HR 4409
Fair Pharmacies for Federal Employees Act of 2025
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Bill overview
This bill, the Fair Pharmacies for Federal Employees Act of 2025, prohibits the common ownership of pharmacies and pharmacy benefit managers (PBMs) by entities that provide health insurance to federal employees. Specifically, it restricts federal agencies, like the Office of Personnel Management, from contracting with carriers that own pharmacies or PBMs, and vice versa. The goal is to prevent anticompetitive practices within the pharmaceutical industry and ensure fair pricing for federal employees’ healthcare.
Key provisions
- Prohibits federal agencies from contracting with carriers that own pharmacies.
- Prohibits federal agencies from contracting with PBMs that own pharmacies.
- Defines ‘pharmacy’ broadly to include mail-order, specialty, retail, and other types of dispensing facilities.
- Defines ‘pharmacy benefit manager’ to encompass entities that negotiate drug prices, manage pharmacy networks, and administer prescription drug benefits.
- Establishes a rule of construction to ensure the FTC, DOJ, HHS, and state attorneys general retain their authority to enforce antitrust laws.
- Clarifies the definition of ‘health plan’ to include various group insurance arrangements.
- Provides definitions for ‘person’ and ‘qualified carrier’ as used in the context of the bill.
- Includes a list of specific types of pharmacies covered by the definition.
Who is affected
- Federal employees
- Office of Personnel Management
- Federal health benefit qualified carriers
Sponsors
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119th CONGRESS — 1st Session
H. R. 4409
IN THE HOUSE OF REPRESENTATIVES
A BILL
To prohibit the common ownership pharmacy benefit managers and pharmacies that provide services under contracts with Federal health plans for Federal employees.
This Act may be cited as the Fair Pharmacies for Federal Employees Act of 2025
.
directly or indirectly owns, operates, controls, or directs the operation of the whole or any part of a pharmacy; or
It shall be unlawful of the Office of Personnel Management or a Federal employee health benefit qualified carrier to contract or subcontract with a pharmacy benefit manager who directly or indirectly owns, operates, controls, or directs the operation of the whole or any part of a pharmacy.
Nothing in this section shall be construed to limit the authority of the Federal Trade Commission, the Inspector General of the Department of Justice, the Department of Health and Human Services, or the attorney general of a State under any other provision of law.
The term person has the meaning given the term in section 8 of the Sherman Act (15 U.S.C. 7).
any organization the National Provider Identifier (NPI) registration of which has 1 or more taxonomy codes under the pharmacy section of the National Uniform Claim Committee (or a subsequent organization); and
The term pharmacy benefit manager means any person, business, or other entity, such as a third-party administrator, regardless of whether such person, business, or entity identifies itself as a pharmacy benefit manager, that, either directly or indirectly through an intermediary (including an affiliate, subsidiary, or agent) or an arrangement with a third party—
acts as a negotiator of prices, rebates, fees, or discounts for prescription drugs on behalf of a health plan or health plan sponsor;
contracts with pharmacies to create pharmacy networks and designs and manages such networks; or
manages or administers the prescription drug benefits provided by a health plan, including the processing and payment of claims for prescription drugs, arranging alternative access to or funding for prescription drugs, the performance of utilization management services, including drug utilization review, the processing of drug prior authorization requests, the adjudication of appeals or grievances related to the prescription drug benefit, contracting with network pharmacies, controlling the cost of covered prescription drugs, or the provision of related services.
qualified carriermeans a voluntary association, corporation, partnership, or other nongovernmental organization which is lawfully engaged in providing, paying for, or reimbursing the cost of, health services under group insurance policies or contracts, medical or hospital service agreements, membership or subscription contracts, or similar group arrangements, in consideration of premiums or other periodic charges payable to the carrier, including a health benefits plan duly sponsored or underwritten by an employee organization and an association of organizations or other entities described in this paragraph sponsoring a health benefits plan.