Patients Before Middlemen Act

Key Points

• This bill aims to lower costs and increase pharmacy choices for people on Medicare by changing how 'middlemen,' known as pharmacy benefit managers, are allowed to make money. It requires these companies to be paid flat fees for their services rather than taking a percentage of high drug prices.
• The policy would require Medicare drug plans to allow any pharmacy to join their network as long as the pharmacy agrees to standard contract terms. This is designed to help independent and local drugstores stay in business and ensure seniors don't have to travel long distances to get their prescriptions.
• Starting in 2028, drug middlemen would be forced to pass 100% of the rebates and discounts they get from drug makers directly to the insurance plans. This prevents these companies from keeping secret profits that could otherwise be used to lower premiums or out-of-pocket costs for patients.
• The bill creates special protections for 'essential' pharmacies in rural or underserved areas. The government would track how much these local shops are being paid compared to large mail-order pharmacies owned by the insurance companies to ensure fair treatment.
• To ensure honesty, the bill gives insurance plans the right to audit their drug middlemen at least once a year. It also allows pharmacies to report unfair contracts to the government without fear of being punished or kicked out of the network.
• If a drug middleman breaks these rules, they could face expensive government fines. Any illegal profits they made would have to be paid back to the Medicare drug plan.