Medicare PBM Accountability Act

HR 5385, the Medicare PBM Accountability Act, requires pharmacy benefit managers (PBMs) working with Medicare Part D prescription drug plans to provide detailed transparency reports about drug pricing, rebates, and costs to the plans and the government. The reports must include specific information on each drug covered, such as pricing benchmarks, rebates, cost-sharing for beneficiaries, and how the plan treats generic drugs versus brand-name drugs and biosimilars versus reference products. PBMs must also allow annual audits by the plans to verify the accuracy of their reports and disclose information about their relationships with affiliated pharmacies. These reporting requirements will apply to plan years beginning on or after January 1, 2026. The bill also directs the Government Accountability Office to study existing reporting requirements for transparency in prescription drug costs.