Patients Choice in Specialty Pharmacy Act

This bill would change federal health insurance law to bar insured group health plans and health insurance companies from requiring, steering, or encouraging enrollees to fill prescriptions at specialty pharmacies the plan or its pharmacy benefit manager owns or controls. This includes charging higher copays or deductibles at other specialty pharmacies, offering discounts tied to using an affiliated pharmacy, or adding delays or paperwork for patients or doctors who use other pharmacies. Plans would also have to let any licensed specialty pharmacy join their network if it accepts the same terms and payment rates as other network specialty pharmacies, with exceptions for fraud or abuse, exclusion from Medicare or state programs, or a shown imminent risk of patient harm. Self-insured plans are not covered, and the rules would apply to plan years starting on or after January 1, 2029.

Full text and official record on Congress.gov

Sponsors

• Neal P. Dunn Republican sponsor
• 1 cosponsors