Congress moves to strip PBMs of hidden profits, mandate patient rebates
H.R. 6609 — Pharmacists Fight Back in Medicare and Medicaid Act · Filed by Jake Auchincloss (D-MA) · 41 cosponsors · Introduced Dec 11, 2025 · Referred to committee
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What it does
This bill imposes strict rules on pharmacy benefit managers (PBMs) in Medicare Part D and Medicaid, requiring them to reimburse pharmacies based on transparent drug acquisition costs plus a small markup, pass manufacturer rebates directly to patients at the point of sale, and prohibit steering patients toward affiliated pharmacies. It also mandates annual reporting and creates criminal and civil penalties for violations, with fines up to $1 million and imprisonment up to 10 years for knowing violations.
Why we flagged it
The bill's core function is regulatory: it constrains PBM profit-taking and opacity by mandating transparent reimbursement, rebate pass-through, and anti-steering rules. It is not a subsidy, carve-out, or commemorative measure—it is a structural constraint on a private intermediary sector.
What the text implies
- PBMs may respond by raising administrative fees or restructuring rebate arrangements to circumvent the spirit of the law, shifting costs to manufacturers or plan sponsors rather than patients.
- The bill's definition of 'steering' is broad and may create litigation risk for PBMs, potentially leading to defensive business practices that reduce innovation in specialty pharmacy networks.
The full analysis lists 5 implications of this text.
Who stands to gain
independent pharmacies; small pharmacy chains; Medicare beneficiaries (lower copays/coinsurance)