BILL POSITION · Updated July 23, 2026 Bills: H.R. 6610 (Federal Employees Health Benefits) H.R. 6609 (Medicare & Medicaid), 119th Congress Status: H.R. 6610 REPORTED FAVORABLY, as amended — House Oversight & Government Reform, July 22, 2026 Related deep dive: PBMs & Pharmacy Access → Label note: This is Patients Rising's position on active legislation. Bills move fast — this reflects where we stand as of the date above. Originally published July 16, 2026; updated after committee markup.
Update — July 23, 2026. The House Oversight and Government Reform Committee marked up H.R. 6610 on July 22 and reported it favorably, as amended by a substitute offered by Chairman Comer. We've read the amended text against what we asked for. Some of it moved our way — meaningfully. One thing didn't. Scroll to "What the markup changed" for the specifics.
A patient standing at the pharmacy counter needs two things to go right. They need a pharmacy they can actually get to. And they need the price they're charged to reflect whatever help was meant for them — not to have that help quietly disappear before it reaches them.
The Pharmacists Fight Back Act — H.R. 6610 for federal employees' plans, with a companion, H.R. 6609, for Medicare and Medicaid — takes real aim at both. On most of what it does, it's a bill patients should want passed. There's one line Congress still needs to get right before it does. Here's our read.
It lets patients keep their pharmacy. The bill stops plans and their middlemen from steering patients into affiliated pharmacies and from quietly narrowing networks until the only "in-network" option is a mail-order warehouse. For someone managing a chronic condition — who relies on a pharmacist who knows their medications, or who simply can't wait days for a shipment — that's not a convenience. It's access. When a local pharmacy closes or a patient is forced out of the one they trust, care gets worse.
It puts rebates back in the patient's hands. Manufacturer rebates were supposed to defray what patients pay. Too often they've been captured somewhere upstream and never reached the person at the counter. This bill requires those rebates to be applied at the point of sale, so the patient's coinsurance or copay is calculated on the net cost of the drug — rebate included. That's the same principle we've fought for everywhere else: the help belongs to the patient it was created for.
It stops patients being pushed onto costlier drugs. Ending practices that force a higher-priced brand when a suitable generic exists means patients aren't charged more so someone else can collect a bigger spread.
It makes the system more honest. A transparent, predictable reimbursement standard — with real penalties behind it — is the kind of clarity patients can't currently get.
Measured against the standard we apply to every drug-pricing change — does it lift financial burden off the patient, and is what remains clear and predictable? — the Pharmacists Fight Back Act largely delivers.
The substitute adopted on July 22 is a real rewrite, not a technical tidy-up — it runs about twice the length of the introduced bill. Four changes matter for patients.
1. Choosing your pharmacy can't be made to cost you more. This is new, and it's the most patient-protective thing in the amendment. The bill now bars a plan from increasing an enrollee's costs for using an in-network pharmacy that isn't owned by the PBM — including by charging that patient a higher cost-sharing obligation for the choice. Pharmacy choice on paper means nothing if exercising it carries a price. Now it can't.
2. "Rebate" got much harder to define around. The amendment adds a definition covering any price concession from a manufacturer — payments, discounts, administration fees, credits, incentives, penalties — including those routed through affiliates, subsidiaries, third parties, or intermediaries. That matters more than it sounds. A narrow definition is an invitation to relabel a rebate as something else and keep it. This one closes that door, which makes the patient's at-the-counter discount real rather than theoretical. We asked for the pass-through to be durable. This is what durable looks like.
3. Enforcement got teeth. The penalty ceilings were multiplied by a thousand — the cap on penalties against a PBM went from $100,000 to $100 million over a ten-year period, and against a carrier from $50,000 to $50 million. A $50,000 maximum against a company operating at PBM scale was a rounding error, not a deterrent. This is a deterrent.
4. Plans have to open their books — and their networks. Carriers and PBMs must now report annually to the Office of Personnel Management on drug spending, pricing, and utilization, and keep records on affiliate pharmacy transactions, transfer pricing, acquisition costs, and fees — with compliance a condition of participating in the program at all. Separately, any pharmacy willing to accept standard contract terms must be allowed into the network. More pharmacies in network means more patients with a pharmacy they can reach.
Two other changes worth knowing: the bill now takes effect two years after enactment rather than one, and it now covers prescription drugs dispensed to an enrollee generally, rather than only drugs the patient administers themselves — a broader scope that reaches more patients.
Here's what didn't change, and it's worth stating plainly because it's the whole reason a patient organization weighs in on a pharmacy-payment bill at all.
The bill sets a floor for what pharmacies get paid: the drug's acquisition cost, plus a professional dispensing fee tied to the state's Medicaid rate, plus a margin of 4 percent of the drug's cost or $50, whichever is less. That's a fair way to pay a pharmacy, and it isn't our concern.
Our concern is that this benchmark must never become the number a patient's cost-sharing is calculated from. For an inexpensive generic, a dispensing fee plus a margin can add up to more than the drug itself costs. If a patient's coinsurance is charged as a percentage of that higher figure, the patient could walk out paying more than they do today — for the exact same prescription.
The bill handles half of this well. It bars a PBM from making the enrollee reimburse the dispensing fee, and — importantly — from "otherwise increasing the amount owed by such individual" to account for that fee. That's broad, and it's the right instinct.
But it addresses the dispensing fee only. The 4-percent-or-$50 margin sits in the same reimbursement formula with no equivalent patient protection. That's the gap, and it's a narrow one: a single clarification confirming that no enrollee's cost-sharing may be calculated on the reimbursement benchmark where doing so would exceed what they pay today would close it. It doesn't require reopening the payment formula. It doesn't cost anything. It just finishes the sentence the bill already started.
One technical note for the drafters. The substitute renumbered the payment provisions — the dispensing fee moved, and the rebate rules took its old designation. But the patient protection above still cites the old subparagraph, which now points at the rebate provision instead of the dispensing fee. We assume this is an artifact of the renumbering rather than a change in intent, and it should be corrected before the bill reaches the floor. A patient protection that cites the wrong provision is a patient protection someone can argue their way out of.
The Pharmacists Fight Back Act got better on July 22. Patients gained a real protection against being charged more for choosing their own pharmacy, a rebate definition that's hard to game, enforcement that a PBM would actually feel, and a transparency regime that will finally generate data on where the money goes.
Pass it. And in the same stroke, confirm that the new payment math can never leave a patient paying more than they would have without the reform, and fix the cross-reference so the protection that's already there points where it's supposed to.
That's not a hard needle to thread. It's one line. Thread it, and this is a bill that does exactly what its name promises — for patients, not just for the parties fighting over the money in between.
Lift the burden. Make it clear. Let no patient pay more.
Patients Rising is a national patient education and advocacy organization for Americans living with chronic and life-threatening illness. Read our deeper explainer on PBMs and pharmacy access [here].
H.R. 6610 was ordered reported favorably, as amended, by the House Committee on Oversight and Government Reform on July 22, 2026. Its companion, H.R. 6609, applying the same reforms to Medicare Part D, Medicare Advantage, and Medicaid managed care, remains pending before the Energy & Commerce and Ways & Means Committees.
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