Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘CommonGround for 
Affordable Health Care Act’’. 
SEC. 2. EXTENSION AND MODIFICATION OF ENHANCED 
PREMIUM TAX CREDIT. 
(a) EXTENSION AND MODIFICATION OF RULES TO 
INCREASE
PREMIUM
ASSISTANCE
AMOUNTS.—Section 
36B(b)(3)(A)(iii) of the Internal Revenue Code of 1986 
is amended— 
(1) by redesignating subclauses (I) and (II) as 
items (aa) and (bb), respectively, and adjusting the 
margins accordingly, 
(2) by striking ‘‘TEMPORARY
PERCENTAGES 
FOR 2021 THROUGH 2025.—In the case of’’ and in-
serting ‘‘TEMPORARY PERCENTAGES FOR CERTAIN 
YEARS.— 
‘‘(I) BEFORE 2026.—In the case 
of’’, and 
(3) by adding at the end the following: 
‘‘(II) 2026.—In the case of a 
taxable year beginning after Decem-
ber 31, 2025, and before January 1, 
2027— 
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‘‘(aa) clause (ii) shall not 
apply for purposes of adjusting 
premium percentages under this 
subparagraph, and 
‘‘(bb) the following table 
shall be applied in lieu of the 
table contained in clause (i): 
‘‘In the case of household income (expressed as a 
percent of poverty line) within the following in-
come tier: 
The initial 
premium 
percentage 
is- 
The final 
premium 
percentage 
is- 
Up to 150% 
0.0% 
0.0%
150% up to 200% 
0.0% 
2.0%
200% up to 250% 
2.0% 
4.0%
250% up to 300% 
4.0% 
6.0%
300% up to 400% 
6.0% 
8.5%
400% up to 600% 
8.5% 
8.5%
600% up to 900% 
8.5% 
9.25%
900% up to 1000% 
9.25% 
10.0%’’. 
(b) EXTENSION AND MODIFICATION OF RULE TO 
ALLOW CREDIT TO TAXPAYERS WHOSE HOUSEHOLD IN-
COME EXCEEDS 400 PERCENT OF POVERTY LINE.—Sec-
tion 36B(c)(1)(E) of such Code is amended— 
(1) by striking ‘‘TEMPORARY RULE FOR 2021 
THROUGH 2025.—In the case of’’ and inserting 
‘‘TEMPORARY RULE FOR CERTAIN YEARS.— 
‘‘(i) BEFORE 2026.—In the case of’’, 
and 
(2) by adding at the end the following: 
‘‘(ii) 2026.—In the case of a taxable 
year beginning after December 31, 2025, 
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and before January 1, 2027, subparagraph 
(A) shall be applied by substituting ‘but 
does not exceed 1000 percent’ for ‘but does 
not exceed 400 percent’.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2025. 
SEC. 3. GUARDRAILS TO PREVENT FRAUD IN EXCHANGES. 
(a) REDUCTION OF FRAUDULENT ENROLLMENT IN 
QUALIFIED HEALTH PLANS.— 
(1) PENALTIES FOR AGENTS AND BROKERS.— 
Section 1411(h)(1) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18081(h)(1)) is 
amended— 
(A) in subparagraph (A)— 
(i) by redesignating clause (ii) as 
clause (iv); 
(ii) in clause (i)— 
(I) in the matter preceding sub-
clause (I), by striking ‘‘If—’’ and all 
that follows through the ‘‘such per-
son’’ in the matter following subclause 
(II) and inserting the following: ‘‘If 
any person (other than an agent or 
broker) fails to provide correct infor-
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mation under subsection (b) and such 
failure is attributable to negligence or 
disregard of any rules or regulations 
of the Secretary, such person’’; and 
(II) in the second sentence, by 
striking ‘‘For purposes’’ and inserting 
the following: 
‘‘(iii) DEFINITIONS OF NEGLIGENCE, 
DISREGARD.—For purposes’’; 
(iii) by inserting after clause (i) the 
following: 
‘‘(ii) CIVIL PENALTIES FOR CERTAIN 
VIOLATIONS BY AGENTS OR BROKERS.—If 
any agent or broker fails to provide correct 
information under subsection (b) or section 
1311(c)(8) or other information, as speci-
fied by the Secretary, and such failure is 
attributable to negligence or disregard of 
any rules or regulations of the Secretary, 
such agent or broker shall be subject, in 
addition to any other penalties that may be 
prescribed by law, including subparagraph 
(C), to a civil penalty of not less than 
$10,000 and not more than $50,000 with 
respect to each individual who is the sub-
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ject of an application for which such incor-
rect information is provided.’’; and 
(iv) in clause (iv) (as so redesignated), 
by inserting ‘‘or (ii)’’ after ‘‘clause (i)’’; 
(B) in subparagraph (B)— 
(i) by inserting ‘‘including subpara-
graph (C),’’ after ‘‘law,’’; 
(ii) by striking ‘‘Any person’’ and in-
serting the following: 
‘‘(i) IN GENERAL.—Any person’’; and 
(iii) by adding at the end the fol-
lowing: 
‘‘(ii) CIVIL PENALTIES FOR KNOWING 
VIOLATIONS BY AGENTS OR BROKERS.— 
‘‘(I) IN GENERAL.—Any agent or 
broker who knowingly provides false 
or fraudulent information under sub-
section (b) or section 1311(c)(8), or 
other false or fraudulent information 
as part of an application for enroll-
ment in a qualified health plan offered 
through an Exchange, as specified by 
the Secretary, shall be subject, in ad-
dition to any other penalties that may 
be prescribed by law, including sub-
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paragraph (C), to a civil penalty of 
not more than $200,000 with respect 
to each individual who is the subject 
of an application for which such false 
or fraudulent information is provided. 
‘‘(II) PROCEDURE.—The provi-
sions of section 1128A of the Social 
Security Act (other than subsections 
(a) and (b) of such section) shall 
apply to a civil monetary penalty 
under subclause (I) in the same man-
ner as such provisions apply to a pen-
alty or proceeding under section 
1128A of the Social Security Act.’’; 
and 
(C) by adding at the end the following: 
‘‘(C) CRIMINAL PENALTIES.—Any agent or 
broker who knowingly and willfully provides 
false or fraudulent information under sub-
section (b) or section 1311(c)(8), or other false 
or fraudulent information as part of an applica-
tion for enrollment in a qualified health plan of-
fered through an Exchange, as specified by the 
Secretary, shall be fined under title 18, United 
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States Code, imprisoned for not more than 10 
years, or both.’’. 
(2) CONSUMER PROTECTIONS.— 
(A) IN GENERAL.—Section 1311(c) of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18031(c)) is amended by adding at the 
end the following new paragraph: 
‘‘(8) AGENT- OR
BROKER-ASSISTED
ENROLL-
MENT IN QUALIFIED HEALTH PLANS IN CERTAIN 
EXCHANGES.— 
‘‘(A) IN GENERAL.—For plan years begin-
ning on or after such date specified by the Sec-
retary, but not later than January 1, 2029, in 
the case of an Exchange that the Secretary op-
erates pursuant to section 1321(c)(1), the Sec-
retary shall establish a verification process for 
new enrollments of individuals in, and changes 
in coverage for individuals under, a qualified 
health plan offered through such Exchange, 
which are submitted by an agent or broker in 
accordance with section 1312(e) and for which 
the agent or broker is eligible to receive a com-
mission. 
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‘‘(B) 
REQUIREMENTS.—The 
enrollment 
verification process under subparagraph (A) 
shall include— 
‘‘(i) a requirement that the agent or 
broker provide with the new enrollment or 
coverage change such documentation or 
evidence (such as a standardized consent 
form) or other sources as the Secretary de-
termines necessary to establish that the 
agent or broker has the consent of the in-
dividual for the new enrollment or coverage 
change; 
‘‘(ii) a requirement that any commis-
sions due to a broker or agent for such 
new enrollment or coverage change are 
paid after the enrollee has resolved all in-
consistencies in accordance with para-
graphs (3) and (4) of section 1411(e); 
‘‘(iii) a requirement that the informa-
tion required under clause (i) and, as ap-
plicable, the date on which inconsistencies 
are resolved as described in clause (ii), is 
accessible to the applicable qualified health 
plan through a database or other resource, 
as determined by the Secretary, so that 
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any commissions due to a broker or agent 
for such enrollment can be effectuated at 
the appropriate time; 
‘‘(iv) a requirement that individuals 
are notified of any changes to enrollment, 
coverage, the agent of record, or premium 
tax credits in a timely manner and that 
such notice provides plain language in-
structions on how individuals can cancel 
unauthorized activity; 
‘‘(v) a requirement that individuals be 
able to access their account information on 
a website or other technology platform, as 
defined by the Secretary, when used to 
submit an enrollment or plan change, in 
lieu of the Exchange website described in 
subsection (d)(4)(C), including information 
on the agent of record, the qualified health 
plan, and when any changes are made to 
the agent of record or the qualified health 
plan, on a consumer-facing website or 
through a toll-free telephone hotline; and 
‘‘(vi) a requirement that the agent or 
broker report to the Secretary any third- 
party marketing organization or field mar-
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keting organization (as such terms are de-
fined in section 1312(e)) involved in the 
chain of enrollment (as so defined) with re-
spect to such new enrollment or coverage 
change. 
‘‘(C) CONSUMER PROTECTION.—The Sec-
retary 
shall 
ensure 
that 
the 
enrollment 
verification process under subparagraph (A) 
prioritizes continuity of coverage and care for 
individuals, including by not disenrolling indi-
viduals from a qualified health plan without the 
consent of the individual, regardless of whether 
the broker, agent, or qualified health plan is in 
violation of any requirement under this para-
graph.’’. 
(B) 
REQUIRED
REPORTING.—Section 
1311(c)(1) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18031(c)(1)) is 
amended— 
(i) in subparagraph (H), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (I), by striking 
the period at the end and inserting ‘‘; 
and’’; and 
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(iii) by adding at the end the fol-
lowing: 
‘‘(J) report to the Secretary the termi-
nation (as defined in section 1312(e)(1)(C)) of 
an issuer.’’. 
(3) AUTHORITY
TO
REGULATE
FIELD
MAR-
KETING
ORGANIZATIONS
AND
THIRD-PARTY
MAR-
KETING
ORGANIZATIONS.—Section 1312(e) of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18032(e)) is amended— 
(A) by redesignating paragraphs (1) and 
(2) as subclauses (I) and (II), respectively, and 
adjusting the margins accordingly; 
(B) in subclause (II) (as so redesignated), 
by striking the period at the end and inserting 
‘‘; and’’; 
(C) by striking the subsection designation 
and heading and all that follows through ‘‘bro-
kers—’’ and inserting the following: 
‘‘(e) REGULATION OF AGENTS, BROKERS, AND CER-
TAIN MARKETING ORGANIZATIONS.— 
‘‘(1) AGENTS, BROKERS, AND
CERTAIN
MAR-
KETING ORGANIZATIONS.— 
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‘‘(A) IN
GENERAL.—The Secretary shall 
establish procedures under which a State may 
allow— 
‘‘(i) agents or brokers—’’; and 
(D) by adding at the end the following: 
‘‘(ii) field marketing organizations 
and third-party marketing organizations to 
participate in the chain of enrollment for 
an individual with respect to qualified 
health plans offered through an Exchange. 
‘‘(B) CRITERIA.—For plan years beginning 
on or after such date specified by the Secretary, 
but not later than January 1, 2029, the Sec-
retary, by regulation, shall establish criteria for 
States to use in determining whether to allow 
agents and brokers to enroll individuals and 
employers in qualified health plans as described 
in subclause (I) of subparagraph (A)(i) and to 
assist individuals as described in subclause (II) 
of such subparagraph and field marketing orga-
nizations and third-party marketing organiza-
tions to participate in the chain of enrollment 
as described in subparagraph (A)(ii). Such cri-
teria shall, at a minimum, require that— 
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mined appropriate by the Secretary, 
review and approval; 
‘‘(V) is a licensed agent or broker 
or meets other licensure requirements, 
as required by the State; 
‘‘(VI) register with the Secretary; 
and 
‘‘(VII) does not compensate any 
individual or organization for referrals 
or any other service relating to the 
sale of, marketing for, or enrollment 
in qualified health plans unless such 
individual or organization meets the 
criteria described in subclauses (I) 
through (VI). 
‘‘(C) DEFINITIONS.—In this paragraph: 
‘‘(i) CHAIN
OF
ENROLLMENT.—The 
term ‘chain of enrollment’, with respect to 
enrollment of an individual in a qualified 
health plan offered through an Exchange, 
means any steps taken from marketing to 
such individual, to such individual making 
an enrollment decision with respect to such 
a plan. 
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‘‘(ii) FIELD
MARKETING
ORGANIZA-
TION.—The term ‘field marketing organi-
zation’ means an organization or individual 
that directly employs or contracts with 
agents and brokers, or contracts with car-
riers, to provide functions relating to en-
rollment of individuals in qualified health 
plans offered through an Exchange as part 
of the chain of enrollment. 
‘‘(iii) MARKETING.—The term ‘mar-
keting’ means the use of marketing mate-
rials to provide information to current and 
prospective enrollees in a qualified health 
plan offered through an Exchange. 
‘‘(iv) MARKETING
MATERIALS.—The 
term ‘marketing materials’ means mate-
rials relating to a qualified health plan of-
fered through an Exchange or benefits of-
fered through an Exchange that— 
‘‘(I) are intended— 
‘‘(aa) to draw an individual’s 
attention to such plan or the pre-
mium tax credits or cost-sharing 
reductions for such plan or plans 
offered through an Exchange; 
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‘‘(bb) to influence an indi-
vidual’s decision-making process 
when selecting a qualified health 
plan in which to enroll; or 
‘‘(cc) to influence an enroll-
ee’s decision to stay enrolled in 
such plan; and 
‘‘(II) include or address content 
regarding the benefits, benefit struc-
ture, premiums, or cost sharing of 
such plan. 
‘‘(v) TERMINATION.—The term ‘ter-
mination’, with respect to a contract or 
business arrangement between an agent or 
broker and a field marketing organization, 
third-party marketing organization, or 
health insurance issuer, means— 
‘‘(I) the ending of such contract 
or business arrangement, either uni-
laterally by one of the parties or on 
mutual agreement; or 
‘‘(II) the expiration of such con-
tract or business arrangement that is 
not replaced by a substantially similar 
agreement. 
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‘‘(vi) THIRD-PARTY MARKETING ORGA-
NIZATION.—The term ‘third-party mar-
keting organization’ means an organization 
or individual that is compensated to per-
form lead generation, marketing, or sales 
relating to enrollment of individuals in 
qualified health plans offered through an 
Exchange as part of the chain of enroll-
ment.’’. 
(4) TRANSPARENCY.—Section 1312(e) of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18032(e)), as amended by paragraph (3), is 
further amended by adding at the end the following 
new paragraphs: 
‘‘(2) AUDITS.— 
‘‘(A) IN GENERAL.—For plan years begin-
ning on or after such date specified by the Sec-
retary, but not later than January 1, 2029, the 
Secretary, in coordination with the States and 
in consultation with the National Association of 
Insurance Commissioners, shall implement a 
process for the oversight and enforcement of 
agent and broker compliance with this section 
and other applicable Federal and State law (in-
cluding regulations) that shall include— 
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‘‘(i) periodic audits of agents and bro-
kers based on— 
‘‘(I) complaints filed with the 
Secretary by individuals enrolled by 
such an agent or broker in a qualified 
health plan offered through an Ex-
change; 
‘‘(II) an incident or enrollment 
pattern that suggests fraud; and 
‘‘(III) other factors determined 
by the Secretary; and 
‘‘(ii) a process under which the Sec-
retary shall share audit results and refer 
potential cases of fraud to the relevant 
State department of insurance. 
‘‘(B) EFFECT.—Nothing in this paragraph 
limits or restricts any referrals made under sec-
tion 1311(i)(3) or any enforcement actions 
under section 1411(h). 
‘‘(3) LIST.—The Secretary shall develop a proc-
ess to regularly provide to qualified health plans, 
Exchanges, and States a list of suspended and ter-
minated agents and brokers.’’. 
(b) REMOVAL OF DECEASED INDIVIDUALS FROM EX-
CHANGE PLANS.—Section 1311(c) of the Patient Protec-
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tion and Affordable Care Act (42 U.S.C. 18031(c)), as 
amended by subsection (a), is further amended by adding 
at the end the following new paragraph: 
‘‘(9) REMOVAL
OF
DECEASED
INDIVIDUALS 
FROM EXCHANGE PLANS.— 
‘‘(A) IN
GENERAL.—Not later than 90 
days after the date of the enactment of this 
paragraph, and on a quarterly basis thereafter, 
the Secretary shall conduct a check of the 
Death Master File (as such term is defined in 
section 203(d) of the Bipartisan Budget Act of 
2013) for purposes of identifying individuals 
enrolled in a qualified health plan through an 
Exchange who are deceased. 
‘‘(B) PROCESS.—The Secretary shall— 
‘‘(i) establish a process to verify that 
an individual identified pursuant to a 
check described in subparagraph (A) is de-
ceased; and 
‘‘(ii) require an Exchange to termi-
nate such individual’s enrollment under a 
qualified health plan.’’. 
(c) STANDARD
OF
PROOF
FOR
TERMINATING 
AGENTS AND BROKERS.—Section 1312(e) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18032(e)), 
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as amended by subsection (a), is further amended by add-
ing at the end the following new paragraph: 
‘‘(4) STANDARD FOR TERMINATION FOR CER-
TAIN
EXCHANGES.—In the case of an agent or 
broker with an agreement in effect with an Ex-
change operated by the Secretary pursuant to sec-
tion 1321(c) to perform activities described in para-
graph (1)(A)(i) with respect to such Exchange, the 
Secretary may terminate such agreement if the Sec-
retary finds, based on a preponderance of the evi-
dence, that such agent or broker has violated such 
agreement, otherwise applicable law, or any other re-
quirement applicable to such agent or broker.’’. 
(d) REQUIREMENT FOR EXCHANGE TO NOTIFY INDI-
VIDUALS OF VALUE OF PREMIUM TAX CREDITS.—Section 
1412(c)(2) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18082(c)(2)) is amended by adding at the 
end the following new subparagraph: 
‘‘(C) EXCHANGE RESPONSIBILITIES.—Be-
ginning January 1, 2027, if an Exchange is no-
tified under paragraph (1) of an advance deter-
mination under section 1411 with respect to the 
eligibility of an individual for a premium tax 
credit under section 36B of the Internal Rev-
enue Code of 1986, the Exchange shall, prior to 
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enrolling such individual in a qualified health 
plan, clearly notify such individual of the 
amount of such tax credit.’’. 
SEC. 4. EXTENDING ANNUAL OPEN ENROLLMENT PERIOD 
FOR EXCHANGES FOR PLAN YEAR 2026. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall revise section 155.410(e) of title 45, 
Code of Federal Regulations (or any successor regulation) 
to provide that the annual open enrollment period deter-
mined for plan year 2026 pursuant to section 1311(c)(6) 
of the Patient Protection and Affordable Care Act (42 
U.S.C. 18031(c)(6)) shall begin on November 1, 2025, 
and end on March 19, 2026. 
(b) NOTIFICATION OF OPEN ENROLLMENT EXTEN-
SION.—The Secretary of Health and Human Services 
shall perform such outreach activities as are necessary to 
inform qualified individuals (as defined in section 
1312(f)(1) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18032(f)(1))) of the extended open enroll-
ment period provided for under subsection (a). 
SEC. 5. MODERNIZING AND ENSURING PBM ACCOUNT-
ABILITY. 
(a) IN GENERAL.— 
(1) 
PRESCRIPTION
DRUG
PLANS.—Section 
1860D–12 of the Social Security Act (42 U.S.C. 
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1395w–112) is amended by adding at the end the 
following new subsection: 
‘‘(h) REQUIREMENTS RELATING TO PHARMACY BEN-
EFIT MANAGERS.—For plan years beginning on or after 
January 1, 2029: 
‘‘(1) AGREEMENTS WITH PHARMACY BENEFIT 
MANAGERS.—Each contract entered into with a 
PDP sponsor under this part with respect to a pre-
scription drug plan offered by such sponsor shall 
provide that any pharmacy benefit manager acting 
on behalf of such sponsor has a written agreement 
with the PDP sponsor under which the pharmacy 
benefit manager, and any affiliates of such phar-
macy benefit manager, as applicable, agree to meet 
the following requirements: 
‘‘(A) NO INCOME OTHER THAN BONA FIDE 
SERVICE FEES.— 
‘‘(i) IN
GENERAL.—The pharmacy 
benefit manager and any affiliate of such 
pharmacy benefit manager shall not derive 
any remuneration with respect to any serv-
ices provided on behalf of any entity or in-
dividual, in connection with the utilization 
of covered part D drugs, from any such en-
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tity or individual other than bona fide serv-
ice fees, subject to clauses (ii) and (iii). 
‘‘(ii) INCENTIVE PAYMENTS.—For the 
purposes of this subsection, an incentive 
payment (as determined by the Secretary) 
paid by a PDP sponsor to a pharmacy 
benefit manager that is performing serv-
ices on behalf of such sponsor shall be 
deemed a ‘bona fide service fee’ (even if 
such payment does not otherwise meet the 
definition of such term under paragraph 
(7)(B)) if such payment is a flat dollar 
amount, is consistent with fair market 
value (as specified by the Secretary), is re-
lated to services actually performed by the 
pharmacy benefit manager or affiliate of 
such pharmacy benefit manager, on behalf 
of the PDP sponsor making such payment, 
in connection with the utilization of cov-
ered part D drugs, and meets additional 
requirements, if any, as determined appro-
priate by the Secretary. 
‘‘(iii) CLARIFICATION
ON
REBATES 
AND DISCOUNTS USED TO LOWER COSTS 
FOR COVERED PART D DRUGS.—Rebates, 
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discounts, and other price concessions re-
ceived by a pharmacy benefit manager or 
an affiliate of a pharmacy benefit manager 
from manufacturers, even if such price 
concessions are calculated as a percentage 
of a drug’s price, shall not be considered a 
violation of the requirements of clause (i) 
if they are fully passed through to a PDP 
sponsor and are compliant with all regu-
latory and subregulatory requirements re-
lated to direct and indirect remuneration 
for manufacturer rebates under this part, 
including in cases where a PDP sponsor is 
acting as a pharmacy benefit manager on 
behalf of a prescription drug plan offered 
by such PDP sponsor. 
‘‘(iv) EVALUATION OF REMUNERATION 
ARRANGEMENTS.—Components of subsets 
of remuneration arrangements (such as 
fees or other forms of compensation paid 
to or retained by the pharmacy benefit 
manager or affiliate of such pharmacy ben-
efit manager), as determined appropriate 
by the Secretary, between pharmacy ben-
efit managers or affiliates of such phar-
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macy benefit managers, as applicable, and 
other entities involved in the dispensing or 
utilization of covered part D drugs (includ-
ing PDP sponsors, manufacturers, phar-
macies, and other entities as determined 
appropriate by the Secretary) shall be sub-
ject to review by the Secretary, in con-
sultation with the Office of the Inspector 
General of the Department of Health and 
Human Services, as determined appro-
priate by the Secretary. The Secretary, in 
consultation with the Office of the Inspec-
tor General, shall review whether remu-
neration under such arrangements is con-
sistent with fair market value (as specified 
by the Secretary) through reviews and as-
sessments of such remuneration, as deter-
mined appropriate. 
‘‘(v) DISGORGEMENT.—The pharmacy 
benefit manager shall disgorge any remu-
neration paid to such pharmacy benefit 
manager or an affiliate of such pharmacy 
benefit manager in violation of this sub-
paragraph to the PDP sponsor. 
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‘‘(vi) ADDITIONAL REQUIREMENTS.— 
The pharmacy benefit manager shall— 
‘‘(I) enter into a written agree-
ment with any affiliate of such phar-
macy benefit manager, under which 
the affiliate shall identify and disgorge 
any remuneration described in clause 
(v) to the pharmacy benefit manager; 
and 
‘‘(II) attest, subject to any re-
quirements determined appropriate by 
the Secretary, that the pharmacy ben-
efit manager has entered into a writ-
ten agreement described in subclause 
(I) with any relevant affiliate of the 
pharmacy benefit manager. 
‘‘(B) TRANSPARENCY REGARDING GUARAN-
TEES
AND
COST
PERFORMANCE
EVALUA-
TIONS.—The pharmacy benefit manager shall— 
‘‘(i) define, interpret, and apply, in a 
fully transparent and consistent manner 
for purposes of calculating or otherwise 
evaluating pharmacy benefit manager per-
formance against pricing guarantees or 
similar cost performance measurements re-
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lated to rebates, discounts, price conces-
sions, or net costs, terms such as— 
‘‘(I) ‘generic drug’, in a manner 
consistent with the definition of the 
term under section 423.4 of title 42, 
Code of Federal Regulations, or a suc-
cessor regulation; 
‘‘(II) ‘brand name drug’, in a 
manner consistent with the definition 
of the term under section 423.4 of 
title 42, Code of Federal Regulations, 
or a successor regulation; 
‘‘(III) ‘specialty drug’; 
‘‘(IV) ‘rebate’; and 
‘‘(V) ‘discount’; 
‘‘(ii) identify any drugs, claims, or 
price concessions excluded from any pric-
ing guarantee or other cost performance 
measure in a clear and consistent manner; 
and 
‘‘(iii) where a pricing guarantee or 
other cost performance measure is based 
on a pricing benchmark other than the 
wholesale acquisition cost (as defined in 
section 1847A(c)(6)(B)) of a drug, cal-
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culate and provide a wholesale acquisition 
cost-based equivalent to the pricing guar-
antee or other cost performance measure. 
‘‘(C) PROVISION OF INFORMATION.— 
‘‘(i) IN
GENERAL.—Not later than 
July 1 of each year, beginning in 2029, the 
pharmacy benefit manager shall submit to 
the PDP sponsor, and to the Secretary, a 
report, in accordance with this subpara-
graph, and shall make such report avail-
able to such sponsor at no cost to such 
sponsor in a format specified by the Sec-
retary under paragraph (5). Each such re-
port shall include, with respect to such 
PDP sponsor and each plan offered by 
such sponsor, the following information 
with respect to the previous plan year: 
‘‘(I) A list of all drugs covered by 
the plan that were dispensed includ-
ing, with respect to each such drug— 
‘‘(aa) the brand name, ge-
neric or non-proprietary name, 
and National Drug Code; 
‘‘(bb) the number of plan 
enrollees for whom the drug was 
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dispensed, the total number of 
prescription claims for the drug 
(including original prescriptions 
and refills, counted as separate 
claims), and the total number of 
dosage units of the drug dis-
pensed; 
‘‘(cc) the number of pre-
scription claims described in item 
(bb) by each type of dispensing 
channel through which the drug 
was dispensed, including retail, 
mail order, specialty pharmacy, 
long term care pharmacy, home 
infusion pharmacy, or other types 
of pharmacies or providers; 
‘‘(dd) the average wholesale 
acquisition cost, listed as cost per 
day’s supply, cost per dosage 
unit, and cost per typical course 
of treatment (as applicable); 
‘‘(ee) the average wholesale 
price for the drug, listed as price 
per day’s supply, price per dos-
age unit, and price per typical 
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course of treatment (as applica-
ble); 
‘‘(ff) the total out-of-pocket 
spending by plan enrollees on 
such drug after application of 
any benefits under the plan, in-
cluding plan enrollee spending 
through copayments, coinsurance, 
and deductibles; 
‘‘(gg) total rebates paid by 
the manufacturer on the drug as 
reported under the Detailed DIR 
Report (or any successor report) 
submitted by such sponsor to the 
Centers for Medicare & Medicaid 
Services; 
‘‘(hh) all other direct or in-
direct remuneration on the drug 
as reported under the Detailed 
DIR Report (or any successor re-
port) submitted by such sponsor 
to the Centers for Medicare & 
Medicaid Services; 
‘‘(ii) the average pharmacy 
reimbursement amount paid by 
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the plan for the drug in the ag-
gregate and disaggregated by dis-
pensing channel identified in item 
(cc); 
‘‘(jj) the average National 
Average Drug Acquisition Cost 
(NADAC); and 
‘‘(kk) total manufacturer-de-
rived revenue, inclusive of bona 
fide service fees, attributable to 
the drug and retained by the 
pharmacy benefit manager and 
any affiliate of such pharmacy 
benefit manager. 
‘‘(II) In the case of a pharmacy 
benefit manager that has an affiliate 
that is a retail, mail order, or spe-
cialty pharmacy, with respect to drugs 
covered by such plan that were dis-
pensed, the following information: 
‘‘(aa) The percentage of 
total prescriptions that were dis-
pensed by pharmacies that are an 
affiliate of the pharmacy benefit 
manager for each drug. 
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‘‘(bb) 
The 
interquartile 
range of the total combined costs 
paid by the plan and plan enroll-
ees, per dosage unit, per course 
of treatment, per 30-day supply, 
and per 90-day supply for each 
drug dispensed by pharmacies 
that are not an affiliate of the 
pharmacy benefit manager and 
that are included in the phar-
macy network of such plan. 
‘‘(cc) 
The 
interquartile 
range of the total combined costs 
paid by the plan and plan enroll-
ees, per dosage unit, per course 
of treatment, per 30-day supply, 
and per 90-day supply for each 
drug dispensed by pharmacies 
that are an affiliate of the phar-
macy benefit manager and that 
are included in the pharmacy 
network of such plan. 
‘‘(dd) The lowest total com-
bined cost paid by the plan and 
plan enrollees, per dosage unit, 
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per course of treatment, per 30- 
day supply, and per 90-day sup-
ply, for each drug that is avail-
able from any pharmacy included 
in the pharmacy network of such 
plan. 
‘‘(ee) The difference between 
the average acquisition cost of 
the affiliate, such as a pharmacy 
or other entity that acquires pre-
scription drugs, that initially ac-
quires the drug and the amount 
reported under subclause (I)(jj) 
for each drug. 
‘‘(ff) A list inclusive of the 
brand name, generic or non-pro-
prietary 
name, 
and 
National 
Drug Code of covered part D 
drugs subject to an agreement 
with a covered entity under sec-
tion 340B of the Public Health 
Service Act for which the phar-
macy benefit manager or an affil-
iate of the pharmacy benefit 
manager had a contract or other 
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arrangement with such a covered 
entity in the service area of such 
plan. 
‘‘(III) Where a drug approved 
under section 505(c) of the Federal 
Food, Drug, and Cosmetic Act (re-
ferred to in this subclause as the ‘list-
ed drug’) is covered by the plan, the 
following information: 
‘‘(aa) A list of currently 
marketed generic drugs approved 
under section 505(j) of the Fed-
eral Food, Drug, and Cosmetic 
Act pursuant to an application 
that references such listed drug 
that are not covered by the plan, 
are covered on the same for-
mulary tier or a formulary tier 
typically associated with higher 
cost-sharing than the listed drug, 
or are subject to utilization man-
agement that the listed drug is 
not subject to. 
‘‘(bb) The estimated average 
beneficiary 
cost-sharing 
under 
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the plan for a 30-day supply of 
the listed drug. 
‘‘(cc) Where a generic drug 
listed under item (aa) is on a for-
mulary tier typically associated 
with higher cost-sharing than the 
listed drug, the estimated aver-
age cost-sharing that a bene-
ficiary would have paid for a 30- 
day supply of each of the generic 
drugs described in item (aa), had 
the plan provided coverage for 
such drugs on the same for-
mulary tier as the listed drug. 
‘‘(dd) A written justification 
for providing more favorable cov-
erage of the listed drug than the 
generic drugs described in item 
(aa). 
‘‘(ee) The number of cur-
rently marketed generic drugs 
approved under section 505(j) of 
the Federal Food, Drug, and 
Cosmetic Act pursuant to an ap-
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plication that references such 
listed drug. 
‘‘(IV) Where a reference product 
(as defined in section 351(i) of the 
Public Health Service Act) is covered 
by the plan, the following information: 
‘‘(aa) A list of currently 
marketed 
biosimilar 
biological 
products licensed under section 
351(k) of the Public Health 
Service Act pursuant to an appli-
cation that refers to such ref-
erence product that are not cov-
ered by the plan, are covered on 
the same formulary tier or a for-
mulary tier typically associated 
with higher cost-sharing than the 
reference product, or are subject 
to utilization management that 
the reference product is not sub-
ject to. 
‘‘(bb) The estimated average 
beneficiary 
cost-sharing 
under 
the plan for a 30-day supply of 
the reference product. 
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‘‘(cc) Where a biosimilar bi-
ological product listed under item 
(aa) is on a formulary tier typi-
cally associated with higher cost- 
sharing than the reference prod-
uct, the estimated average cost- 
sharing that a beneficiary would 
have paid for a 30-day supply of 
each of the biosimilar biological 
products described in item (aa), 
had the plan provided coverage 
for such products on the same 
formulary tier as the reference 
product. 
‘‘(dd) A written justification 
for providing more favorable cov-
erage of the reference product 
than the biosimilar biological 
product described in item (aa). 
‘‘(ee) The number of cur-
rently marketed biosimilar bio-
logical products licensed under 
section 351(k) of the Public 
Health Service Act, pursuant to 
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an application that refers to such 
reference product. 
‘‘(V) Total gross spending on 
covered part D drugs by the plan, not 
net of rebates, fees, discounts, or 
other direct or indirect remuneration. 
‘‘(VI) The total amount retained 
by the pharmacy benefit manager or 
an affiliate of such pharmacy benefit 
manager in revenue related to utiliza-
tion of covered part D drugs under 
that plan, inclusive of bona fide serv-
ice fees. 
‘‘(VII) The total spending on cov-
ered part D drugs net of rebates, fees, 
discounts, or other direct and indirect 
remuneration by the plan. 
‘‘(VIII) An explanation of any 
benefit design parameters under such 
plan that encourage plan enrollees to 
fill prescriptions at pharmacies that 
are an affiliate of such pharmacy ben-
efit manager, such as mail and spe-
cialty home delivery programs, and re-
tail and mail auto-refill programs. 
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‘‘(IX) The following information: 
‘‘(aa) A list of all brokers, 
consultants, advisors, and audi-
tors that receive compensation 
from the pharmacy benefit man-
ager or an affiliate of such phar-
macy benefit manager for refer-
rals, 
consulting, 
auditing, 
or 
other services offered to PDP 
sponsors related to pharmacy 
benefit management services. 
‘‘(bb) The amount of com-
pensation provided by such phar-
macy benefit manager or affiliate 
to each such broker, consultant, 
advisor, and auditor. 
‘‘(cc) The methodology for 
calculating the amount of com-
pensation provided by such phar-
macy benefit manager or affil-
iate, for each such broker, con-
sultant, advisor, and auditor. 
‘‘(X) A list of all affiliates of the 
pharmacy benefit manager. 
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‘‘(XI) A summary document sub-
mitted in a standardized template de-
veloped by the Secretary that includes 
such information described in sub-
clauses (I) through (X). 
‘‘(ii) WRITTEN EXPLANATION OF CON-
TRACTS
OR
AGREEMENTS
WITH
DRUG 
MANUFACTURERS.— 
‘‘(I) IN
GENERAL.—The phar-
macy benefit manager shall, not later 
than 30 days after the finalization of 
any contract or agreement between 
such pharmacy benefit manager or an 
affiliate of such pharmacy benefit 
manager and a drug manufacturer (or 
subsidiary, agent, or entity affiliated 
with such drug manufacturer) that 
makes rebates, discounts, payments, 
or other financial incentives related to 
one or more covered part D drugs or 
other prescription drugs, as applica-
ble, of the manufacturer directly or 
indirectly contingent upon coverage, 
formulary placement, or utilization 
management conditions on any other 
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covered part D drugs or other pre-
scription drugs, as applicable, submit 
to the PDP sponsor a written expla-
nation of such contract or agreement. 
‘‘(II) REQUIREMENTS.—A writ-
ten explanation under subclause (I) 
shall— 
‘‘(aa) include the manufac-
turer subject to the contract or 
agreement, all covered part D 
drugs 
and 
other 
prescription 
drugs, as applicable, subject to 
the contract or agreement and 
the manufacturers of such drugs, 
and a high-level description of 
the terms of such contract or 
agreement and how such terms 
apply to such drugs; and 
‘‘(bb) be certified by the 
Chief Executive Officer, Chief Fi-
nancial Officer, or General Coun-
sel of such pharmacy benefit 
manager, or affiliate of such 
pharmacy benefit manager, as 
applicable, or an individual dele-
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gated with the authority to sign 
on behalf of one of these officers, 
who reports directly to the offi-
cer. 
‘‘(III) DEFINITION
OF
OTHER 
PRESCRIPTION DRUGS.—For purposes 
of this clause, the term ‘other pre-
scription drugs’ means prescription 
drugs covered as supplemental bene-
fits under this part or prescription 
drugs paid outside of this part. 
‘‘(D) AUDIT RIGHTS.— 
‘‘(i) IN GENERAL.—Not less than once 
a year, at the request of the PDP sponsor, 
the pharmacy benefit manager shall allow 
for an audit of the pharmacy benefit man-
ager to ensure compliance with all terms 
and conditions under the written agree-
ment described in this paragraph and the 
accuracy of information reported under 
subparagraph (C). 
‘‘(ii) AUDITOR.—The PDP sponsor 
shall have the right to select an auditor. 
The pharmacy benefit manager shall not 
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impose any limitations on the selection of 
such auditor. 
‘‘(iii) PROVISION OF INFORMATION.— 
The pharmacy benefit manager shall make 
available to such auditor all records, data, 
contracts, and other information necessary 
to confirm the accuracy of information 
provided under subparagraph (C), subject 
to reasonable restrictions on how such in-
formation must be reported to prevent re-
disclosure of such information. 
‘‘(iv) TIMING.—The pharmacy benefit 
manager must provide information under 
clause (iii) and other information, data, 
and records relevant to the audit to such 
auditor within 6 months of the initiation of 
the audit and respond to requests for addi-
tional information from such auditor with-
in 30 days after the request for additional 
information. 
‘‘(v) INFORMATION
FROM
AFFILI-
ATES.—The pharmacy benefit manager 
shall be responsible for providing to such 
auditor information required to be reported 
under subparagraph (C) or under clause 
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(iii) of this subparagraph that is owned or 
held by an affiliate of such pharmacy ben-
efit manager. 
‘‘(2) ENFORCEMENT.— 
‘‘(A) IN
GENERAL.—Each PDP sponsor 
shall— 
‘‘(i) disgorge to the Secretary any 
amounts disgorged to the PDP sponsor by 
a pharmacy benefit manager under para-
graph (1)(A)(v); 
‘‘(ii) require, in a written agreement 
with any pharmacy benefit manager acting 
on behalf of such sponsor or affiliate of 
such pharmacy benefit manager, that such 
pharmacy benefit manager or affiliate re-
imburse the PDP sponsor for any civil 
money penalty imposed on the PDP spon-
sor as a result of the failure of the phar-
macy benefit manager or affiliate to meet 
the requirements of paragraph (1) that are 
applicable to the pharmacy benefit man-
ager or affiliate under the agreement; and 
‘‘(iii) require, in a written agreement 
with any such pharmacy benefit manager 
acting on behalf of such sponsor or affil-
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iate of such pharmacy benefit manager, 
that such pharmacy benefit manager or af-
filiate be subject to punitive remedies for 
breach of contract for failure to comply 
with the requirements applicable under 
paragraph (1). 
‘‘(B) REPORTING
OF
ALLEGED
VIOLA-
TIONS.—The Secretary shall make available and 
maintain a mechanism for manufacturers, PDP 
sponsors, pharmacies, and other entities that 
have contractual relationships with pharmacy 
benefit managers or affiliates of such pharmacy 
benefit managers to report, on a confidential 
basis, alleged violations of paragraph (1)(A) or 
subparagraph (C). 
‘‘(C) ANTI-RETALIATION AND ANTI-COER-
CION.—Consistent with applicable Federal or 
State law, a PDP sponsor shall not— 
‘‘(i) retaliate against an individual or 
entity for reporting an alleged violation 
under subparagraph (B); or 
‘‘(ii) coerce, intimidate, threaten, or 
interfere with the ability of an individual 
or entity to report any such alleged viola-
tions. 
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‘‘(3) CERTIFICATION OF COMPLIANCE.— 
‘‘(A) IN
GENERAL.—Each PDP sponsor 
shall furnish to the Secretary (at a time and in 
a manner specified by the Secretary) an annual 
certification of compliance with this subsection, 
as well as such information as the Secretary de-
termines necessary to carry out this subsection. 
‘‘(B) IMPLEMENTATION.—Notwithstanding 
any other provision of law, the Secretary may 
implement this paragraph by program instruc-
tion or otherwise. 
‘‘(4) RULE
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed as— 
‘‘(A) prohibiting flat dispensing fees or re-
imbursement or payment for ingredient costs 
(including customary, industry-standard dis-
counts directly related to drug acquisition that 
are retained by pharmacies or wholesalers) to 
entities that acquire or dispense prescription 
drugs; or 
‘‘(B) modifying regulatory requirements or 
sub-regulatory program instruction or guidance 
related to pharmacy payment, reimbursement, 
or dispensing fees. 
‘‘(5) STANDARD FORMATS.— 
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‘‘(A) IN GENERAL.—Not later than June 
1, 2028, the Secretary shall specify standard, 
machine-readable formats for pharmacy benefit 
managers to submit annual reports required 
under paragraph (1)(C)(i). 
‘‘(B) IMPLEMENTATION.—Notwithstanding 
any other provision of law, the Secretary may 
implement this paragraph by program instruc-
tion or otherwise. 
‘‘(6) CONFIDENTIALITY.— 
‘‘(A) IN GENERAL.—Information disclosed 
by a pharmacy benefit manager, an affiliate of 
a pharmacy benefit manager, a PDP sponsor, 
or a pharmacy under this subsection that is not 
otherwise publicly available or available for pur-
chase shall not be disclosed by the Secretary or 
a PDP sponsor receiving the information, ex-
cept that the Secretary may disclose the infor-
mation for the following purposes: 
‘‘(i) As the Secretary determines nec-
essary to carry out this part. 
‘‘(ii) To permit the Comptroller Gen-
eral to review the information provided. 
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‘‘(iii) To permit the Director of the 
Congressional Budget Office to review the 
information provided. 
‘‘(iv) To permit the Executive Direc-
tor of the Medicare Payment Advisory 
Commission to review the information pro-
vided. 
‘‘(v) To the Attorney General for the 
purposes of conducting oversight and en-
forcement under this title. 
‘‘(vi) To the Inspector General of the 
Department of Health and Human Serv-
ices in accordance with its authorities 
under the Inspector General Act of 1978 
(section 406 of title 5, United States 
Code), and other applicable statutes. 
‘‘(B) RESTRICTION ON USE OF INFORMA-
TION.—The Secretary, the Comptroller General, 
the Director of the Congressional Budget Of-
fice, and the Executive Director of the Medicare 
Payment Advisory Commission shall not report 
on or disclose information disclosed pursuant to 
subparagraph (A) to the public in a manner 
that would identify— 
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‘‘(i) a specific pharmacy benefit man-
ager, affiliate, pharmacy, manufacturer, 
wholesaler, PDP sponsor, or plan; or 
‘‘(ii) contract prices, rebates, dis-
counts, or other remuneration for specific 
drugs in a manner that may allow the 
identification of specific contracting parties 
or of such specific drugs. 
‘‘(7) DEFINITIONS.—For purposes of this sub-
section: 
‘‘(A) AFFILIATE.—The term ‘affiliate’ 
means, with respect to any pharmacy benefit 
manager or PDP sponsor, any entity that, di-
rectly or indirectly— 
‘‘(i) owns or is owned by, controls or 
is controlled by, or is otherwise related in 
any ownership structure to such pharmacy 
benefit manager or PDP sponsor; or 
‘‘(ii) acts as a contractor, principal, or 
agent to such pharmacy benefit manager 
or PDP sponsor, insofar as such con-
tractor, principal, or agent performs any of 
the functions described under subpara-
graph (C). 
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‘‘(B) BONA FIDE SERVICE FEE.—The term 
‘bona fide service fee’ means a fee that is reflec-
tive of the fair market value (as specified by the 
Secretary, through notice and comment rule-
making) for a bona fide, itemized service actu-
ally performed on behalf of an entity, that the 
entity would otherwise perform (or contract for) 
in the absence of the service arrangement and 
that is not passed on in whole or in part to a 
client or customer, whether or not the entity 
takes title to the drug. Such fee must be a flat 
dollar amount and shall not be directly or indi-
rectly based on, or contingent upon— 
‘‘(i) drug price, such as wholesale ac-
quisition cost or drug benchmark price 
(such as average wholesale price); 
‘‘(ii) the amount of discounts, rebates, 
fees, or other direct or indirect remunera-
tion with respect to covered part D drugs 
dispensed to enrollees in a prescription 
drug plan, except as permitted pursuant to 
paragraph (1)(A)(ii); 
‘‘(iii) coverage or formulary placement 
decisions or the volume or value of any re-
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ferrals or business generated between the 
parties to the arrangement; or 
‘‘(iv) any other amounts or meth-
odologies prohibited by the Secretary. 
‘‘(C) PHARMACY BENEFIT MANAGER.—The 
term ‘pharmacy benefit manager’ means any 
person or entity that, either directly or through 
an intermediary, acts as a price negotiator or 
group purchaser on behalf of a PDP sponsor or 
prescription drug plan, or manages the pre-
scription drug benefits provided by such spon-
sor or plan, including the processing and pay-
ment of claims for prescription drugs, the per-
formance of drug utilization review, the proc-
essing of drug prior authorization requests, the 
adjudication of appeals or grievances related to 
the prescription drug benefit, contracting with 
network pharmacies, controlling the cost of cov-
ered part D drugs, or the provision of related 
services. Such term includes any person or enti-
ty that carries out one or more of the activities 
described in the preceding sentence, irrespective 
of whether such person or entity calls itself a 
‘pharmacy benefit manager’.’’. 
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(2) MA–PD PLANS.—Section 1857(f)(3) of the 
Social Security Act (42 U.S.C. 1395w–27(f)(3)) is 
amended by adding at the end the following new 
subparagraph: 
‘‘(F) REQUIREMENTS RELATING TO PHAR-
MACY BENEFIT MANAGERS.—For plan years be-
ginning on or after January 1, 2029, section 
1860D–12(h).’’. 
(3) NONAPPLICATION OF PAPERWORK REDUC-
TION ACT.—Chapter 35 of title 44, United States 
Code, shall not apply to the implementation of this 
subsection. 
(4) FUNDING.— 
(A) SECRETARY.—In addition to amounts 
otherwise available, there is appropriated to the 
Centers for Medicare & Medicaid Services Pro-
gram Management Account, out of any money 
in the Treasury not otherwise appropriated, 
$113,000,000 for fiscal year 2026, to remain 
available until expended, to carry out this sub-
section. 
(B) OIG.—In addition to amounts other-
wise available, there is appropriated to the In-
spector General of the Department of Health 
and Human Services, out of any money in the 
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Treasury 
not 
otherwise 
appropriated, 
$20,000,000 for fiscal year 2026, to remain 
available until expended, to carry out this sub-
section. 
(b) GAO STUDY AND REPORT ON PRICE-RELATED 
COMPENSATION ACROSS THE SUPPLY CHAIN.— 
(1) STUDY.—The Comptroller General of the 
United States (in this subsection referred to as the 
‘‘Comptroller General’’) shall conduct a study de-
scribing the use of compensation and payment struc-
tures related to a prescription drug’s price within 
the retail prescription drug supply chain in part D 
of title XVIII of the Social Security Act (42 U.S.C. 
1395w–101 et seq.). Such study shall summarize in-
formation from Federal agencies and industry ex-
perts, to the extent available, with respect to the fol-
lowing: 
(A) The type, magnitude, other features 
(such as the pricing benchmarks used), and 
prevalence of compensation and payment struc-
tures related to a prescription drug’s price, 
such as calculating fee amounts as a percentage 
of a prescription drug’s price, between inter-
mediaries in the prescription drug supply chain, 
including— 
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(i) pharmacy benefit managers; 
(ii) PDP sponsors offering prescrip-
tion drug plans and Medicare Advantage 
organizations offering MA–PD plans; 
(iii) drug wholesalers; 
(iv) pharmacies; 
(v) manufacturers; 
(vi) pharmacy services administrative 
organizations; 
(vii) brokers, auditors, consultants, 
and other entities that— 
(I) advise PDP sponsors offering 
prescription drug plans and Medicare 
Advantage organizations offering MA– 
PD plans regarding pharmacy bene-
fits; or 
(II) review PDP sponsor and 
Medicare Advantage organization con-
tracts with pharmacy benefit man-
agers; and 
(viii) other service providers that con-
tract with any of the entities described in 
clauses (i) through (vii) that may use 
price-related compensation and payment 
structures, such as rebate aggregators (or 
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other entities that negotiate or process 
price concessions on behalf of pharmacy 
benefit managers, plan sponsors, or phar-
macies). 
(B) The primary business models and com-
pensation structures for each category of inter-
mediary described in subparagraph (A). 
(C) Variation in price-related compensation 
structures between affiliated entities (such as 
entities with common ownership, either full or 
partial, and subsidiary relationships) and unaf-
filiated entities. 
(D) Potential conflicts of interest among 
contracting entities related to the use of pre-
scription drug price-related compensation struc-
tures, such as the potential for fees or other 
payments set as a percentage of a prescription 
drug’s price to advantage formulary selection, 
distribution, or purchasing of prescription drugs 
with higher prices. 
(E) Notable differences, if any, in the use 
and level of price-based compensation struc-
tures over time and between different market 
segments, such as under part D of title XVIII 
of the Social Security Act (42 U.S.C. 1395w– 
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101 et seq.) and the Medicaid program under 
title XIX of such Act (42 U.S.C. 1396 et seq.). 
(F) The effects of drug price-related com-
pensation structures and alternative compensa-
tion structures on Federal health care programs 
and program beneficiaries, including with re-
spect to cost-sharing, premiums, Federal out-
lays, biosimilar and generic drug adoption and 
utilization, drug shortage risks, and the poten-
tial for fees set as a percentage of a drug’s 
price to advantage the formulary selection, dis-
tribution, or purchasing of drugs with higher 
prices. 
(G) Other issues determined to be relevant 
and appropriate by the Comptroller General. 
(2) REPORT.—Not later than 2 years after the 
date of enactment of this section, the Comptroller 
General shall submit to Congress a report containing 
the results of the study conducted under paragraph 
(1), together with recommendations for such legisla-
tion and administrative action as the Comptroller 
General determines appropriate. 
(c) MEDPAC REPORTS
ON AGREEMENTS WITH 
PHARMACY BENEFIT MANAGERS WITH RESPECT TO PRE-
SCRIPTION DRUG PLANS AND MA–PD PLANS.— 
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(1) IN GENERAL.—The Medicare Payment Ad-
visory Commission shall submit to Congress the fol-
lowing reports: 
(A) INITIAL REPORT.—Not later than the 
first March 15 occurring after the date that is 
2 years after the date on which the Secretary 
makes the data available to the Commission, a 
report regarding agreements with pharmacy 
benefit managers with respect to prescription 
drug plans and MA–PD plans. Such report 
shall include, to the extent practicable— 
(i) a description of trends and pat-
terns, including relevant averages, totals, 
and other figures for the types of informa-
tion submitted; 
(ii) an analysis of any differences in 
agreements and their effects on plan en-
rollee out-of-pocket spending and average 
pharmacy reimbursement, and other im-
pacts; and 
(iii) any recommendations the Com-
mission determines appropriate. 
(B) FINAL
REPORT.—Not later than 2 
years after the date on which the Commission 
submits the initial report under subparagraph 
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(A), a report describing any changes with re-
spect to the information described in subpara-
graph (A) over time, together with any rec-
ommendations the Commission determines ap-
propriate. 
(2) FUNDING.—In addition to amounts other-
wise available, there is appropriated to the Medicare 
Payment Advisory Commission, out of any money in 
the 
Treasury 
not 
otherwise 
appropriated, 
$1,000,000 for fiscal year 2026, to remain available 
until expended, to carry out this subsection. 
SEC. 6. EXPEDITED CONSIDERATION OF ENHANCED PRE-
MIUM TAX CREDIT REFORM BILL. 
(a) QUALIFYING LEGISLATION.— 
(1) IN GENERAL.—Only an enhanced premium 
tax credit reform bill shall be entitled to expedited 
consideration under this section. 
(2) DEFINITION.—In this section, the term 
‘‘enhanced premium tax credit reform bill’’ means a 
bill or joint resolution which consists solely of legis-
lative language with respect to continued health in-
surance premium savings, including more significant 
reforms, that has accumulated at least 10 cospon-
sors from each of the majority party and the minor-
ity party at the time it is offered. 
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(b) CONSIDERATION IN THE HOUSE OF REPRESENT-
ATIVES.— 
(1) REFERRAL
AND
REPORTING.—Any com-
mittee of the House of Representatives to which an 
enhanced premium tax credit reform bill is referred 
shall report the enhanced premium tax credit reform 
bill to the House of Representatives without amend-
ment not later than 5 legislative days after the date 
on which the enhanced premium tax credit reform 
bill was so referred. If a committee of the House of 
Representatives fails to report an enhanced premium 
tax credit reform bill within that period, that com-
mittee shall be automatically discharged from con-
sideration of the enhanced premium tax credit re-
form bill, and the enhanced premium tax credit re-
form bill shall be placed on the appropriate calendar. 
(2) PROCEEDING
TO
CONSIDERATION.—After 
the last committee authorized to consider an en-
hanced premium tax credit reform bill reports it to 
the House of Representatives or has been discharged 
from its consideration, it shall be in order to move 
to proceed to consider the enhanced premium tax 
credit reform bill in the House of Representatives. 
Such a motion shall not be in order after the House 
of Representatives has disposed of a motion to pro-
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ceed with respect to the enhanced premium tax cred-
it reform bill. The previous question shall be consid-
ered as ordered on the motion to its adoption with-
out intervening motion. The motion shall not be de-
batable. A motion to reconsider the vote by which 
the motion is disposed of shall not be in order. 
(3) VOTE ON PASSAGE.—The vote on passage 
of the enhanced premium tax credit reform bill shall 
occur not later than 3 legislative days after the date 
on which the last committee authorized to consider 
the enhanced premium tax credit reform bill reports 
it to the House of Representatives or is discharged. 
(c) EXPEDITED PROCEDURE IN THE SENATE.— 
(1) 
COMMITTEE
CONSIDERATION.—An 
en-
hanced premium tax credit reform bill introduced in 
the Senate shall be jointly referred to the committee 
or committees of jurisdiction, which committees shall 
report the enhanced premium tax credit reform bill 
without any revision and with a favorable rec-
ommendation, an unfavorable recommendation, or 
without recommendation, not later than 5 session 
days after the date on which the enhanced premium 
tax credit reform bill was so referred. If any com-
mittee to which an enhanced premium tax credit re-
form bill is referred fails to report the enhanced pre-
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mium tax credit reform bill within that period, that 
committee shall be automatically discharged from 
consideration of the enhanced premium tax credit re-
form bill, and the enhanced premium tax credit re-
form bill shall be placed on the appropriate calendar. 
(2) PROCEEDING.—Notwithstanding rule XXII 
of the Standing Rules of the Senate, it is in order, 
not later than 2 days of session after the date on 
which an enhanced premium tax credit reform bill is 
reported or discharged from all committees to which 
the enhanced premium tax credit reform bill was re-
ferred, for the majority leader of the Senate or the 
designee of the majority leader to move to proceed 
to the consideration of the enhanced premium tax 
credit reform bill. It shall also be in order for any 
Member of the Senate to move to proceed to the 
consideration of the enhanced premium tax credit re-
form bill at any time after the conclusion of such 2- 
day period. A motion to proceed is in order even 
though a previous motion to the same effect has 
been disagreed to. All points of order against the 
motion to proceed to the enhanced premium tax 
credit reform bill are waived. The motion to proceed 
is not debatable. The motion is not subject to a mo-
tion to postpone. A motion to reconsider the vote by 
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which the motion is agreed to or disagreed to shall 
not be in order. If a motion to proceed to the consid-
eration of the enhanced premium tax credit reform 
bill is agreed to, the enhanced premium tax credit 
reform bill shall remain the unfinished business until 
disposed of. All points of order against an enhanced 
premium tax credit reform bill and against consider-
ation of the enhanced premium tax credit reform bill 
are waived. 
(d) CONSIDERATION BY THE OTHER HOUSE.— 
(1) IN
GENERAL.—If, before passing an en-
hanced premium tax credit reform bill, a House re-
ceives from the other House an enhanced premium 
tax credit reform bill of the other House— 
(A) the enhanced premium tax credit re-
form bill of the other House shall not be re-
ferred to a committee; and 
(B) the procedure in the receiving House 
shall be the same as if no enhanced premium 
tax credit reform bill had been received from 
the other House until the vote on passage, when 
the enhanced premium tax credit reform bill re-
ceived from the other House shall supplant the 
enhanced premium tax credit reform bill of the 
receiving House. 
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sage of the enhanced premium tax credit reform bill 
received from the House of Representatives. 
(3) VETOES.—If the President vetoes an en-
hanced premium tax credit reform bill, consideration 
of a veto message in the Senate under this para-
graph shall be 10 hours equally divided between the 
majority and minority leaders of the Senate or the 
designees of the majority and minority leaders of the 
Senate. 
(f) VOTE ON PASSAGE.—The vote on final passage 
in the House of Representatives and the Senate of the en-
hanced premium tax credit reform bill shall occur not later 
than July 1, 2026. 
(g) EXERCISE OF RULEMAKING POWER.—This sec-
tion is enacted by Congress— 
(1) as an exercise of the rulemaking power of 
the Senate and House of Representatives, respec-
tively, and as such it is deemed a part of the rules 
of each House, respectively, but applicable only with 
respect to the procedure to be followed in that 
House in the case of an enhanced premium tax cred-
it reform bill, and it supersedes other rules only to 
the extent that it is inconsistent with such rules; and 
(2) with full recognition of the constitutional 
right of either House to change the rules (so far as 
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relating to the procedure of that House) at any time, 
in the same manner, and to the same extent as in 
the case of any other rule of that House. 
Æ 
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