Federal RuleAug 21
62
DOL Rewrites Disability Rules for 'Merit-Based Opportunity' Push
RuleLabor DepartmentFederal Contract Compliance Programs OfficeSignificant Wallet
119-hr-10549119th CongressWALLET
Patients Choice in Specialty Pharmacy Act
Sponsored By: Representative Dunn, Neal P. [R-FL-2]
Introduced
Summary
Guarantees patients can choose which specialty pharmacy fills their prescriptions. This bill would bar health plans and issuers from steering enrollees to affiliated specialty pharmacies and would limit when plans can exclude qualified specialty pharmacies from networks.
Show full summary
- Patients and families: Enrollees could not be forced or pushed to use an affiliated specialty pharmacy by higher copays, conditioned discounts, or added administrative delays when they pick a non‑affiliated specialty pharmacy.
- Independent specialty pharmacies: Licensed specialty pharmacies that meet uniform network terms and accept the same reimbursement would generally have to be allowed into networks, subject to narrow exceptions for fraud, program exclusion, or imminent patient harm.
- Plans, issuers, and PBMs: The steering and exclusion limits apply to insured group health plans and issuers but exclude self‑insured plans. The bill defines an "affiliated specialty pharmacy" to include pharmacies controlled by a plan or a pharmacy benefit manager and sets standards for what counts as a specialty pharmacy.
Effective date: would apply to plan years beginning on or after January 1, 2029.
Personalized for You
How does this bill affect your finances?
Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Protecting choice of specialty pharmacies
If enacted, this bill would stop many insurers and plans (except self-insured group plans) from forcing you to use a plan-owned specialty pharmacy. Plans and issuers would be banned from steering you by raising your copay, charging more coinsurance or deductibles, offering discounts only if you use an affiliated specialty pharmacy, or adding delays or penalties for using a non‑affiliated pharmacy. Plans would also have to let licensed specialty pharmacies join networks if the pharmacy meets the same network terms and accepts the same pay rates, unless the pharmacy has fraud or program exclusions or poses imminent patient harm. The bill would define "affiliated" and "specialty pharmacy" and limit recognized accreditors to three named organizations. These changes would apply to plan years beginning on or after January 1, 2029.
Sponsors & CoSponsors
Sponsor
Dunn, Neal P. [R-FL-2]
FL • R
Cosponsors
Rep. Wilson, Joe [R-SC-2]
SC • R
Sponsored 9/24/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov