Net Effective Cost Transparency and Prescription Drug Affordability Act of 2026

The Net Effective Cost Transparency and Prescription Drug Affordability Act of 2026 requires Medicare Part D and Advantage plans to use a standardized public bidding process for pharmacy benefit managers starting in 2028, ensuring that the lowest projected net effective cost is generally selected. The bill mandates that plan sponsors maintain real-time tools to track actual drug costs and escrow funds to refund enrollees if they are overcharged relative to their bids. It also establishes a new five-star rating system for these plans based on how closely actual spending matches projections, with low-performing plans required to notify beneficiaries of alternative options. Additionally, the legislation extends similar transparency requirements to commercial health plans by requiring them to disclose projected net effective costs in their bid submissions.