Federal employee drug plans would get new limits on pharmacy middlemen

What does this do?

HR 6610 places new rules on pharmacy benefit managers, the companies that manage prescription drug coverage for federal employee health plans. PBMs would have to pay pharmacies based on publicly tracked pricing data plus a standard dispensing fee, and would be required to pass drug rebates from manufacturers directly to patients at the pharmacy counter. They could not direct patients toward pharmacies they own or have a financial relationship with.

Who does it affect?

The roughly 8 million federal employees, retirees, and their family members enrolled in the Federal Employees Health Benefits program would be directly affected. Independent community pharmacies and large PBM companies that currently control drug pricing and distribution in these plans would also be affected.

Why does it matter?

PBMs would face new restrictions on steering, pricing, and rebate handling that could alter how prescription drug costs flow through federal health plans. Companies that do not comply face escalating consequences, up to and including a full ban from participating in federal employee health coverage.

What does it cost, and who pays?

• Up to $10,000 fine per violation
• 10 fines in 10 years triggers ban
• Rebates must go to patients