The Pharmacists Fight Back Act establishes payment and reimbursement standards for pharmacy benefits managers (PBMs) administering prescription drug benefits under federal health care programs, including Medicare Part D, Medicare Advantage, Medicaid managed care, the Federal Employees Health Benefits Plan, and TRICARE. The bill requires PBMs to reimburse in-network pharmacies based on national average drug acquisition cost plus a small markup, pay state-level professional dispensing fees, and pass through at least 80 percent of rebates to beneficiaries at the point of sale. It prohibits PBMs from engaging in steering, spread pricing, outcome-based reimbursement adjustments, and other practices that restrict beneficiary pharmacy choice or reduce pharmacy reimbursement. The bill also amends Medicaid transparency requirements to expand the definition of covered pharmacies and includes civil and criminal enforcement provisions.
