Federal RuleAug 21
62
DOL Rewrites Disability Rules for 'Merit-Based Opportunity' Push
RuleLabor DepartmentFederal Contract Compliance Programs OfficeSignificant Wallet
119-hr-6610119th CongressWALLET
Pharmacists Fight Back [in Federal Employee Health Benefit Plans Act]
Sponsored By: Representative Auchincloss, Jake [D-MA-4]
In Committee
Summary
This bill would rein in pharmacy benefit managers in Federal Employee Health Benefits plans and push more drug costs and rebates to the point of sale. It sets specific reimbursement formulas, bans steering and other PBM practices, and creates penalties and enforcement tools to force compliance.
Show full summary
- Federal employees and their families would see manufacturer rebates reduce coinsurance or copays at checkout, and carriers would receive the remainder of those rebates.
- In-network pharmacies would be paid ingredient cost based on the national average drug acquisition cost (NADAC) or, if NADAC is unavailable, wholesale acquisition cost, plus the lesser of 4% of NADAC or $50. They would also get a professional dispensing fee equal to the State Medicaid fee under Title XIX.
- Pharmacy benefit managers would face $10,000 penalties per violation with caps of $100,000 per PBM and $50,000 per carrier per 10-year period. After a fifth penalty the carrier must submit a remediation plan within 60 days. The Attorney General may sue to collect penalties and recovered amounts go to the Employees Health Benefits Fund.
The changes would take effect one year after enactment.
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
4 provisions identified: 2 benefits, 0 costs, 2 mixed.
Lower drug costs at FEHB pharmacies
This bill would set how in-network FEHB pharmacies get paid. Ingredient cost would equal NADAC on the day of claim adjudication, or WAC if NADAC is unavailable. PBMs would add the lesser of 4% of that cost or $50. PBMs would also pay the State Medicaid dispensing fee where the pharmacy is located. Manufacturer rebates for drugs obtained at in-network pharmacies would be applied at the point of sale to lower your copay or coinsurance. These rules would start one year after enactment.
Carrier duties and remediation rules
This bill would require FEHB carriers to follow the PBM payment and prohibition rules and to include contract terms that block payments to debarred PBMs. Carriers would have to cooperate with OPM inspections and provide documents, staff, and facilities when asked. If a carrier is tied to a PBM that gets a fifth penalty in a 10-year period, the carrier must file a remediation plan within 60 days and OPM must inspect within 60 days of that plan. Carriers could not pay debarred PBMs during the debarment. These rules would start one year after enactment.
Fines and possible debarment for PBMs
This bill would let OPM impose $10,000 penalties for each PBM violation. A PBM could not face more than $100,000 in penalties per 10-year period with respect to a carrier, and a carrier's total penalties could not exceed $50,000 per 10-year period. OPM could debar a PBM that gets 10 or more penalties in any 10-year period; debarment would start 90 days after the first penalty used to trigger it. The Attorney General could sue to collect penalties and recovered amounts would go to the Employees Health Benefits Fund. These rules would start one year after enactment.
Clear definitions for PBMs and pharmacies
This bill would add clear definitions for key terms used in the PBM rules for FEHB plans. It would define affiliate, beneficiary, in-network pharmacy, pharmacy benefits manager, pharmacy benefits management services, and prescription drug for enforcement purposes. These definitions would help apply the payment and penalty rules. These definitions would take effect one year after enactment.
Sponsors & CoSponsors
Sponsor
Auchincloss, Jake [D-MA-4]
MA • D
Cosponsors
Rep. De La Cruz, Monica [R-TX-15]
TX • R
Sponsored 9/24/2026
Rep. Crawford, Eric A. "Rick" [R-AR-1]
AR • R
Sponsored 10/1/2026
Rep. Wilson, Joe [R-SC-2]
SC • R
Sponsored 10/29/2026
Rep. Comer, James [R-KY-1]
KY • R
Sponsored 12/11/2025
Rep. Harshbarger, Diana [R-TN-1]
TN • R
Sponsored 12/11/2025
Rep. Carter, Earl L. "Buddy" [R-GA-1]
GA • R
Sponsored 12/11/2025
Rep. Ciscomani, Juan [R-AZ-6]
AZ • R
Sponsored 12/11/2025
Rep. Moulton, Seth [D-MA-6]
MA • D
Sponsored 12/11/2025
Rep. Deluzio, Christopher R. [D-PA-17]
PA • D
Sponsored 12/11/2025
Rep. Tlaib, Rashida [D-MI-12]
MI • D
Sponsored 12/11/2025
Rep. Budzinski, Nikki [D-IL-13]
IL • D
Sponsored 12/11/2025
Rep. Krishnamoorthi, Raja [D-IL-8]
IL • D
Sponsored 12/11/2025
Rep. Khanna, Ro [D-CA-17]
CA • D
Sponsored 12/11/2025
Rep. Cohen, Steve [D-TN-9]
TN • D
Sponsored 12/11/2025
Rep. Pressley, Ayanna [D-MA-7]
MA • D
Sponsored 12/11/2025
Rep. Gonzalez, Vicente [D-TX-34]
TX • D
Sponsored 12/11/2025
Rep. Moore, Barry [R-AL-1]
AL • R
Sponsored 12/11/2025
Rep. Subramanyam, Suhas [D-VA-10]
VA • D
Sponsored 12/11/2025
Rep. Pocan, Mark [D-WI-2]
WI • D
Sponsored 12/11/2025
Rep. Bishop, Sanford D. [D-GA-2]
GA • D
Sponsored 12/11/2025
Rep. McCollum, Betty [D-MN-4]
MN • D
Sponsored 12/11/2025
Rep. Westerman, Bruce [R-AR-4]
AR • R
Sponsored 12/23/2025
Rep. Scott, Austin [R-GA-8]
GA • R
Sponsored 1/7/2026
Rep. Fleischmann, Charles J. "Chuck" [R-TN-3]
TN • R
Sponsored 1/7/2026
Rep. Rogers, Harold [R-KY-5]
KY • R
Sponsored 1/7/2026
Rep. Maloy, Celeste [R-UT-2]
UT • R
Sponsored 1/7/2026
Rep. McGarvey, Morgan [D-KY-3]
KY • D
Sponsored 1/7/2026
Rep. Bergman, Jack [R-MI-1]
MI • R
Sponsored 1/9/2026
Rep. Sessions, Pete [R-TX-17]
TX • R
Sponsored 1/9/2026
Rep. Clyde, Andrew S. [R-GA-9]
GA • R
Sponsored 1/30/2026
Rep. Rogers, Mike D. [R-AL-3]
AL • R
Sponsored 2/4/2026
Rep. Aderholt, Robert B. [R-AL-4]
AL • R
Sponsored 2/9/2026
Rep. Burchett, Tim [R-TN-2]
TN • R
Sponsored 4/14/2026
Rep. Strong, Dale W. [R-AL-5]
AL • R
Sponsored 4/14/2026
Rep. Mann, Tracey [R-KS-1]
KS • R
Sponsored 4/21/2026
Rep. Langworthy, Nicholas A. [R-NY-23]
NY • R
Sponsored 5/4/2026
Rep. Palmer, Gary J. [R-AL-6]
AL • R
Sponsored 5/14/2026
Rep. Figures, Shomari [D-AL-2]
AL • D
Sponsored 6/3/2026
Rep. Frost, Maxwell [D-FL-10]
FL • D
Sponsored 7/6/2026
Rep. McCormick, Richard [R-GA-7]
GA • R
Sponsored 7/9/2026
Rep. Ansari, Yassamin [D-AZ-3]
AZ • D
Sponsored 7/20/2026
Rep. Bresnahan, Robert P. [R-PA-8]
PA • R
Sponsored 7/20/2026
Rep. Thompson, Bennie G. [D-MS-2]
MS • D
Sponsored 8/3/2026
Rep. Ezell, Mike [R-MS-4]
MS • R
Sponsored 8/24/2026
Rep. Kelly, Trent [R-MS-1]
MS • R
Sponsored 8/27/2026
Rep. Grijalva, Adelita S. [D-AZ-7]
AZ • D
Sponsored 9/16/2026
Rep. Guest, Michael [R-MS-3]
MS • R
Sponsored 9/16/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov