Bill > HR6610

This bill, titled the "Pharmacists Fight Back [in Federal Employee Health Benefit Plans Act]," aims to regulate the practices of pharmacy benefit managers (PBMs) who administer prescription drug benefits for federal employees. A PBM is an entity that manages or administers plans that pay for, reimburse, or cover the cost of prescription drugs. The bill mandates that health benefit plans, when contracting with PBMs, must ensure these PBMs reimburse in-network pharmacies (licensed pharmacies not barred from participation) for the ingredient cost of a drug based on national average drug acquisition costs or wholesale acquisition costs, plus a small percentage or a flat fee, and pay a professional dispensing fee equivalent to what the state pays under Medicaid. Furthermore, PBMs must pass manufacturer rebates on to beneficiaries at the point of sale by reducing their coinsurance or copayment, and remit the remaining rebate amount to the health plan carrier. The bill also prohibits PBMs from steering beneficiaries to specific pharmacies, including their own affiliates, or creating network rules that unfairly exclude or restrict in-network pharmacies. It also prevents PBMs from influencing drug manufacturers to limit distribution and from recouping dispensing fees from beneficiaries. To enforce these provisions, the bill introduces monetary penalties for PBMs and carriers that violate these requirements, with escalating penalties and potential debarment for PBMs after repeated violations. The Office of Personnel Management is tasked with overseeing these regulations and conducting inspections, with provisions for hearings and judicial review for PBMs and carriers facing penalties. These changes are set to take effect one year after the bill's enactment.

Government Affairs

https://www.congress.gov/bill/119th-congress/house-bill/6610/all-info