Sponsors (35)
Introduced December 11, 2025 by Jake Auchincloss · Last progress December 11, 2025
The bill reduces out-of-pocket drug costs for FEHB beneficiaries and strengthens payments and contractual protections for pharmacies, but may raise premiums, prompt narrower plan offerings, and create uneven state-level payment effects while increasing enforcement-related legal costs.
FEHB enrollees (federal employees, retirees, and their families) will pay lower out-of-pocket prescription 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 viability.
FEHB plans and beneficiaries gain stronger contractual protections against PBM steering and exclusionary network practices, preserving beneficiary choice of pharmacy and reducing restrictive PBM tactics.
FEHB enrollees, taxpayers, and employers could face higher premiums or federal costs if increased pharmacy reimbursements and dispensing fees raise overall benefit expenses.
PBMs and carriers may respond to the new rules and compliance costs by narrowing plan offerings or formularies or limiting networks, which could reduce drug access or choice for beneficiaries.
Tying pharmacy dispensing fees to Medicaid-equivalent rates could produce uneven payments across states and unintended pricing distortions that affect pharmacy economics regionally.
Based on analysis of 2 sections of legislative text.
Conditions FEHB plan approval on PBMs reimbursing pharmacies at NADAC (or WAC) plus a set markup and state Medicaid dispensing fee, applying rebates at point‑of‑sale, and banning steering/restrictive networks.
Requires the Office of Personnel Management (OPM) to refuse to contract with or approve Federal Employee Health Benefit (FEHB) plans unless their pharmacy benefit managers (PBMs) meet new payment, rebate-pass-through, and contracting rules. PBMs would have to reimburse in‑network pharmacies at an ingredient cost tied to the national average drug acquisition cost (NADAC) or wholesale acquisition cost (WAC) plus a small markup, pay pharmacies a professional dispensing fee equal to the State Medicaid dispensing fee where the pharmacy is located, apply manufacturer rebates at point‑of‑sale to reduce patient copays/coinsurance, and remit rebate amounts (minus the patient reduction) to the FEHB carrier. OPM also must require FEHB plans to include contractual prohibitions and cooperation requirements on PBMs and carriers that bar steering enrollees to specific pharmacies (including affiliates), promoting one in‑network pharmacy over others, creating networks or practices that exclude or restrict in‑network pharmacies, inducing manufacturers to limit distribution to certain pharmacies, and other restrictive practices; plans that do not include these PBM restrictions cannot be approved by OPM.