H.R. 6609: Pharmacists Fight Back in Medicare and Medicaid Act
This bill, titled the "Pharmacists Fight Back in Medicare and Medicaid Act," proposes amendments to the Social Security Act, specifically targeting the regulation of pharmacy benefit managers (PBMs) in Medicare and Medicaid programs. Here’s a breakdown of the key provisions:
1. Requirements for Pharmacy Benefit Managers (PBMs) in Medicare
The bill introduces new requirements for Medicare prescription drug plans beginning in 2027:
- Pharmacy Payment Compliance: PBMs must adhere to specific payment standards for pharmacies, ensuring they are reimbursed based on the national average drug acquisition cost or wholesale acquisition cost, plus a fixed percentage or a cap.
- Dispensing Fees: PBMs must pay pharmacies a dispensing fee equivalent to what is established under state Medicaid plans, without requiring patients to cover this additional cost.
- Prohibition of Steering: PBMs are prohibited from directing patients to specific pharmacies, particularly those affiliated with the PBM.
- Rebate Pass-Through: If a PBM receives manufacturer rebates, these must be applied at the point of sale to reduce the patient’s coinsurance or copayment.
- Annual Reporting: PBMs must submit annual reports to the Secretary confirming compliance with these requirements.
2. Medicaid Provisions
Similar rules are proposed for Medicaid, which require that:
- Payment Standards: Entities covering outpatient drugs must ensure payments match the drug cost standards established in Medicare, including a dispensing fee and any applicable rebates to the state.
- Steering Restrictions: PBMs and relevant entities are similarly barred from steering patients to specific pharmacies.
3. Transparency Enhancements
The bill aims to improve transparency within the Medicaid program by revising reporting and compliance standards so that pharmacies must report acquisition prices and other financial data as part of state surveys. Additionally:
- Public Access to Pricing: States must make information on drug acquisition prices publicly available.
4. Penalties for Non-Compliance
To enforce these standards, the bill establishes criminal and civil penalties for PBMs that do not comply, including the possibility of fines and imprisonment for serious violations. Specific violations that could lead to penalties include:
- Failure to comply with payment requirements.
- Engaging in steering practices.
- Not adhering to rebate pass-through mandates.
5. Effective Dates
The majority of the provisions are set to come into effect starting January 1, 2027, allowing time for stakeholders to adapt to the new regulations.
Relevant Companies
- CVS: Acts as a pharmacy benefit manager and may face compliance requirements and operational changes due to the act.
- ANTM: As a managed care organization, it will need to align its practices with the new PBM regulations in Medicare and Medicaid.
- ELAN: May also be impacted due to its involvement in pharmaceutical management services.
This is an AI-generated summary of the bill text. There may be mistakes.
Sponsors
31 bill sponsors
-
TrackJake Auchincloss
Sponsor
-
TrackJack Bergman
Co-Sponsor
-
TrackSanford D. Bishop, Jr.
Co-Sponsor
-
TrackNikki Budzinski
Co-Sponsor
-
TrackEarl L. "Buddy" Carter
Co-Sponsor
-
TrackJuan Ciscomani
Co-Sponsor
-
TrackSteve Cohen
Co-Sponsor
-
TrackJames Comer
Co-Sponsor
-
TrackChristopher R. Deluzio
Co-Sponsor
-
TrackCharles J. "Chuck" Fleischmann
Co-Sponsor
-
TrackRuss Fulcher
Co-Sponsor
-
TrackCraig Goldman
Co-Sponsor
-
TrackVicente Gonzalez
Co-Sponsor
-
TrackDiana Harshbarger
Co-Sponsor
-
TrackRo Khanna
Co-Sponsor
-
TrackRaja Krishnamoorthi
Co-Sponsor
-
TrackStephen F. Lynch
Co-Sponsor
-
TrackCeleste Maloy
Co-Sponsor
-
TrackBetty McCollum
Co-Sponsor
-
TrackMorgan McGarvey
Co-Sponsor
-
TrackBarry Moore
Co-Sponsor
-
TrackSeth Moulton
Co-Sponsor
-
TrackScott H. Peters
Co-Sponsor
-
TrackMark Pocan
Co-Sponsor
-
TrackAyanna Pressley
Co-Sponsor
-
TrackHarold Rogers
Co-Sponsor
-
TrackAustin Scott
Co-Sponsor
-
TrackPete Sessions
Co-Sponsor
-
TrackSuhas Subramanyam
Co-Sponsor
-
TrackRashida Tlaib
Co-Sponsor
-
TrackBruce Westerman
Co-Sponsor
Actions
2 actions
| Date | Action |
|---|---|
| Dec. 11, 2025 | Introduced in House |
| Dec. 11, 2025 | Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. |
Corporate Lobbying
0 companies lobbying
None found.
* Note that there can be significant delays in lobbying disclosures, and our data may be incomplete.
