119th (2025–2027)
H.R. 6609
The Pharmacists Fight Back in Medicare and Medicaid Act establishes new federal requirements for pharmacy benefit managers (PBMs) that manage prescription drug coverage under Medicare Part D and Medicaid, effective January 1, 2027. The bill requires PBMs to reimburse pharmacies based on the national average drug acquisition cost plus 4% (or $50, whichever is less), pay dispensing fees matching state Medicaid rates, and pass manufacturer rebates directly to patients at the point of sale to reduce out-of-pocket costs. The legislation prohibits PBMs from steering patients to affiliated pharmacies and mandates annual compliance reporting and expanded pharmacy surveys with publicly available national drug pricing data. The bill establishes significant enforcement mechanisms, including criminal penalties of up to 10 years imprisonment and $1 million fines, plus civil penalties of $1 million per violation, for PBMs that knowingly violate the payment and rebate requirements.