I 
119TH CONGRESS 
1ST SESSION H. R. 6609 
To amend titles XI, XVIII, and XIX of the Social Security Act to establish 
certain requirements under Medicare and Medicaid with respect to pre-
scription drug benefits and pharmacy benefit managers. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 11, 2025 
Mr. AUCHINCLOSS (for himself, Mrs. HARSHBARGER, Mr. COMER, Mr. CAR-
TER of Georgia, Mr. CISCOMANI, Mr. MOULTON, Mr. DELUZIO, Mr. 
PETERS, Ms. TLAIB, Ms. BUDZINSKI, Mr. KRISHNAMOORTHI, Mr. 
KHANNA, Mr. LYNCH, Mr. GOLDMAN of Texas, Mr. COHEN, Ms. 
PRESSLEY, Mr. VICENTE GONZALEZ of Texas, Mr. MOORE of Alabama, 
Mr. SUBRAMANYAM, Mr. POCAN, Mr. BISHOP, and Ms. MCCOLLUM) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committee on Ways and 
Means, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To amend titles XI, XVIII, and XIX of the Social Security 
Act to establish certain requirements under Medicare 
and Medicaid with respect to prescription drug benefits 
and pharmacy benefit managers. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Pharmacists Fight 
Back in Medicare and Medicaid Act’’. 
SEC. 2. ESTABLISHING CERTAIN REQUIREMENTS WITH RE-
SPECT TO PBMS. 
(a) MEDICARE.— 
(1) 
PRESCRIPTION
DRUG
PLANS.—Section 
1860D–12 of the Social Security Act (42 U.S.C. 
1395w–112) is amended by adding at the end the 
following new subsection: 
‘‘(h) REQUIREMENTS RELATING TO PHARMACY BEN-
EFIT MANAGERS.—For plan years beginning on or after 
January 1, 2027: 
‘‘(1) IN GENERAL.—Each contract entered into 
with a PDP sponsor under this part with respect to 
a prescription drug plan offered by such sponsor 
shall provide— 
‘‘(A) that the sponsor (and any pharmacy 
benefit manager acting on behalf of such spon-
sor, including any affiliate of such PBM, as ap-
plicable)— 
‘‘(i) shall comply with the pharmacy 
payment requirements described in para-
graph (2); 
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‘‘(ii) shall comply with the rebate 
pass-through requirements described in 
paragraph (3); 
‘‘(iii) shall comply with the reporting 
requirement described in paragraph (4); 
and 
‘‘(iv) may not engage in steering; and 
‘‘(B) that any pharmacy benefit manager 
acting on behalf of such sponsor has a written 
agreement with the PDP sponsor under which 
the PBM, and any affiliate of such PBM, as 
applicable, agrees to meet the requirements de-
scribed in subparagraph (A). 
‘‘(2) PHARMACY
PAYMENT
REQUIREMENTS.— 
For purposes of paragraph (1)(A)(i), the pharmacy 
payment requirements described in this paragraph 
are, with respect to a PDP sponsor (and a PBM 
acting on behalf of such sponsor, including any affil-
iate of such PBM, as applicable) the following: 
‘‘(A) The sponsor, PBM, or affiliate reim-
burses an in-network pharmacy for the ingre-
dient cost of a covered part D drug in an 
amount equal to the sum of— 
‘‘(i) the national average drug acquisi-
tion cost for the drug as of the day that 
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