Sponsors (41)
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
The bill increases transparency and reduces out-of-pocket drug costs for FEHB beneficiaries and strengthens pharmacy reimbursements and OPM oversight, but risks higher premiums/federal costs, narrower plan or formulary options, uneven state-level payment effects, and added legal/admin burdens.
FEHB enrollees (especially people with chronic conditions) will pay lower out-of-pocket prescription 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 (based on NADAC plus up to 4% or $50 and Medicaid-equivalent dispensing fees), improving pharmacy revenue stability and reducing hidden PBM spread pricing.
FEHB beneficiaries will have stronger protections for pharmacy choice because plans gain contractual tools to limit PBM steering and exclusionary network practices.
Taxpayers and FEHB enrollees could face higher premiums or increased federal costs if higher pharmacy reimbursements and dispensing fees raise overall benefit expenses.
Patients (including those with chronic conditions) may experience reduced drug access or choice if PBMs/carriers respond to compliance costs by narrowing networks, limiting plan offerings, or tightening formularies.
Pharmacies and state programs could see uneven or distorted payments because tying dispensing fees to variable state Medicaid rates may produce inconsistent reimbursements across states.
Based on analysis of 2 sections of legislative text.
Conditions FEHB plan approval on PBM rules: NADAC/WAC plus margin reimbursements, state Medicaid dispensing fees, point-of-sale rebate passthrough, and bans on PBM steering/exclusion.
Requires the Office of Personnel Management (OPM) to deny approval or contracting for Federal Employee Health Benefit (FEHB) plans unless those plans impose specific limits and requirements on pharmacy benefit managers (PBMs). The bill forces PBMs serving FEHB plans to reimburse in‑network pharmacies using NADAC or WAC plus a small margin, pay state Medicaid dispensing fees, apply manufacturer rebates at point-of-sale to lower patient cost-sharing, remit rebate amounts to carriers (less the patient reduction), and prohibits a range of PBM steering and exclusion practices. The law uses OPM contracting authority to enforce these rules for FEHB plans, and adds explicit contractual prohibitions and cooperation duties on PBMs and carriers to protect independent pharmacies and to increase rebate transparency and patient point-of-sale savings.