S. 882 — Patients Before Middlemen Act

This section requires prescription drug plan (PDP) sponsors to permit participation by any willing pharmacy meeting standard contract terms and conditions as a network pharmacy for plan years beginning on or after January 1, 2028, with such terms required to be reasonable and relevant per standards established by the Secretary by the first Monday in April 2027 (informed by a request for information issued by April 1, 2026, on PDP contracting practices). It also requires the Secretary to publish reports at least every two years until 2034, and periodically thereafter, on trends in reimbursements, payments, network participation, pharmacy counts, cost-sharing, and dispensing volumes for essential retail pharmacies (i.e., independent retail pharmacies in medically underserved areas; rural areas lacking another pharmacy within 10 miles; suburban areas within 2 miles; or urban areas within 1 mile) under Part D and Medicare Advantage prescription drug (MA-PD) plans, including comparisons to non-essential pharmacies and between PDP and MA-PD networks.

This section establishes requirements for pharmacy benefit managers (PBMs) under Medicare Part D prescription drug plans (PDPs), effective for plan years beginning on or after January 1, 2028, by adding a new subsection (h) to Section 1860D–12 of the Social Security Act (42 U.S.C. 1395w–112). PDP sponsor contracts with PBMs must include written agreements under which PBMs and their affiliates agree to the following: (1) derive no remuneration for services related to covered Part D drugs other than bona fide service fees, subject to exceptions for certain incentive payments (deemed bona fide if flat dollar amount, consistent with fair market value, related to services performed, and meeting Secretary-specified requirements) and for manufacturer rebates, discounts, or price concessions (not a violation if fully passed through to the PDP sponsor and compliant with direct and indirect remuneration rules); (2) undergo Secretary review (in consultation with the HHS Office of Inspector General), as appropriate, of remuneration arrangements for consistency with fair market value; (3) disgorge improper remuneration to the PDP sponsor, with PBMs required to enter written agreements with affiliates for such disgorgement and attest compliance; (4) apply pricing guarantees and cost performance measures transparently by consistently defining terms such as generic drug, brand name drug, specialty drug, rebate, and discount (consistent with 42 C.F.R. § 423.4 or successor where applicable); clearly identifying exclusions; and providing wholesale acquisition cost equivalents for non-wholesale acquisition cost-based measures; and (5) submit annual reports to the PDP sponsor and Secretary by July 1 (beginning in 2028) on specified information.