Healthcare (Prescription Drugs)

in committee · United States · House Dec 18, 2025

HR 6837: To amend the Employee Retirement Income Security Act of 1974 to ensure that pharmacy benefit managers are considered fiduciaries, and for other purposes.

HR 6837 amends federal law to require pharmacy benefit managers (PBMs) to act as fiduciaries for employer-sponsored health plans, meaning they must prioritize plan participants' interests. The bill mandates PBMs to disclose how they receive compensation (including rebates or fees) from drug manufacturers or other sources. It also prohibits PBMs from avoiding liability for mistakes by seeking indemnification and clarifies that PBMs cannot be the "responsible fiduciary" for disclosure purposes. These changes apply to group health plans starting 12 months after the bill becomes law.

Topics ✓ HealthcareSupports HealthcareBill mandates PBMs to prioritize plan participants' interests and disclose compensation, improving transparency and accountability in prescription drug coverage under employer health plans.85% confidence

Sub-Topics Prescription Drugs

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in committee · United States · House Feb 4, 2025

HR 950: Saving Seniors Money on Prescriptions Act

HR 950, the Saving Seniors Money on Prescriptions Act, requires pharmacy benefit managers (PBMs) working with Medicare Part D prescription drug plans to provide detailed annual reports starting in 2028. These reports must include transparent information about drug pricing, rebates, out-of-pocket costs for beneficiaries, and how brand-name drugs compare to generic alternatives. The bill specifically targets PBMs' relationships with affiliated pharmacies and requires them to disclose how their contracts affect drug costs for Medicare beneficiaries. It also mandates an annual report from the Government Accountability Office (GAO) to assess and streamline existing reporting requirements for health plans and PBMs. The goal is to increase transparency around prescription drug pricing in Medicare plans to help seniors understand and potentially reduce their medication costs.

Topics ✓ HealthcareSupports HealthcareRequires PBMs to disclose drug pricing/rebates for Medicare Part D, improving transparency and reducing out-of-pocket costs for seniors, directly enhancing patient access to affordable prescriptions.95% confidence

Sub-Topics Medicaid Medicare Prescription Drugs

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in committee · United States · Senate Jun 23, 2025

S 2145: GUARD Veterans’ Health Care Act

The GUARD Veterans' Health Care Act (S 2145) requires Medicare Advantage plans and prescription drug plans to reimburse the Department of Veterans Affairs (VA) for health care services provided to veterans enrolled in those plans. The bill establishes a clear reimbursement process with a 45-day payment timeline, interest for late payments, and penalties for noncompliance, including triple damages for willful failures to pay. It also modifies VA's authority to recover costs for care provided to veterans with non-service-connected disabilities from third parties like insurance companies. These provisions apply to Medicare Advantage and prescription drug plan years beginning on or after January 1, 2026.

Topics ✓ HealthcareSupports HealthcareRequires Medicare Advantage plans to reimburse VA for veteran care, ensuring timely payment and preventing VA financial strain, directly strengthening veterans' healthcare access and funding.92% confidence ✓ VeteransSupports VeteransRequires Medicare plans to reimburse VA for veteran care with penalties, ensuring timely payments and access to healthcare benefits.95% confidence

Sub-Topics Medicare Prescription Drugs National Guard & Reserve Veteran Education Veteran Healthcare

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in committee · United States · House Mar 18, 2025

HR 2214: DRUG Act

This bill prohibits pharmacy benefit managers (PBMs) from receiving payments tied to prescription drug prices or rebates starting January 1, 2027. Instead, PBMs may only charge flat, itemized fees for actual services performed (e.g., claim processing), not based on drug costs or discounts. It directly affects PBMs and health insurance plans by requiring compensation to be decoupled from drug pricing, while allowing rebates to be passed through to lower net drug costs. The law aims to reduce conflicts of interest in PBM operations without changing drug pricing itself.

Topics ✓ HealthcareSupports HealthcareDecouples PBM fees from drug prices, requiring flat service fees. Aims to reduce net drug costs and improve patient access to medications by eliminating rebate-based compensation structures.92% confidence

Sub-Topics Insurance Prescription Drugs

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in committee · United States · House May 20, 2026

HR 6580: VA National Formulary Act of 2025

The VA National Formulary Act of 2025 creates a single, uniform list of drugs available at all VA medical facilities, replacing any local drug lists. It establishes a Pharmacy and Therapeutics Committee to make evidence-based decisions on drug inclusion (reviewing new FDA-approved drugs within 120 days) and sets up a 96-hour timeline for processing veterans' requests for nonformulary drugs. The VA must report annual formulary changes to Congress and implement a tiered copayment system that lowers costs for formulary drugs. The bill also includes provisions for negotiating drug discounts and value-based agreements to achieve cost savings.

Topics ✓ HealthcareSupports HealthcareCreates uniform VA drug formulary with evidence-based decisions and faster processing for nonformulary drugs, improving veterans' medication access and system consistency.95% confidence ✓ VeteransSupports VeteransCreates uniform drug access, 120-day FDA review, 96-hour nonformulary processing - directly improves VA healthcare access and consistency for veterans.95% confidence

Sub-Topics Prescription Drugs Veteran Benefits Veteran Education Veteran Healthcare

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in committee · United States · House Dec 3, 2025

HR 6400: Rx ACCESS Act

The Rx ACCESS Act improves prescription drug access for TRICARE beneficiaries, including military service members, retirees, and their families, by establishing fair reimbursement standards for pharmacies and expanding medication choice. It requires pharmacies to be reimbursed at actual drug costs (or the national average drug cost for certain medications) plus a standard dispensing fee, while banning hidden fees like point-of-sale charges. Starting October 1, 2026, beneficiaries can choose how they receive non-generic medications for ongoing health conditions. The law also mandates annual audits to verify reimbursement fairness and ensure pharmacy networks provide accessible care, especially in rural and underserved areas.

Topics ✓ HealthcareSupports HealthcareExpands prescription drug access for military beneficiaries by mandating fair pharmacy reimbursement and banning hidden fees, improving affordability and choice in medication coverage.95% confidence ✓ VeteransSupports VeteransBill improves TRICARE prescription drug access for veterans (retirees/families), expanding healthcare benefits by banning hidden fees and ensuring fair reimbursement.95% confidence

Sub-Topics Prescription Drugs

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in committee · United States · Senate Mar 4, 2025

S 832: EPIC Act of 2025

The EPIC Act of 2025 extends the required time period for negotiating drug prices under the federal program for biologic drugs. It changes the rule so that biologic drug manufacturers must wait at least 11 years after FDA approval before their drug can be included in price negotiations, starting with the 2028 initial price applicability year. This specifically affects biologic drug manufacturers, as the change applies only to biologics (not small-molecule drugs, which already have different rules). The bill modifies Section 1192(e)(1)(A)(ii) of the Social Security Act to implement this longer waiting period. This is a concrete policy change to the timing of drug price negotiations, not a new program or broader policy shift.

Topics ✗ HealthcareOpposes HealthcareExtends 11-year wait for biologic drug price negotiations, delaying cost reductions and maintaining higher drug prices, restricting patient access and increasing healthcare costs.92% confidence

Sub-Topics Medicaid Medicare Prescription Drugs

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in committee · United States · House Mar 11, 2025

HR 2041: Hidden Fee Disclosure Act of 2025

The Hidden Fee Disclosure Act of 2025 requires pharmacy benefit managers and third-party administrators providing services to employee benefit plans to disclose detailed information about their compensation structures. Covered service providers must annually report all fees, rebates, discounts, and other financial arrangements they receive, including how much is retained versus passed through to the plan. This includes specific details about spread pricing, rebate handling, and compensation from drug manufacturers. The bill applies to all contracts entered into on or after January 1, 2026, and aims to increase transparency for plan fiduciaries managing employee health benefits.

Topics ✓ HealthcareSupports HealthcareRequires transparency in pharmacy benefit manager fees, protecting patients from hidden costs and improving cost clarity in healthcare financing.85% confidence ✓ Labor & EmploymentSupports Labor & EmploymentRequires transparency in pharmacy benefit manager fees for employee health plans, preventing hidden costs that could reduce benefit value for workers.85% confidence

Sub-Topics Prescription Drugs

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passed · United States · House Dec 18, 2025

HR 6703: Lower Health Care Premiums for All Americans Act

The Lower Health Care Premiums for All Americans Act (HR 6703) requires large health plans (with at least 100 average participants) and pharmacy benefit managers to submit detailed reports every six months on drug spending, rebates, and out-of-pocket costs. These reports include specific information on drug costs, rebates received, pricing structures, and spending patterns, making this information available to plan sponsors and participants. The bill also establishes new rules for association health plans and health reimbursement arrangements to expand affordable coverage options for workers and self-employed individuals. The primary goal of these reporting requirements is to increase transparency around health care costs, allowing consumers and employers to make more informed decisions about health coverage. The bill does not directly set or reduce premiums but provides data that could inform future premium negotiations and decisions.

Topics ✓ HealthcareSupports HealthcareRequires transparency in drug pricing/rebates to lower premiums, improving cost access for patients.85% confidence

Sub-Topics Insurance Prescription Drugs

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in committee · United States · House Nov 19, 2025

HR 6157: FORCE Act of 2025

The FORCE Act of 2025 allows eligible first responders to enroll in Medicare at age 57 instead of the standard 65. To qualify, individuals must be between 57 and 64 years old, have worked 10+ years in specific first responder occupations (identified by Bureau of Labor Statistics codes like 33-1010 or 33-2000), and not yet qualify for standard Medicare at age 65. The bill establishes a new Medicare benefit section with premiums based on standard Part B/A costs, funded through a dedicated "Medicare First Responder Trust Fund." It ensures these enrollees receive full Medicare benefits, including prescription drug coverage, without affecting existing Medicare or Medicaid eligibility.

Topics ✓ HealthcareSupports HealthcareExpands Medicare eligibility for first responders to age 57, providing earlier health insurance coverage. Directly advances healthcare access for a specific group through expanded coverage.90% confidence ✓ Labor & EmploymentSupports Labor & EmploymentExpands Medicare access for first responders (specific worker group), providing earlier healthcare benefits which aligns with expanding worker benefits.85% confidence

Sub-Topics Medicaid Medicare Prescription Drugs

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