Pharmacists Fight Back [in Federal Employee Health Benefit Plans Act]
Sponsored By: Representative Auchincloss
Introduced
Summary
Lowering drug costs for federal employees by changing how pharmacy benefit managers are paid and punished is the bill's main aim. It would set new payment and reimbursement rules for PBMs in the Federal Employee Health Benefits Program and create enforcement tools for noncompliance.
Show full summary
- Federal employee health plans would face reduced PBM costs, which could ease pressure on plan spending and member costs.
- Pharmacy benefit managers (PBMs) working with those plans would have new payment and reimbursement requirements and could face penalties, debarment, and other sanctions for failing to comply.
- Agencies that oversee the Federal Employee Health Benefits Program would get new enforcement authorities and due‑process procedures, and the new rules would take effect 1 year after enactment.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 1 benefits, 0 costs, 3 mixed.
Lower prescription costs for federal employees
If enacted, PBMs in Federal employee health plans would have to pay in‑network pharmacies the national average drug acquisition cost (NADAC) on the claim day or, if not listed, the wholesale acquisition cost (WAC), plus the smaller of 4% or $50. PBMs would also pay the State Medicaid dispensing fee where the pharmacy is located. Manufacturer rebates would have to be applied at the point of sale to lower your copay or coinsurance, and PBMs could not reduce reimbursement after a claim. These rules would start one year after enactment.
Pharmacy choice protected for enrollees
If enacted, PBMs and their affiliates in Federal employee health plans could not require you to use a particular pharmacy or advertise one in‑network pharmacy over others. They could not design networks or credentialing rules that exclude in‑network pharmacies. PBMs could not press drug makers to limit where a drug is sold. These protections would begin one year after enactment.
PBM definitions and one-year delay
If enacted, the bill would define key terms used in the PBM rules, including 'pharmacy benefits manager', 'affiliate', 'beneficiary', and 'in‑network pharmacy'. The bill would also make the PBM duties, prohibitions, and enforcement measures effective one year after enactment. These changes would clarify who is covered and when the rules apply.
Stronger PBM penalties and oversight
If enacted, OPM would fine PBMs $10,000 for each violation of the PBM rules. A PBM's fines tied to a single carrier could not exceed $100,000 in any 10‑year period, and a carrier's fines could not exceed $50,000 in any 10‑year period. OPM could debar a PBM after 10 or more penalties and carriers could not pay a debarred PBM. Carriers must cooperate with OPM inspections and, after a fifth penalty tied to a PBM, submit a remediation plan within 60 days. PBMs and carriers would have notice, an on‑the‑record hearing, and the right to appeal to U.S. District Court. OPM generally must start penalty action within six years of a violation. These rules would start one year after enactment.
Sponsors & CoSponsors
Sponsor
Auchincloss
MA • D
Cosponsors
Comer
KY • R
Sponsored 12/11/2025
Harshbarger
TN • R
Sponsored 12/11/2025
Carter (GA)
GA • R
Sponsored 12/11/2025
Ciscomani
AZ • R
Sponsored 12/11/2025
Moulton
MA • D
Sponsored 12/11/2025
Deluzio
PA • D
Sponsored 12/11/2025
Tlaib
MI • D
Sponsored 12/11/2025
Budzinski
IL • D
Sponsored 12/11/2025
Krishnamoorthi
IL • D
Sponsored 12/11/2025
Khanna
CA • D
Sponsored 12/11/2025
Cohen
TN • D
Sponsored 12/11/2025
Pressley
MA • D
Sponsored 12/11/2025
Gonzalez, V.
TX • D
Sponsored 12/11/2025
Moore (AL)
AL • R
Sponsored 12/11/2025
Subramanyam
VA • D
Sponsored 12/11/2025
Pocan
WI • D
Sponsored 12/11/2025
Bishop
GA • D
Sponsored 12/11/2025
McCollum
MN • D
Sponsored 12/11/2025
Westerman
AR • R
Sponsored 12/23/2025
Scott, Austin
GA • R
Sponsored 1/7/2026
Fleischmann
TN • R
Sponsored 1/7/2026
Rogers (KY)
KY • R
Sponsored 1/7/2026
Maloy
UT • R
Sponsored 1/7/2026
McGarvey
KY • D
Sponsored 1/7/2026
Bergman
MI • R
Sponsored 1/9/2026
Sessions
TX • R
Sponsored 1/9/2026
Clyde
GA • R
Sponsored 1/30/2026
Roll Call Votes
No roll call votes available for this bill.
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