Sponsors (3)
The bill trades stronger separation, transparency, and reduced conflicts in FEHB drug purchasing — which may lower costs and improve fairness for federal employees — against a risk of fewer contracting options, disrupted networks, higher administrative or premium costs, and potential shifts in market power that could offset some benefits.
Federal employees and FEHB enrollees could face fewer PBM/insurer conflicts of interest in drug pricing and formulary decisions, which may lower out-of-pocket costs for patients (including those with chronic conditions).
Federal employees gain stronger separation between FEHB insurers and pharmacy/PBM ownership, improving fairness and reducing potential improper influence over benefits decisions.
The bill increases market oversight and transparency by defining key terms (e.g., pharmacy, PBM, qualified carrier), enabling clearer enforcement and procurement compliance for OPM and related regulators.
FEHB contracting options for OPM could shrink, which may raise administrative costs or drive up premiums and taxpayer costs if fewer carriers qualify.
Some enrollees — particularly those in rural areas or with chronic conditions — could lose access to existing provider or pharmacy networks if current FEHB carriers or PBMs are excluded and replacements alter networks.
The market could see unintended shifts in negotiating power toward independent PBMs or non-integrated carriers, creating new concentration or leverage points elsewhere in the drug supply chain.
Based on analysis of 2 sections of legislative text.
Blocks OPM and FEHB carriers from contracting with insurers or PBMs that own, operate, control, or direct pharmacies, and bans PBM contracting that involves pharmacy ownership or control.
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 own, operate, control, or direct pharmacies or that own/operate/control pharmacy benefit managers (PBMs). It also bars OPM and FEHB carriers from contracting or subcontracting with PBMs that own, operate, control, or direct any pharmacy. The text defines key terms such as “pharmacy,” “pharmacy benefit manager,” “health plan,” and “qualified carrier.” The measure does not allocate funding or create new programs; it instead changes contracting rules for the FEHB program and preserves review and enforcement authority of agencies like the FTC, DOJ Inspector General, HHS, and state attorneys general under other laws.