Pharmacists Fight Back in Medicare and Medicaid Act

Key Points

• This bill targets pharmacy benefit managers (PBMs) that act as middlemen between drug manufacturers and insurance plans under Medicare and Medicaid. It requires PBMs to pass drug rebates directly to patients at the point of sale, lowering what people pay out of pocket for their prescriptions.
• The bill bans PBMs from steering patients to specific pharmacies, including pharmacies the PBM owns. This means patients could keep using their local neighborhood pharmacy without being penalized with higher costs or limited choices.
• Pharmacies would receive standardized payments based on what drugs actually cost to acquire, plus a small markup and a dispensing fee. This prevents PBMs from paying pharmacies less than what they paid for the drug, which has been a major problem for independent pharmacies.
• PBMs that knowingly break these rules could face felony criminal charges, fines up to $1 million, and up to 10 years in prison. The bill also creates civil monetary penalties for violations.
• The bill expands drug pricing surveys beyond retail pharmacies to include mail-order, specialty, nursing home, and hospital pharmacies, and requires all survey data to be made public. This would give states, pharmacies, and the public much more visibility into what drugs actually cost.
• All major provisions take effect for plan years starting January 1, 2027, giving insurers, PBMs, and states about one year to adjust their contracts and systems to comply with the new rules.