Pharmacists Fight Back in Medicare and Medicaid Act
Sponsored By: Representative Auchincloss
Introduced
Summary
Would curb PBM practices by forcing rebate pass-through and setting firm pharmacy payment rules. It would create a new federal regime for pharmacy benefit managers in Medicare Part D and align Medicaid contracts with the same payment, reporting, and anti‑steering rules starting for plan years and contracts beginning January 1, 2027.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 1 benefits, 0 costs, 3 mixed.
New PBM contracts and reporting rules
This bill would require Part D plan contracts to force PBMs and affiliates to follow pharmacy payment, rebate pass-through, and no-steering rules for plan years starting January 1, 2027. PBMs acting for a sponsor would need a written agreement with the sponsor and must certify compliance to the sponsor and the Secretary by July 1, 2028 and every year after. The bill would also define key terms like PBM, steering, and manufacturer rebate and align those definitions between Medicare and Medicaid. These changes increase oversight and require new administrative reporting by PBMs and plans.
Tougher PBM criminal and civil penalties
This bill would make it a felony for a PBM or related person to knowingly break specified Part D or Medicaid pharmacy payment, steering, or rebate pass-through rules. A conviction could bring a fine up to $1,000,000, up to 10 years in prison, or both. The bill would also create a civil monetary penalty of $1,000,000 for each such act. These enforcement rules would begin on January 1, 2027.
Rebates must lower your drug costs
This bill would require Part D plans and PBMs to apply manufacturer rebates at the pharmacy to reduce your copay or coinsurance. Cost-sharing would be calculated on the drug reimbursement amount minus the rebate (or the drug-and-enrollee-specific rebate). PBMs would pass remaining rebate amounts to the plan, and plans would remit specified amounts to the Secretary for subsidy-eligible individuals. The rule and a change to Part D bidding assumptions would take effect for plan years beginning January 1, 2027, and bid adjustments start with plan year 2027.
Higher minimum pay for pharmacies
This bill would set a floor for what in-network pharmacies get paid. Ingredient cost would be the NADAC (or WAC if NADAC is unavailable) on the claim date plus an add-on equal to 4% of that price, capped at $50. Plans and PBMs would also have to pay the State Medicaid dispensing fee where the pharmacy is located, and enrollees could not be charged to cover that fee. The bill would expand State surveys so pharmacies report net acquisition prices and the Secretary would publish NADAC and noncompliance lists; States could not use non-retail pharmacy prices to set retail rates. These changes would apply to plan years and contracts starting January 1, 2027.
Sponsors & CoSponsors
Sponsor
Auchincloss
MA • D
Cosponsors
Rep. Harshbarger, Diana [R-TN-1]
TN • R
Sponsored 12/11/2025
Rep. Comer, James [R-KY-1]
KY • R
Sponsored 12/11/2025
Rep. Carter, Earl L. "Buddy" [R-GA-1]
GA • R
Sponsored 12/11/2025
Ciscomani
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
Peters
CA • D
Sponsored 12/11/2025
Rep. Tlaib, Rashida [D-MI-12]
MI • D
Sponsored 12/11/2025
Budzinski
IL • D
Sponsored 12/11/2025
Rep. Krishnamoorthi, Raja [D-IL-8]
IL • D
Sponsored 12/11/2025
Khanna
CA • D
Sponsored 12/11/2025
Rep. Lynch, Stephen F. [D-MA-8]
MA • D
Sponsored 12/11/2025
Goldman (TX)
TX • R
Sponsored 12/11/2025
Cohen
TN • D
Sponsored 12/11/2025
Rep. Pressley, Ayanna [D-MA-7]
MA • D
Sponsored 12/11/2025
Gonzalez, V.
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
Bishop
GA • D
Sponsored 12/11/2025
McCollum
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
Rogers (KY)
KY • R
Sponsored 1/7/2026
Fulcher
ID • R
Sponsored 1/7/2026
Maloy
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
Sessions
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
Aderholt
AL • R
Sponsored 2/9/2026
Rep. Williams, Roger [R-TX-25]
TX • R
Sponsored 2/23/2026
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. James, John [R-MI-10]
MI • R
Sponsored 4/30/2026
Langworthy
NY • R
Sponsored 5/4/2026
Rep. Palmer, Gary J. [R-AL-6]
AL • R
Sponsored 5/14/2026
Rep. Tenney, Claudia [R-NY-24]
NY • R
Sponsored 5/14/2026
Roll Call Votes
No roll call votes available for this bill.
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