Sponsors (3)
The bill aims to reduce PBM–pharmacy conflicts and preserve enforcement tools to promote transparency and competition in FEHB drug purchasing, but may narrow plan choices, increase administrative burden, and risk weakening bargaining leverage that could raise drug costs for enrollees.
Federal employees enrolled in FEHB plans would face fewer PBM–pharmacy vertical ties, reducing conflicts of interest in drug dispensing/pricing and improving transparency in benefit administration.
The legislation preserves enforcement authority for the FTC, DOJ, HHS IG, and state attorneys general, keeping antitrust and consumer-protection avenues available to challenge anti‑competitive conduct affecting federal health plans.
By blocking integrated PBM–pharmacy ownership structures, the bill could increase transparency and competition in prescription drug procurement for FEHB plans, which may produce fairer pricing outcomes for enrollees and taxpayers.
Federal employees and retirees could face fewer FEHB plan options if carriers or PBMs are disqualified, narrowing choice and possibly raising premiums or administrative costs.
If PBM participation declines, FEHB plans may lose negotiating leverage with drug manufacturers and pharmacy networks, potentially raising prescription drug costs for enrollees, including seniors and retirees.
OPM and carriers would face increased administrative complexity to verify indirect ownership/control relationships and maintain compliance, raising administrative costs and potentially slowing plan operations.
Based on analysis of 2 sections of legislative text.
Prevents OPM and FEHB carriers from using PBMs or insurers that own, operate, control, or direct pharmacies for FEHB contracts; restricts contracting with vertically integrated PBMs.
Introduced July 15, 2025 by S. Raja Krishnamoorthi · Last progress July 15, 2025
Prohibits the Office of Personnel Management (OPM) from contracting with Federal Employee Health Benefits (FEHB) carriers that directly or indirectly own, operate, control, or direct a pharmacy or a pharmacy benefit manager (PBM). It also bars OPM, FEHB carriers, and their contractors from contracting or subcontracting with PBMs that own, operate, control, or direct a pharmacy. The measure defines key terms (health plan, person, pharmacy, PBM, qualified carrier) and preserves enforcement authority for federal and state enforcement agencies.