Sponsors (40)
Conditions OPM approval of FEHB plans on PBM rules that require NADAC/WAC-based pharmacy reimbursements, Medicaid-level dispensing fees, and point-of-sale rebate pass-through while banning steering and exclusionary PBM practices.
The bill reduces out-of-pocket drug costs for FEHB enrollees and improves pharmacy pay and transparency, but it risks higher premiums or federal costs, potential narrowing of plan options, and added legal/compliance burdens.
FEHB enrollees (federal employees, retirees, dependents) will pay lower out-of-pocket drug costs because manufacturer rebates are applied at point-of-sale to reduce coinsurance and copays.
In-network pharmacies will receive higher and more transparent reimbursements (NADAC plus up to 4% or $50 and Medicaid-equivalent dispensing fees), improving pharmacy revenue stability and potentially preserving local pharmacy access.
FEHB beneficiaries gain stronger protections against PBM steering and exclusionary network practices, increasing beneficiary choice of pharmacy and reducing PBM-driven limitations.
FEHB carriers, federal coffers, or enrollees could face higher premiums or increased federal costs if higher pharmacy reimbursements and dispensing fees raise overall benefit expenses.
PBMs and carriers may pass compliance costs or respond by narrowing plan offerings or formularies, which could limit drug access or choice for beneficiaries.
New civil penalties and debarment authority could trigger additional litigation and administrative burdens for PBMs and carriers, increasing legal and compliance costs that may be passed on to plans or enrollees.
Based on analysis of 2 sections of legislative text.
Official title: To amend chapter 89 of title 5, United States Code, to limit the costs of pharmacy benefit managers with respect to Federal employee health benefit plans, and for other purposes.
Introduced December 11, 2025 by Jake Auchincloss · Last progress December 11, 2025
Requires the Office of Personnel Management (OPM) to refuse to contract with or approve Federal Employee Health Benefits (FEHB) plans unless their pharmacy benefit managers (PBMs) meet new payment, transparency, and conduct rules. The bill sets minimum pharmacy reimbursement (based on NADAC or WAC plus a percentage or dollar cap), requires PBMs to pay pharmacies a professional dispensing fee equal to the State Medicaid dispensing fee, and forces point-of-sale manufacturer rebate pass-through to reduce enrollees' cost-sharing and to remit remaining rebate amounts to the carrier. Also bars PBMs and affiliates from steering enrollees to particular pharmacies, excluding or restricting in-network pharmacies through network design or accreditation hoops, inducing manufacturers to limit distribution, and other anti-competitive practices; OPM may not approve FEHB plans unless contracts include these prohibitions and cooperation requirements for PBMs and carriers.