounts associated with affiliated pharmacies, pharmacy dispensing payments, and average enrollee cost sharing—the portion paid by the patient. They would include projected “net effective cost,” defined as the sponsor’s total annual cost of covered drugs on the plan’s covered-drug list furnished to its enrollees, plus differences between projected and actual costs for the latest three years with available data.
The total dollar amount that the pharmacy benefit manager expects to receive in connection with services performed on behalf of the sponsor— (I) as bona fide service fees (as defined in section 1860D–12(h)(7)(B)); (II) as incentive payments (as described under section 1860D–12(h)(1)(A)(ii)); and (III) as price concessions, including rebates, discounts, and other direct or indirect remunerations received from all pharmacy and non-pharmacy sources.
(I) the aggregate expected utilization of all such drugs; (II) the aggregate wholesale acquisition cost for all such drugs; (III) the aggregate amount expected to be received by the pharmacy benefit manager, from all pharmacy and non-pharmacy sources, as price concessions, including rebates, discounts, and other direct or indirect remunerations in connection with all such drugs, displayed as a percentage of such aggregate wholesale acquisition cost; (IV) of the amount described in subclause (III), the aggregate amount expected to be attributable to such drugs dispensed by a pharmacy that is an affiliate (as defined in section 1860D–12(h)(7)(A)) of the pharmacy benefit manager; (V) the aggregate net ingredient cost for all such drugs; (VI) the average payment to a pharmacy for dispensing all such drugs; and (VII) the average cost sharing, in dollars, for an enrollee in such plan with respect to all such drugs.
(iii) The projected net effective cost for such year. (iv) With respect to the most recent 3-year period for which data is available, a description of any variation between the projected net effective cost and the actual net effective cost.
the term net effective cost means, with respect to a prescription drug plan offered by a PDP sponsor and a plan year, the total cost to such sponsor of all covered part D drugs included on the formulary of the plan that are furnished to all enrollees in such plan for such year.
The Secretary would publish the submitted bid data annually in combined form with identifying information removed. Regulations implementing the bidding-process paragraph would be due within 180 days after its enactment.
The Secretary shall annually publish, in an aggregated, deidentified format, the information described in subparagraph (B) and submitted to the Secretary in accordance with paragraph (1)(B)(ii).
Not later than 180 days after the date of enactment of this paragraph, the Secretary shall promulgate regulations to carry out this paragraph.
A sponsor selecting a bid other than the lowest projected-cost bid would have to submit information supporting a finding that the choice is necessary to advance a significant program interest. The Secretary could make that finding only if documented determinations show that the interest materially benefits enrollees or advances statutory objectives, is not already reflected in the cost calculation, and cannot reasonably be achieved through the lowest-cost bid. Its importance must clearly outweigh the extra cost, and approval must represent a reasonable and efficient use of federal resources. The supplied text does not expressly require Secretary approval before the sponsor selects the bid.
in the case that the bid selected at the conclusion of the process described in subparagraph (A) is not the bid with the lowest projected net effective cost, information sufficient to support a finding under paragraph (3) that the selection of the bid so selected is necessary to advance a significant programmatic interest identified by such sponsor.
the Secretary may find that selection of such bid is necessary to advance a significant programmatic interest identified by such sponsor
(i) the programmatic interest identified by the sponsor materially benefits enrollees under the plan, or advances statutory program objectives; (ii) the programmatic interest is not already reflected in the calculation of the net effective cost of the plan; (iii) the programmatic interest cannot reasonably be achieved through selection of the bid with the lowest projected net effective cost received by the sponsor; (iv) the importance of the programmatic interest clearly outweighs the additional cost under this part; and (v) approval of the bid represents a reasonable and efficient use of Federal resources
each determination under subparagraph (A) is supported by documentation sufficient for congressional oversight, audit, and program review purposes.
A sponsor providing its own pharmacy benefit management services would also face the bidding requirements if it provides those services for another sponsor during the same year. The provision expressly covers that defined group of sponsors.
In the case of a PDP sponsor described in subparagraph (B) that intends to provide its own pharmacy benefit management services for a year, the requirements under this subsection shall apply with respect to such sponsor as if such sponsor were entering into a contract with a pharmacy benefit manager to provide such services.
a PDP sponsor described in this subparagraph is, with respect to a year, a PDP sponsor that provides pharmacy benefit management services on behalf of another PDP sponsor for such year.
Starting with plan years beginning January 1, 2028, or later, sponsors would periodically report information allowing comparison of actual patient charges with their bids. They would maintain a real-time tool showing each covered drug’s actual cost after negotiated price reductions to the sponsor, Secretary, and enrollee. Sponsors would also hold enough money in an escrow account to refund incorrectly collected amounts.
For plan years beginning on or after January 1, 2028, each contract entered into with a PDP sponsor under this part with respect to a prescription drug plan offered by such sponsor shall require such sponsor to— (A) periodically submit to the Secretary, at such time and in such form as the Secretary may require, information sufficient to allow the Secretary to compare actual cost-sharing for enrollees in the plan to the cost-sharing described in the bid
maintain a real-time cost-sharing tool that reflects, with respect to each covered part D drug included on the formulary of such plan, the actual cost of such drug (net of any price concessions, including rebates, discounts, and other direct or indirect remunerations negotiated in connection with such drug) to— (i) the sponsor; (ii) the Secretary; and (iii) the enrollee
maintain in an escrow account sufficient funds to refund to enrollees in the plan any amounts incorrectly collected for such year
Beginning with 2028 plan years, annual audits would cover at least one-third of Part D sponsors. Audits would compare delivered coverage and patient charges with approved bids. For plans charging patients a percentage of drug costs across different tiers, audits would check dollar payments against the maximum amounts reflected in the bid and marketed at enrollment. Sampling and estimates based on samples would be permitted to the extent used in other Part D audits.
For plan years beginning on or after January 1, 2028, the Secretary shall carry out the following oversight activities
Annual audits (i) In general The Secretary shall audit not less than one-third of all PDP sponsors with a contract to offer a prescription drug plan under this part to verify that the prescription drug coverage provided under the plan reflects the prescription drug coverage proposed to be provided under the bid
the cost-sharing amounts paid by enrollees under the plan, expressed as dollar amounts, and whether such amounts are consistent with the cost-sharing described in the bid
in the case that such plan implements tiered cost-sharing, and provides for such cost-sharing to be imposed as coinsurance, whether the cost-sharing amounts paid by enrollees, expressed as dollar amounts, are consistent with (and do not exceed) the maximum allowable cost-sharing reflected in such bid (and marketed to enrollees at the time of plan selection), as determined on the basis of actual out-of-pocket costs.
the Secretary may use sampling and extrapolation methodologies to the extent that such methodologies are used in connection with other audits under this part.
The Secretary would compare actual and projected costs, including quarterly cost differences and the effect of midyear covered-drug-list changes on patient charges. If a quarter’s cost variation exceeds the regulatory threshold, the sponsor would receive notice and have 30 calendar days to provide a written explanation and corrective action plan.
Such comparison shall include— (i) a quarterly analysis of any variation between the projected and actual net effective cost (as defined in subsection (i)(5)); and (ii) an analysis of the impact of any mid-year formulary changes on the cost-sharing of enrollees in the plan.
If, pursuant to subparagraph (B)(i), the Secretary determines that the actual net effective cost incurred by a PDP sponsor for a calendar quarter varies from the projected net effective cost included in the bid submitted under section 1860D–11(b)(2)(C)(v) by more than the percentage established under clause (ii), the Secretary shall— (I) provide notice to the PDP sponsor of such variation; and (II) require the PDP sponsor to submit, not later than 30 calendar days after such notice— (aa) a written explanation of such variation; and (bb) a corrective action plan to address such variation.
The Secretary would set the acceptable cost-variation threshold by regulation, at no more than 10 percent. In setting it, the Secretary would consider historical spending variation, expensive drugs, changes in drug use and clinical practice, rebates, enrollment, benefit design, and other material factors beyond the sponsor’s or benefit manager’s control.
the Secretary shall establish, through rulemaking, a percentage (not to exceed 10 percent) that represents an acceptable level of variation between the projected and actual net effective cost for a year.
(I) historical variation in spending under this part; (II) the impact of high-cost covered part D drugs on overall spending under this part; (III) changes in drug utilization, formulary composition, and clinical practice patterns; (IV) variability in price concessions, including rebates, discounts, and other direct or indirect remunerations; (V) differences between projected and actual enrollment, and differences between projected and actual enrollee characteristics; (VI) plan benefit designs and cost-sharing structures; and (VII) other factors beyond the control of the PDP sponsor, or the pharmacy benefit manager providing pharmacy benefit management services on behalf of such sponsor, that may materially affect costs.
The Secretary could audit particular drugs, pharmacies, or statistically valid samples of claims. These audits could investigate cost differences, check consistency with bid assumptions, and assess financial advantages to benefit managers or affiliates that were not reasonably reflected in the bid.
The Secretary may conduct an item-level audit of a prescription drug plan under this part, including an audit on the basis of a specific covered part D drug, a specific pharmacy, or a statistically valid sample of individual claims
(I) identifying the cause of any variation between the projected and actual net effective cost for a year; (II) verifying that costs incurred under the plan are consistent with the assumptions and information included in the bid submitted under section 1860D–11(b); and (III) assessing whether pricing, reimbursement, or utilization patterns result in a differential financial benefit to a pharmacy benefit manager or an affiliate (as defined in subsection (h)(7)(A)) that is not reasonably reflected in the net effective cost or other information submitted in such bid.
The Secretary would monitor covered-drug-list changes throughout the year for patterns the bill calls beneficiary bait-and-switch practices. These include materially higher costs than the bid described, systematic shifts toward drugs or pharmacies not reasonably reflected in the bid, or other substantial coverage changes reasonably expected to affect a person’s enrollment choice.
The Secretary shall monitor changes to the formulary of a prescription drug plan under this part throughout the plan year to identify patterns that may constitute beneficiary bait-and-switch practices.
a pattern of formulary changes or related utilization management practices that, in the aggregate— (I) materially increase enrollee cost-sharing or overall costs relative to the coverage described in the bid submitted under section 1860D–11(b); (II) result in a systematic shift in utilization toward certain covered part D drugs, pharmacies, or other arrangements (including through the preferential placement of drugs or the use of pharmacies or affiliates of a pharmacy benefit manager) that were not reasonably reflected in such bid; or (III) otherwise have the effect of materially altering the prescription drug coverage offered under the plan in a manner that would reasonably be expected to affect an enrollee’s plan selection at the time of enrollment.
A public report would compare actual and projected costs across all Part D sponsors and describe any combined savings attributable to the benefit-manager bidding process. Requiring this report does not establish that savings would occur.
The Secretary shall make publicly available a report comparing the actual costs incurred in connection with a prescription drug plan under this part to the projected costs included in bids submitted under section 1860D–11(b)(2). Such comparison shall be aggregated across all PDP sponsors, and shall describe any aggregate savings attributable to the bidding process required under subsection (i) (in relation to pharmacy benefit managers).
Sponsors would face civil penalties of up to $100,000 per violation for false or misleading bid information, including material omissions; up to $25,000 per calendar day for failing to provide required information, until corrected; and up to $10,000 per violation when annual actual net effective cost exceeds the projection by more than the regulatory threshold. The last penalty would account for the size and duration of the excess.
A PDP sponsor that provides false or misleading information (including a material omission) in a bid submission under section 1860D–11(b) shall be subject to a civil monetary penalty of not more than $100,000 per violation.
A PDP sponsor that fails to provide any information required to be provided under section 1860D–11(b) or subsection (i) or (j) shall be subject to a civil monetary penalty of not more than $25,000 per calendar day until such failure is corrected.
In the case that the actual net effective cost (as defined in subsection (i)(5)) for a prescription drug plan under this part and a plan year exceeds the projected net effective cost for such plan included in the bid submitted under section 1860D–11(b) by more than the percentage established under subsection (j)(2)(C)(ii), the PDP sponsor offering such plan shall be subject to a civil monetary penalty of not more than $10,000 per violation. In determining the amount of such penalty, the Secretary shall take into account the magnitude and duration of such deviation.
When actual annual costs materially exceed projected costs, the Secretary could require sponsors to refund enrollees amounts retained by the sponsor, benefit manager, or its affiliate that are attributable to the difference. This could include costs not directly charged to patients. Refunds would be coordinated with the referenced existing refund rule where feasible, and penalties would be reviewable in federal district court.
actual costs for a prescription drug plan under this part and a plan year (including amounts associated with enrollee cost-sharing and other amounts not directly charged to enrollees) materially exceeds the projected costs for such plan included in the bid submitted under section 1860D–11(b), the Secretary may require the PDP sponsor offering such plan to refund plan enrollees for such amounts retained by the sponsor, a pharmacy benefit manager providing pharmacy benefit management services on behalf of such sponsor, or an affiliate of such pharmacy benefit manager as are attributable to such disparity.
To the extent feasible, the Secretary shall coordinate the application of this subparagraph with the requirements under section 423.294(b) of title 42, Code of Federal Regulations (or a successor regulation).
Any penalty imposed under this paragraph shall be subject to judicial review in the United States district court for the district in which the violation occurred, consistent with section 1128A(e).
Benefit-manager agreements would guarantee that annual actual net effective cost stays within the permitted excess over projected cost, with periodic reconciliation set by the Secretary. Exceeding that limit would require a payment to the sponsor of up to $10,000 per violation and allow the sponsor to end the contract without penalty. Sponsors could also end contracts without penalty when the benefit manager fails to provide information needed for oversight compliance.
guarantees that the actual net effective cost (as defined in subsection (i)(5)) for the year will not exceed the projected net effective cost by more than the percentage established under subsection (j)(2)(C)(ii), with periodic reconciliation requirements on a frequency established by the Secretary
in the case that such actual net effective cost does exceed such projected net effective cost by more than such percentage— (aa) the pharmacy benefit manager will pay to the PDP sponsor a penalty (not to exceed $10,000 per violation); and (bb) the PDP sponsor may terminate the contract without penalty.
The pharmacy benefit manager agrees— (I) to provide to the PDP sponsor with such information as the sponsor requires to comply with the requirements under subsection (j); and (II) that, if the pharmacy benefit manager fails to provide such information to the PDP sponsor, the PDP sponsor may terminate the contract without penalty.
Section 2 would add requirements to submit each covered written agreement to the Secretary within 30 days after it takes effect, certify benefit-manager compliance quarterly, and immediately report any failure to meet the agreement’s obligations. These requirements are added to section 1860D–12(h)(2)(A), but the existing language identifying who must perform them is not supplied; the duty holder cannot be established from this amendment alone.
(C) in paragraph (2)(A)— (i) in clause (ii), by striking and at the end; (ii) in clause (iii), by striking the period at the end and inserting a semicolon; and (iii) by adding at the end the following new clauses:
(iv) submit to the Secretary a copy of each such written agreement not later than the date that is 30 days after the effective date of such agreement; (v) certify to the Secretary on a quarterly basis that each pharmacy benefit manager that has entered into such an agreement is meeting all the obligations under such agreement; and (vi) in the case that any pharmacy benefit manager that has entered into such an agreement fails to meet all the obligations under such agreement, immediately report such failure to the Secretary
For Medicare Advantage plans that include prescription drug coverage, section 3 would add a reference to the new bidding subsection in the existing compliance statute. The amended statutory provision is not reproduced, limiting what this source alone establishes about how that cross-reference operates.
MA–PD compliance Section 1857(f)(3)(G) of the Social Security Act (42 U.S.C. 1395w–27(f)(3)(G)) is amended by inserting and section 1860D–12(i) before the period at the end.
(i) Requiring standardized public bidding process for pharmacy benefit managers
A new Medicare Advantage drug-cost performance measure would evaluate projected-versus-actual cost differences, the timeliness and adequacy of corrective plans, whether corrections reduced later differences, related increases in patient charges, and compliance with reconciliation and transparency reporting requirements.
The performance measure established under subparagraph (A) shall evaluate— (i) the percentage variation between the projected and actual net effective cost (as defined in section 1860D–12(i)(5)) for a year; (ii) the timeliness and adequacy of any corrective action plans submitted in connection with such a variation (as required under section 1860D–12(j)(2)(C)(i)(II)(bb)); (iii) the extent to which implementing such corrective actions successfully reduced such variations in subsequent quarters; (iv) the frequency and magnitude of beneficiary cost-sharing increases attributable to such a variation or a formulary change; and (v) the plan’s compliance with the reconciliation and transparency reporting requirements under section 1860D–12(j).
The proposed scale would assign five stars for costs within 2 percent of projections with no required corrective actions; four for costs within 5 percent with timely, effective corrections; and three for costs within 10 percent with adequate corrections. The two- and one-star clauses literally say costs “exceeding 10 percent of bid projections” and “exceeding 15 percent of bid projections,” respectively. They also assign low ratings for inadequate corrections, failure to submit corrective plans, or repeated noncompliance. The wording leaves uncertainty about the intended low-rating cost thresholds and how overlapping conditions would be resolved.
The Secretary shall establish a 5-star rating scale for the performance measure under this paragraph, where— (i) 5 stars indicates actual costs within 2 percent of bid projections with no required corrective actions; (ii) 4 stars indicates actual costs within 5 percent of bid projections with timely and effective corrective actions; (iii) 3 stars indicates actual costs within 10 percent of bid projections with adequate corrective actions; (iv) 2 stars indicates actual costs exceeding 10 percent of bid projections or inadequate corrective actions; and (v) 1 star indicates actual costs exceeding 15 percent of bid projections, failure to submit corrective action plans, or repeated noncompliance.
The new measure would receive at least the median weight—the middle weight among the other measures—in the overall star rating. It would be fully included when calculating ratings for quality bonus payments.
The performance measure established under this paragraph shall be weighted at not less than the median weight of all other measures used in calculating the overall star rating under this subsection.
Performance on this measure shall be fully integrated into the overall star ratings calculation for purposes of quality bonus payments under paragraph (4).
Annual public ratings would show each Medicare Advantage drug plan’s cost variation, corrective-action results, and national and regional comparisons. Plans receiving two stars or fewer on this measure would notify enrollees and provide alternative-plan information during annual enrollment. Standard notices would explain implications for premiums, deductibles, patient charges, and taxpayer costs.
The Secretary shall publicly report each MA–PD plan’s performance on this measure as part of the annual star ratings release under paragraph (3), including— (i) specific percentage variation between projected and actual net effective costs; (ii) corrective action outcomes; and (iii) comparison to national and regional benchmarks.
MA–PD plans receiving ratings of 2 stars or below on the measure established under this paragraph shall notify enrollees of their performance and provide information on alternative plan options during the annual enrollment period.
The Secretary shall establish standardized formats for beneficiary notifications that clearly explain the implications of low ratings on such measure, including enrollee costs for premiums, deductibles, cost sharing, and overall taxpayer burden.
Section 3 specifies January 1, 2028, for incorporating the measure, but also sets an enactment-dependent schedule: data collection would start with the first plan year beginning after one year has passed since enactment; first ratings would be due by the second plan year following initial collection; and bonus payments would be affected beginning with the third plan year following initial collection. The text does not expressly explain how these schedules would be coordinated.
beginning January 1, 2028, with respect to an MA–PD plan, incorporating the pharmacy benefit management services performance measure described in paragraph (8)
The Secretary shall begin collecting data for the performance measure established under this paragraph beginning with the first plan year beginning after the date that is 1 year after the date of enactment of the Net Effective Cost Transparency and Prescription Drug Affordability Act of 2026.
The Secretary shall publish the first star ratings under this paragraph not later than the second plan year following the initial data collection.
Performance on this measure shall affect quality bonus payments beginning with the third plan year following initial data collection.
Standalone Medicare Part D plans would receive a comparable performance-measurement and public-reporting system using the same criteria and rating scale.
The Secretary shall establish a comparable performance measurement and public reporting system for prescription drug plans under part D, using the same measurement criteria and rating scale established under this paragraph.
For covered commercial plans, section 4 would add a uniform projected-cost disclosure for every benefit-manager bid received by a covered service provider on the plan’s behalf. The existing provision identifying the disclosure’s recipient is not supplied. The new definition would measure the plan’s total annual cost for covered drugs on its covered-drug list that would be furnished to its enrollees if the bid were accepted.
Section 408(b)(2)(B)(iii) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1108(b)(2)(B)(iii)) is amended by adding at the end the following: (VII) A description, in a uniform format, of the projected net effective cost for the applicable plan year for each bid received by the covered service provider on behalf of the covered plan from an entity providing pharmacy benefit management services.
the total annual cost to the covered plan of all covered drugs in the formulary that would be furnished to all enrollees in such plan for such year if such bid were accepted.
Section 4 would define bona fide service fees as fair-market-value charges for genuine, itemized services performed for a drug manufacturer or covered plan that the manufacturer would otherwise perform or the plan would otherwise purchase. The definition also requires that the fees not be passed on, wholly or partly, to the covered plan, whether or not the benefit manager takes possession of the drug.
The term bona fide service fees means fees charged that represent fair-market value for bona fide, itemized services performed on behalf of a drug manufacturer or a covered plan (as defined in section 408(b)(2)(B)(ii)) and that the manufacturer would otherwise perform, or the covered plan would otherwise contract for in the absence of a service arrangement, and that are not passed on in whole or in part to the covered plan, whether or not an entity offering pharmacy benefit management services takes possession of the drug.
The commercial-plan amendments would apply to plan years beginning after calendar year 2027.
The amendments made by this section shall apply with respect to plan years beginning after calendar year 2027.
The supplied actions snapshot, updated September 22, 2026, records introduction in the House on September 14, 2026, and referral that day to Energy and Commerce, Ways and Means, and Education and Workforce for provisions within their respective jurisdictions. This snapshot does not establish subsequent action or enactment.
Source snapshot updated 2026-09-22T14:26:35Z.
2026-09-14: Introduced in House
2026-09-14: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
A closer look
Reviewed version: Introduced in House · 2026-09-14. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy rider attached to appropriations was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish the contents or attachment history of other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for particular recipients or places was identified in the complete supplied introduced text. This conclusion is limited to that version; formal earmark status in other versions or accompanying materials is not established.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
None identified in the reviewed text
No materially narrow preferential benefit, carve-out, or special exemption was identified in the complete supplied introduced text under the requested definition. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials.
Full text preserved for this analysis. Legislative record snapshot: Sep 22, 2026. How PlainBill uses AI