LUGPA Policy Brief: The Pharmacists Fight Back Act (2025)

January 2026 

Background

On December 11, 2025, Representatives Jake Auchincloss (D-MA), James Comer (R-KY), and Diana Harshbarger (R-TN) reintroduced the Pharmacists Fight Back Act, a bipartisan effort to curb the influence of Pharmacy Benefit Managers (PBMs) across federal health programs and the commercial market.

PBMs, powerful intermediaries controlling formularies, pharmacy networks, and drug reimbursement, have faced increasing bipartisan scrutiny for opaque pricing practices, patient steering, and self-dealing that drive up prescription drug costs while undermining independent pharmacies and providers. The 2025 bill builds on earlier efforts and reflects mounting evidence that PBM consolidation and vertical integration harm patients, employers, and taxpayers.

Key Provisions

The legislation targets core PBM practices that drive higher costs and restrict patient choice:

• Transparent Reimbursement Model
  Requires PBMs to reimburse pharmacies using a market-based benchmark tied to the National Average Drug Acquisition Cost (NADAC) plus a dispensing fee, effectively eliminating spread pricing.
• Patient Rebate Pass-Through
  Mandates that negotiated rebates be passed directly to patients at the point of sale, lowering out-of-pocket costs rather than subsidizing PBM profits.
• Enhanced Patient Choice
  Prohibits PBMs from restricting pharmacy networks or penalizing patients for using independent or non-affiliated pharmacies.
• Prohibition on Drug and Pharmacy Steering
  Bans PBMs from favoring higher-cost brand drugs over generics or biosimilars and from steering patients to PBM-owned or affiliated pharmacies.
• Protections for Community Pharmacies
  Outlaws abusive contract terms and anti-competitive practices that disadvantage independent pharmacies.
• Stronger Oversight and Penalties
  Establishes enhanced federal oversight of PBMs operating in federal health programs, with meaningful penalties for violations.

FTC Findings Reinforce the Case for Reform

Momentum behind the legislation is reinforced by the Federal Trade Commission’s second interim staff report on PBMs, released January 14, 2025, which documented widespread anti-competitive conduct, including:

• Excessive markups on specialty generic drugs used to treat cancer, HIV, and pulmonary hypertension
• Extreme market concentration, with roughly 80% of U.S. prescriptions controlled by a small number of PBMs
• Self-dealing and preferential reimbursement to PBM-owned pharmacies at rates multiple times higher than those paid to independents
• Systematic exclusion of generics and biosimilars to preserve rebate revenue, worsening affordability for patients
• Ongoing FTC enforcement activity signaling potential future regulatory or legal action

The FTC found that vertically integrated PBMs increasingly convert specialty generics into high-margin profit centers—often at the direct expense of patients and unaffiliated providers.

Why This Matters to LUGPA Members

PBM practices affect more than retail pharmacy access. For urology practices, particularly those providing oncology, specialty drug administration, or in-office dispensing, PBM-driven formulary restrictions, rebate incentives, and patient steering can disrupt care continuity, increase administrative burden, and raise patient costs.

The Pharmacists Fight Back Act reflects a broader bipartisan shift toward PBM accountability that could improve drug affordability, restore patient choice, and level the playing field for independent providers across the care continuum.

The Pharmacists Fight Back Act (2025) represents a significant step toward restoring transparency, competition, and patient-centered decision-making in the prescription drug market. With strong bipartisan sponsorship and growing regulatory scrutiny of PBMs, the bill adds momentum to a reform effort that aligns closely with LUGPA’s priorities on access, affordability, and independent practice sustainability.