DRUG Act

The DRUG Act (H.R. 6283) aims to improve services provided by pharmacy benefit managers (PBMs) by prohibiting them from receiving remuneration from entities for prescription drug services, with limited exceptions, and by imposing new accountability and conduct rules starting in 2026.

Sec. 2, Improving pharmacy benefit manager services: For plan years beginning on or after January 1, 2026, PBMs generally cannot receive any remuneration from any entity for services related to prescription drugs. An exception allows PBMs to charge a bona fide service fee, which must be a flat dollar amount and cannot be based on drug prices, discounts, rebates, or other prohibited amounts. A bona fide service fee is defined as fair market value for an itemized service actually performed that the entity would otherwise perform. A PBM is defined broadly to include any entity that acts as a price negotiator or manages prescription drug benefits.

Sec. 2, Accountability and conduct: PBMs are prohibited from charging a health plan a different amount for a drug's ingredient cost or dispensing fee than what the PBM reimburses a pharmacy. They cannot reimburse a network pharmacy less than they would reimburse a pharmacy they own or control for the same drug or services. PBMs also cannot directly or indirectly steer patients to pharmacies they own or control, including through benefit designs that increase costs for using other pharmacies, requiring use of only owned pharmacies, or retaliating against patients who choose other pharmacies.

Sec. 2, Enforcement: The Secretary of Health and Human Services, in consultation with the Secretaries of Labor and Treasury, will enforce these rules. PBMs must disgorge any payments received in violation of the remuneration prohibition or the bona fide service fee agreement. Violators face a civil monetary penalty of $10,000 for each day the violation continues. The Secretary will initially implement these rules through interim final regulations.

Sec. 2, Rules of construction: Nothing in this section prohibits payments for ingredient cost reimbursement or pharmacy dispensing fees. It also does not prohibit rebates, discounts, or other price concessions from being fully passed through to a health plan to lower net drug costs.

Sec. 2, Amendments to ERISA, Internal Revenue Code, and Federal Employees Health Benefits Act: Identical provisions are added to the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and the Federal Employees Health Benefits Act, applying the same PBM rules to group health plans, health insurance issuers, and federal employee health benefits plans.