DRUG Act

This bill, the Delinking Revenue from Unfair Gouging Act or DRUG Act, aims to improve services provided by pharmacy benefit managers (PBMs) by restricting how they charge fees and conduct business, with enforcement through civil penalties.

Sec. 2, Improving pharmacy benefit manager services: The bill amends three federal laws (Public Health Service Act, Employee Retirement Income Security Act of 1974, and Internal Revenue Code of 1986) to add nearly identical provisions. Starting in 2026, PBMs generally cannot charge or receive fees from any entity for services, except they may charge a flat service fee that is a flat dollar amount not based on drug prices, discounts, rebates, or other specified amounts. The bill defines a PBM broadly as any entity that negotiates drug prices or manages prescription drug benefits for group health plans or insurers.

Accountability and conduct: PBMs are prohibited from charging a plan or insurer a different amount for a drug's ingredient cost or dispensing fee than what they reimburse a pharmacy. They cannot reimburse an independent pharmacy less than they would reimburse a pharmacy they own or control for the same drug or service. 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.

Enforcement: The relevant Secretary (of Health and Human Services, Labor, or Treasury) will enforce these rules. Violations are subject to a civil penalty of $10,000 per day the violation continues, with enforcement procedures similar to those under the Social Security Act. The Secretary will implement these provisions through interim final regulations.