Contact Congress about H.R. 6609: Pharmacists Fight Back in Medicare and Medicaid Act

Pharmacies would have to be paid under a new national formula in Medicare and Medicaid managed care. Medicare drug rebates would lower some patients' costs at the counter, and PBMs could face major penalties for steering patients or breaking the new rules.

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Pharmacists Fight Back in Medicare and Medicaid Act is a House bill in committee. The latest recorded action: Referred to the Committee on Energy 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 jurisdiction of the committee concerned.

Latest action on H.R. 6609: Referred to the Committee on Energy 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 jurisdiction of the committee concerned.

Who this affects: This bill mainly affects independent and community pharmacies, PBMs, Medicare drug plans, Medicaid managed care plans, and people who get prescriptions through those programs. Pharmacies could see more standard payment rules and fewer fees that cut into what they are paid. Medicare patients, especially people taking costly drugs, could see rebate savings at the counter. PBMs and plans would face tighter limits on networks, steering, reporting, and rebate handling. States would get more Medicaid rebate money from PBMs and more drug pricing data.

Why this matters: This bill matters because it would change who gets drug rebate money and how pharmacies are paid in two major public health programs. That could help some pharmacies stay open and lower some patients' costs at the counter. It could also change insurance premiums, plan contracts, and how pharmacy networks are built. The bill also gives states and the public more pricing data in Medicaid, but it does not say exactly how that data will be used later.

Key provisions in H.R. 6609

• Medicare Part D plans, Medicare Advantage drug plans, and their PBMs would have to use a set formula when they pay in-network pharmacies for a drug's cost. They would use the national average drug acquisition cost, or the wholesale acquisition cost if that number is not available, plus up to 4% or $50.
• Pharmacies would also have to get a dispensing fee based on the Medicaid fee in their state. PBMs could not add fees that claw back that money or shrink what the pharmacy really gets paid.
• Drug company rebates in Medicare Part D would have to lower what patients pay at the counter. If a PBM gets the rebate, it must send the rest of that money to the health plan after the patient's copay or coinsurance is reduced.
• Rebate money tied to Medicare patients who get the low-income subsidy would have to go to the federal government. Plan sponsors would have to send that amount in.
• PBMs and plans could not push patients toward certain pharmacies in many different ways in Medicare and Medicaid. That ban includes preferred or narrow pharmacy networks that give better treatment to some in-network pharmacies.

How Modern Action helps you take action on H.R. 6609

You do not have to start with a blank letter. Modern Action turns the bill, your position, and the relevant congressional context into a message you can edit and send. The goal is to make contacting Congress clear, specific, and useful without forcing you to parse bill text or figure out the right office on your own.

Questions people ask about H.R. 6609

What is H.R. 6609?

Pharmacies would have to be paid under a new national formula in Medicare and Medicaid managed care. Medicare drug rebates would lower some patients' costs at the counter, and PBMs could face major penalties for steering patients or breaking the new rules.

How do I support or oppose H.R. 6609?

Choose support, oppose, or ask for changes on Modern Action. The action flow drafts the message for you and keeps the wording tied to this bill.

Who should I contact about H.R. 6609?

Modern Action uses your location to route the action to the congressional offices relevant to the bill and your representation.

Can Modern Action explain H.R. 6609 before I act?

Yes. Modern Action gives you a plain-English summary, current status, and action context before you send anything.