This legislation requires the Medicare Payment Advisory Commission (MedPAC) to deliver two comprehensive reports to Congress regarding agreements between pharmacy benefit managers (PBMs) and Medicare prescription drug plans, including Medicare Advantage Prescription Drug (MA-PD) plans. The initial report , due two years after data availability, must describe trends and patterns in these agreements. It will also analyze how these agreements affect plan enrollee out-of-pocket spending and average pharmacy reimbursement , alongside other impacts, and include appropriate recommendations. A final report , due two years after the initial submission, will then detail any changes in this information over time and offer updated recommendations to Congress.