H.R. 4409: Fair Pharmacies for Federal Employees Act of 2025

The bill titled the "Fair Pharmacies for Federal Employees Act of 2025" aims to address ownership conflicts in the pharmaceutical industry related to federal employee health plans. The key provisions include:

Prohibitions on Ownership

The bill establishes that it is unlawful for certain entities to own or operate pharmacies or pharmacy benefit managers (PBMs) that provide services under federal employee health plans.

• Federal Employee Health Benefit Options: It prohibits the Office of Personnel Management (OPM) from contracting with health benefit carriers that own or control any part of a pharmacy or a PBM.
• PBM Ownership Restrictions: Similarly, it prohibits the OPM or any qualified health benefit carrier from contracting with a PBM that owns or controls any part of a pharmacy.

Definitions

For clarity, the bill defines several key terms:

• Health Plan: This refers to a group insurance policy or similar contract that provides, pays for, or reimburses expenses for health services.
• Person: The term follows the definition established in the Sherman Act.
• Pharmacy: Defined as any licensed person or business permitted to dispense medications, including various types of pharmacies such as mail-order and specialty pharmacies.
• Pharmacy Benefit Manager: This includes entities that manage pharmacy benefits, negotiate drug prices, and administer prescription drug benefits for health plans.
• Qualified Carrier: This refers to organizations that provide health services through group insurance or similar arrangements.

Impact on Regulations

The bill does not limit the authority of other regulatory bodies, including the Federal Trade Commission or the Department of Health and Human Services, to enforce existing laws related to competition and health services.

Overall Purpose

The primary goal of this legislation is to promote fair competition in the pharmacy sector by separating the ownership of pharmacies and PBMs from health insurance providers servicing federal employees, thereby reducing potential conflicts of interest that might influence drug pricing and access.

Relevant Companies

• CVS - CVS Health Corporation, a health services company that includes pharmacy benefit management and pharmacy operations, may need to restructure operations if they are found to be contractually involved with federal employee health plans.
• UNH - UnitedHealth Group Incorporated, which has a division managing pharmacy benefits and might be affected by restrictions on owning pharmacies tied to their insurance offerings.
• ANTM - Anthem, Inc. may also need to reevaluate its business structure regarding pharmacy management and insurance operations under this legislation.