119th Congress · introduced in the Senate · Mar 6, 2025
Patients Before Middlemen Act
Official title from Congress.gov
Latest action (Mar 6, 2025): Read twice and referred to the Committee on Finance.
View on Congress.govPolicy area: Health
Congressional Research Service summary, version: Introduced in Senate (Mar 6, 2025)
Patients Before Middlemen Act
This bill establishes certain standards and reporting requirements for prescription drug plan (PDP) sponsors, pharmacy benefit managers (PBMs), and pharmacies under the Medicare prescription drug benefit and Medicare Advantage.
Specifically, the Centers for Medicare & Medicaid Services (CMS) must develop reasonable and relevant standards for contracts between PDP sponsors and pharmacies. The CMS must seek input from interested stakeholders when developing these standards. PDP sponsors are subject to civil penalties for violating these standards; PBMs must reimburse PDP sponsors for civil penalties that result from their responsibilities.
The bill also requires the CMS to report periodically on essential retail pharmacies (i.e., pharmacies that serve as the only pharmacy within a certain radius) with respect to costs, contracts, and other specified information, particularly in relation to other types of pharmacies.
Additionally, PBMs may not receive any income other than flat, bona fide service fees. PBMs must turn over any excess amounts they receive to PDP sponsors; PDP sponsors must turn over these amounts to the CMS. In addition, PBMs must report to PDP sponsors and to the CMS an itemized list of prescription drugs that were dispensed during the previous year and related data about costs, claims, affiliated pharmacies, and other specified information. PDP sponsors may audit PBMs to ensure compliance with these requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations.
The bill's changes generally apply beginning in 2028.
Includes amendment, cloture, and procedural votes. Each is labeled with its exact question; only a passage question is a vote to pass the bill.
No recorded roll calls on this bill in coverage.
Read twice and referred to the Committee on Finance.
Introduced in Senate
Actions from Congress.gov, newest first.
LD-2 reports whose issue descriptions explicitly cite this bill (bill type and number validated against Congress.gov records). A citation does not establish the client's position or any contact with a member.
Loading lobbying reportsCoverage: reports for 2025 onward, posted Jan 1, 2025 through Oct 24, 2026.
105 citations; showing the 25 most recently posted.
NATIONAL COMMUNITY PHARMACISTS ASSOCIATION · lobbying firm or registrant: NATIONAL COMMUNITY PHARMACISTS ASSOCIATION
2026 Q3 report (Jul 1, 2026 – Sep 30, 2026) · posted Oct 21, 2026 · issue area: Medicare/Medicaid
$370,000
Spent on own lobbying
S.891, the Bipartisan Health Care Act; S.882, the Patients Before Middlemen Act; S.927, the Protecting Pharmacies in Medicaid Act; H.R.3164/S.2426, the Mainstreet Pharmacy Access Act/the Ensuring Communit…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
CVS HEALTH (AND SUBSIDIARIES) · lobbying firm or registrant: CVS HEALTH (AND SUBSIDIARIES)
2026 Q3 report (Jul 1, 2026 – Sep 30, 2026) · posted Oct 21, 2026 · issue area: Medicare/Medicaid
$2,040,000
Spent on own lobbying
…g, vaccination, and treatment. Issues related to Accountable Care Organizations. Issues related to Medicare Shared Savings Program. Issues related to Medicaid. S. 882, The Patients Before Middlemen (PBM) Act S. 927, The Protecting Pharmacies in Medicaid Act S. 1105 - No Unreasonable Payments, Coding, Or Diagnoses for the Eld…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
EMD SERONO INC · lobbying firm or registrant: EMD SERONO, INC.
2026 Q3 report (Jul 1, 2026 – Sep 30, 2026) · posted Oct 20, 2026 · issue area: Health Issues
$730,000
Spent on own lobbying
…ns H.R. 6703: Lower Health Care Premiums for All Americans Act; provisions related to Pharmacy Benefit Management (PBM) S. 864: HELP Copays Act; all provisions S. 882: Patients Before Middlemen Act; all provisions S. 891: Bipartisan Health Care Act; provisions related to Titles I, II, VIII, and IX S. 1862: Orphan CURES Act;…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · lobbying firm or registrant: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2026 Q3 report (Jul 1, 2026 – Sep 30, 2026) · posted Oct 20, 2026 · issue area: Pharmacy
$3,010,000
Spent on own lobbying
…Act - Sen. Warnock, Raphael - Drug copay caps S. 652 - Protecting Patients from Deceptive Drugs Ads Act - Sen. Durbin, Richard - Drug advertising requirements S. 882 - Patients Before Middlemen Act - Sen. Blackburn, Marsha - PBM reforms S. 891 - Bipartisan Health Care Act - Sen. Wyden, Ron - PBM reforms and transparency S.…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
NATIONAL ASSOCIATION OF CHAIN DRUG STORES · lobbying firm or registrant: NATIONAL ASSOCIATION OF CHAIN DRUG STORES
2026 Q3 report (Jul 1, 2026 – Sep 30, 2026) · posted Oct 20, 2026 · issue area: Pharmacy
$480,000
Spent on own lobbying
…ccess to Pharmacist Services Act H.R. 4317 PBM Reform Act S. 526 Pharmacy Benefit Manager (PBM) Transparency Act S. 527 Prescription Pricing for the People Act S. 882 Patients Before Middlemen (PBM) Act S. 927 Protecting Pharmacies in Medicaid Act S. 1404 Combating Organized Retail Crime Act S. 2426 Equitable Community Acces…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
NATIONAL ASSOCIATION OF CHAIN DRUG STORES · lobbying firm or registrant: NATIONAL ASSOCIATION OF CHAIN DRUG STORES
2026 Q3 report (Jul 1, 2026 – Sep 30, 2026) · posted Oct 20, 2026 · issue area: Medicare/Medicaid
$480,000
Spent on own lobbying
H.R. 2484 Seniors Access to Critical Medications Act H.R. 3164 Ensuring Community Access to Pharmacist Services Act H.R. 4317 PBM Reform Act S. 882 Patients Before Middlemen (PBM) Act S. 927 Protecting Pharmacies in Medicaid Act S. 2626 Equitable Community Access to Pharmacist Services Act S. 3345 PBM Pric…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
AMERICAN COLLEGE OF RHEUMATOLOGY · lobbying firm or registrant: AMERICAN COLLEGE OF RHEUMATOLOGY
2026 Q3 report (Jul 1, 2026 – Sep 30, 2026) · posted Oct 20, 2026 · issue area: Health Issues
$50,000
Spent on own lobbying
…(HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resi…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
AMERICAN COLLEGE OF RHEUMATOLOGY · lobbying firm or registrant: AMERICAN COLLEGE OF RHEUMATOLOGY
2026 Q3 report (Jul 1, 2026 – Sep 30, 2026) · posted Oct 20, 2026 · issue area: Budget/Appropriations
$50,000
Spent on own lobbying
…(HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resi…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
AMERICAN COLLEGE OF RHEUMATOLOGY · lobbying firm or registrant: AMERICAN COLLEGE OF RHEUMATOLOGY
2026 Q3 report (Jul 1, 2026 – Sep 30, 2026) · posted Oct 20, 2026 · issue area: Medicare/Medicaid
$50,000
Spent on own lobbying
…(HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resi…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
NATIONAL ASSOCIATION OF CHAIN DRUG STORES · lobbying firm or registrant: VAN SCOYOC ASSOCIATES
2026 Q3 report (Jul 1, 2026 – Sep 30, 2026) · posted Oct 19, 2026 · issue area: Health Issues
$70,000
Paid to lobbying firm
…2026, Division B - Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2026, Implementation of PBM Reform S.882, Patients Before Middlemen Act, Entirety
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
NATIONAL ASSOCIATION OF CHAIN DRUG STORES · lobbying firm or registrant: VAN SCOYOC ASSOCIATES
2026 Q3 report (Jul 1, 2026 – Sep 30, 2026) · posted Oct 19, 2026 · issue area: Medicare/Medicaid
$70,000
Paid to lobbying firm
…2026, Division B - Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2026, Implementation of PBM Reform S.882, Patients Before Middlemen Act, Entirety
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
NATIONAL ASSOCIATION OF CHAIN DRUG STORES · lobbying firm or registrant: VAN SCOYOC ASSOCIATES
2026 Q3 report (Jul 1, 2026 – Sep 30, 2026) · posted Oct 19, 2026 · issue area: Pharmacy
$70,000
Paid to lobbying firm
…2026, Division B - Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2026, Implementation of PBM Reform S.882, Patients Before Middlemen Act, Entirety S.3788, CLEAR LABELS Act, Entirety
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
CAMBIA HEALTH SOLUTIONS · lobbying firm or registrant: CAMBIA HEALTH SOLUTIONS
2026 Q3 report (Jul 1, 2026 – Sep 30, 2026) · posted Oct 15, 2026 · issue area: Medicare/Medicaid
$670,000
Spent on own lobbying
…tronic Prior Authorization (H.R. 3514, H.R. 8375), Provider Directories (S. 891), Telehealth Extending Flexibilities (H.R. 4206, S. 1261), Transparency & PBMs (S. 882; S. 891, S. 3345, H.R. 9392), Physician Fee Schedule, Site Neutrality (H.R. 7149), Broker/Agents (H.R. 9395), MLR (H.R. 9644).
Congress inferred from the report year; bill number matches Congress.gov records and the bill predates the report; no title was cited with it. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
EMD SERONO INC · lobbying firm or registrant: EMD SERONO, INC.
2026 Q2 report (Apr 1, 2026 – Jun 30, 2026) · posted Jul 21, 2026 · issue area: Health Issues
$700,000
Spent on own lobbying
…ns H.R. 6703: Lower Health Care Premiums for All Americans Act; provisions related to Pharmacy Benefit Management (PBM) S. 864: HELP Copays Act; all provisions S. 882: Patients Before Middlemen Act; all provisions S. 891: Bipartisan Health Care Act; provisions related to Titles I, II, VIII, and IX S. 1862: Orphan CURES Act;…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
AMERICAN COLLEGE OF RHEUMATOLOGY · lobbying firm or registrant: AMERICAN COLLEGE OF RHEUMATOLOGY
2026 Q2 report (Apr 1, 2026 – Jun 30, 2026) · posted Jul 20, 2026 · issue area: Health Issues
$180,000
Spent on own lobbying
…(HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resi…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
AMERICAN COLLEGE OF RHEUMATOLOGY · lobbying firm or registrant: AMERICAN COLLEGE OF RHEUMATOLOGY
2026 Q2 report (Apr 1, 2026 – Jun 30, 2026) · posted Jul 20, 2026 · issue area: Budget/Appropriations
$180,000
Spent on own lobbying
…(HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resi…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
AMERICAN COLLEGE OF RHEUMATOLOGY · lobbying firm or registrant: AMERICAN COLLEGE OF RHEUMATOLOGY
2026 Q2 report (Apr 1, 2026 – Jun 30, 2026) · posted Jul 20, 2026 · issue area: Medicare/Medicaid
$180,000
Spent on own lobbying
…(HR 2433) Resident Education Deferred Interest (REDI) Act (HR 2028 / S 942) Help Ensure Lower Patient (HELP) Copays Act (S. 864) Patients Before Middlemen Act (S. 882) PBM Transparency Act (S. 526) Prescription Pricing for the People Act (S. 527) Conrad State 30 and Physician Access Reauthorization Act (HR 1585 / S 709) Resi…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) · lobbying firm or registrant: AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP)
2026 Q2 report (Apr 1, 2026 – Jun 30, 2026) · posted Jul 20, 2026 · issue area: Pharmacy
$3,010,000
Spent on own lobbying
…Act - Sen. Warnock, Raphael - Drug copay caps S. 652 - Protecting Patients from Deceptive Drugs Ads Act - Sen. Durbin, Richard - Drug advertising requirements S. 882 - Patients Before Middlemen Act - Sen. Blackburn, Marsha - PBM reforms S. 891 - Bipartisan Health Care Act - Sen. Wyden, Ron - PBM reforms and transparency S.…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
CVS HEALTH (AND SUBSIDIARIES) · lobbying firm or registrant: CVS HEALTH (AND SUBSIDIARIES)
2026 Q2 report (Apr 1, 2026 – Jun 30, 2026) · posted Jul 20, 2026 · issue area: Medicare/Medicaid
$3,570,000
Spent on own lobbying
…g, vaccination, and treatment. Issues related to Accountable Care Organizations. Issues related to Medicare Shared Savings Program. Issues related to Medicaid. S. 882, The Patients Before Middlemen (PBM) Act S. 927, The Protecting Pharmacies in Medicaid Act S. 1105 - No Unreasonable Payments, Coding, Or Diagnoses for the Eld…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
NATIONAL ASSOCIATION OF CHAIN DRUG STORES · lobbying firm or registrant: NATIONAL ASSOCIATION OF CHAIN DRUG STORES
2026 Q2 report (Apr 1, 2026 – Jun 30, 2026) · posted Jul 20, 2026 · issue area: Pharmacy
$290,000
Spent on own lobbying
…ccess to Pharmacist Services Act H.R. 4317 PBM Reform Act S. 526 Pharmacy Benefit Manager (PBM) Transparency Act S. 527 Prescription Pricing for the People Act S. 882 Patients Before Middlemen (PBM) Act S. 927 Protecting Pharmacies in Medicaid Act S. 1404 Combating Organized Retail Crime Act S. 2426 Equitable Community Acces…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
NATIONAL ASSOCIATION OF CHAIN DRUG STORES · lobbying firm or registrant: NATIONAL ASSOCIATION OF CHAIN DRUG STORES
2026 Q2 report (Apr 1, 2026 – Jun 30, 2026) · posted Jul 20, 2026 · issue area: Medicare/Medicaid
$290,000
Spent on own lobbying
H.R. 2484 Seniors Access to Critical Medications Act H.R. 3164 Ensuring Community Access to Pharmacist Services Act H.R. 4317 PBM Reform Act S. 882 Patients Before Middlemen (PBM) Act S. 927 Protecting Pharmacies in Medicaid Act S. 2626 Equitable Community Access to Pharmacist Services Act S. 3345 PBM Pric…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
FOOD MARKETPLACE INC · lobbying firm or registrant: FOOD MARKETPLACE INC.
2026 Q2 report (Apr 1, 2026 – Jun 30, 2026) · posted Jul 20, 2026 · issue area: Pharmacy
$584,000
Spent on own lobbying
…eration (DIR), and transparency Issues relating to pharmacy reimbursement, scope of practice, access to pharmacist-provided care Patients Before Middlemen Act (S. 882) Protecting Pharmacies in Medicaid Act (S. 927) Main Street Pharmacy Access Act (H.R. 3164/S. 2426) PBM Reform Act (H.R. 4317) S.3345 - PBM Price Transparency…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
CAMBIA HEALTH SOLUTIONS · lobbying firm or registrant: CAMBIA HEALTH SOLUTIONS
2026 Q2 report (Apr 1, 2026 – Jun 30, 2026) · posted Jul 20, 2026 · issue area: Medicare/Medicaid
$700,000
Spent on own lobbying
…tronic Prior Authorization (H.R. 3514, H.R. 8375), Provider Directories (S. 891), Telehealth Extending Flexibilities (H.R. 4206, S. 1261), Transparency & PBMs (S. 882; S. 891, S. 3345), Physician Fee Schedule, Site Neutrality (H.R. 7149, H.R. 3417 from 118th), Broker/Agents (H.R. 9395).
Congress inferred from the report year; bill number matches Congress.gov records and the bill predates the report; no title was cited with it. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
NATIONAL COMMUNITY PHARMACISTS ASSOCIATION · lobbying firm or registrant: NATIONAL COMMUNITY PHARMACISTS ASSOCIATION
2026 Q2 report (Apr 1, 2026 – Jun 30, 2026) · posted Jul 17, 2026 · issue area: Medicare/Medicaid
$270,000
Spent on own lobbying
S.891, the Bipartisan Health Care Act; S.882, the Patients Before Middlemen Act; S.927, the Protecting Pharmacies in Medicaid Act; H.R.3164/S.2426, the Mainstreet Pharmacy Access Act/the Ensuring Communit…
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing
NATIONAL ASSOCIATION OF CHAIN DRUG STORES · lobbying firm or registrant: VAN SCOYOC ASSOCIATES
2026 Q2 report (Apr 1, 2026 – Jun 30, 2026) · posted Jul 17, 2026 · issue area: Medicare/Medicaid
$80,000
Paid to lobbying firm
…2026, Division B - Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2026, Implementation of PBM Reform S.882, Patients Before Middlemen Act, Entirety
Congress inferred from the report year; bill number and the title cited with it match Congress.gov records, and the bill predates the report. The amount is lobbying spending for every issue on this report, not this bill alone, and none of it is paid to any member of Congress. View filing