PBM FAIR Act

The PBM FAIR Act was introduced on December 17, 2025, by Sen. Marshall (R-KS) with three cosponsors (Kaine, Grassley, Hassan) and referred to the Senate HELP Committee. This is an early-stage bill with a bipartisan coalition — unusual for healthcare price transparency legislation. The bill has a companion in the House (HR6837), referred to Education and Workforce Committee, increasing the probability of eventual passage. Funding: $0. This is a regulatory mandate, not a spending bill. The mechanism is amending ERISA to define PBMs as fiduciaries, forcing full disclosure of all compensation from drug manufacturers, and eliminating spread pricing. The money trail is about removing undisclosed revenue — the PBMs' ~$50B in annual manufacturer rebate and fee revenue becomes illegal. Structural winners and losers: The Big 3 PBMs — CVS Caremark ($CVS), Express Scripts ($CI), and Optum Rx ($UNH) — are direct losers. These three control ~80% of the US prescription drug market. The bill eliminates their ability to retain manufacturer rebates, charge undisclosed administrative fees, and profit from spread pricing on generic drugs. Smaller PBMs and independent pharmacies could benefit from reduced anticompetitive practices. Real market data: CVS at $80.98 (7-day +5.95%, 30-day +15.55%); CI at $284.92 (7-day +3.72%, 30-day +8.76%); UNH at $366.77 (7-day +3.75%, 30-day +41.6%). All three have rallied significantly in the past 30 days — UNH's 41.6% surge is notable. This rally likely reflects the market pricing the bill as low-probability given its early stage. Any progress — committee markup, hearing announcements, or cosponsor additions — would reverse these gains. Timeline: Early stage. Next steps: committee hearing, markup, then Senate floor vote. The 119th Congress runs through January 2027. This bill is a multi-year overhang, not an immediate threat. However, the bipartisan support (GOP + Dem cosponsors) and companion House bill elevate the risk profile above typical early-stage reform bills.