The "Pharmacy Benefit Manager Reform Act of 2025" seeks to enhance transparency and accountability within the prescription drug supply chain, particularly concerning Pharmacy Benefit Managers (PBMs). For Medicare Part D, the bill mandates an "any willing pharmacy" policy, requiring Prescription Drug Plan (PDP) sponsors to allow any pharmacy meeting standard terms to join their network. The Secretary of Health and Human Services is directed to establish standards for "reasonable and relevant" contract terms by April 2028, following a request for information to gather insights on current PBM practices, reimbursement, and dispensing fees. The legislation also introduces measures to support "essential retail pharmacies," defined as non-affiliated pharmacies in underserved areas. The Secretary must publish biennial reports on trends affecting these pharmacies, including reimbursement and network participation, and maintain a public list of such pharmacies. To enforce these provisions, the bill establishes a process for pharmacies to report alleged PBM violations, empowering the Secretary to investigate and impose civil monetary penalties or other sanctions, while also protecting pharmacies from retaliation. A key component of the bill is the modernization of PBM accountability, effective January 2028. PBMs and their affiliates will be restricted to earning only "bona fide service fees," with rebates and discounts required to be fully passed through to PDP sponsors. The bill mandates comprehensive annual transparency reports from PBMs to PDP sponsors and the Secretary, detailing drug costs, dispensing channels, patient out-of-pocket spending, rebates, and PBM-retained revenue. These reports will include specific data on affiliated pharmacies and justifications for formulary decisions. Furthermore, PDP sponsors will gain audit rights over PBMs to verify compliance and data accuracy. The bill extends similar PBM oversight and reporting requirements to commercial group health plans and health insurance issuers, ensuring greater transparency in their contracts and drug pricing. PBMs serving these plans must provide detailed semi-annual reports, and plans must offer summary information to participants and beneficiaries upon request. In Medicaid, the bill aims to ensure accurate payments to pharmacies by requiring the Secretary to conduct surveys of retail and non-retail pharmacy drug prices to establish National Average Drug Acquisition Cost (NADAC) benchmarks. Pharmacies will be required to respond to these surveys, with penalties for non-compliance or false information. Crucially, the bill prohibits "abusive spread pricing" in Medicaid, mandating a transparent pass-through pricing model where PBM payments to pharmacies are limited to ingredient cost and a professional dispensing fee, with administrative fees reflecting fair market value. Any spread pricing will not be eligible for Federal matching payments, and the Office of the Inspector General will oversee these provisions.