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Pharmacists Fight Back Act

H.R. 9096 Rep. Jake Auchincloss (D-MA-4) In committee
Bill text PDF
  1. Introduced Jul 23
  2. Committee Jul 23
  3. Passed House Next
  4. Passed Senate Not yet
  5. To President Not yet
  6. Law Not yet
Where it stands
In committee, Jul 23, 2024Next: House vote
680d ago Dec 17, 2024: Referred to the Subcommittee on Health.
Final votes
No roll callsNo recorded vote on this bill yet
Lobbying
1company, 1 filing
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Summary

This bill sets rules for how pharmacy benefits managers (PBMs) must pay and reimburse pharmacies under federal health care programs, and it improves prescription drug price transparency under Medicaid.

Sec. 2, Pharmacy payment and reimbursement: PBMs must reimburse in-network pharmacies for the ingredient cost of a drug based on the national average drug acquisition cost plus a small fee (2% of that cost or $25, whichever is less), pay a professional dispensing fee equal to the state's Medicaid fee, and calculate a beneficiary's cost sharing at the point of sale by reducing the price by at least 80% of rebates received. PBMs are prohibited from steering patients to specific pharmacies, restricting pharmacy choice, charging patients more than the pharmacy is reimbursed, requiring brand-name drugs when a generic is available, engaging in spread pricing, reducing pharmacy reimbursement after a claim, or basing reimbursement on outcomes or metrics. PBMs may recoup funds from audits only for overpayments, misfills, or fraud, with fraud recoupments passed back to the federal program. Violations are felonies punishable by up to $1,000,000 per act and/or 10 years imprisonment, and private persons may bring civil actions on behalf of the U.S. Government under the same terms as the False Claims Act.

Sec. 3, Improving prescription drug transparency under the Medicaid program: The bill expands the types of pharmacies that must report drug pricing data to the state (including mail-order, specialty, nursing home, hospital, and clinic pharmacies, but not charitable or not-for-profit pharmacies). States must require all such pharmacies to respond to drug price surveys, regardless of whether payment comes from the state, a managed care entity, or a PBM. The Secretary must make national drug acquisition price information publicly available, including monthly survey response rates, sampling details, and information on price concessions. No state or federal health care program may use pricing data from non-retail pharmacies to set reimbursement rates for retail community pharmacies.

Summary of the bill text as introduced in House (Jul 23, 2024), generated by SecBot from the official bill text; the Library of Congress summary is not yet published.

Official record from Congress.gov, the House Clerk and the Senate; lobbying from Lobbying Disclosure Act filings. Updated Oct 28, 2026.