Congresswoman Celeste Maloy (R, UT-02) last week joined as a co-sponsor of two bipartisan bills aimed at reforming the practices of pharmacy benefit managers, or PBMs, within Medicare, Medicaid, and federal health programs. The legislation includes the Pharmacists Fight Back in Medicare and Medicaid Act and the Pharmacists Fight Back in Federal Health Benefit Plans Act.
The legislation is focused on increasing transparency, ensuring fair pharmacy reimbursement, and lowering costs for patients enrolled in Medicare, Medicaid, and the Federal Employees Health Benefits Program. The bills standardize minimum pharmacy reimbursement rates, require full pass-through of manufacturer rebates to patients and plan sponsors, ban PBM steering toward PBM-owned pharmacies, eliminate spread pricing and clawbacks, and impose new transparency and certification requirements. Enforcement provisions include civil and criminal penalties for violations within federal health programs.
“PBMs play a powerful role in our healthcare system, but that power must come with accountability,” said Congresswoman Maloy. “These bipartisan bills promote transparency, fair dealing, and patient-focused care while helping ensure Utah pharmacies can continue serving the communities that rely on them. I am grateful to Representatives Auchincloss (D, MA-04), Harshbarger (R, TN-01), and Comer (R, KY-01) for introducing legislation that tackles predatory behavior that often victimizes the most vulnerable.”
For Utah, where many rural and independent pharmacies serve as the most accessible point of care, these reforms aim to stabilize local pharmacies and protect patient access to medications and pharmacist services.
State leaders and pharmacy advocates welcomed the legislation.
“Community pharmacy is collapsing, and patients are paying the price,” said Scott Robinson, an owner and operator of eight independent pharmacies with over 25 years of experience. “Pharmacy deserts are spreading across America while PBMs and corporate shareholders grow richer by siphoning money out of patient care. This system is unsustainable, unjust, and dangerous to public health. The Pharmacist Fight Back Bill and related reforms are not optional—they are necessary to stop the bleeding and restore fairness, transparency, and access to care. Every day Congress delays, more pharmacies close and more communities lose access to lifesaving medications and trusted healthcare professionals. Action is needed now—before irreversible damage is done to America’s healthcare system.”
Utah State Senator Evan Vickers, a pharmacist and leader in PBM reform, said, “I sincerely appreciate Congresswoman Maloy tackling this very difficult healthcare issue. These pieces of legislation are designed to cut patient costs, increase access to patients’ choice of pharmacy, and help local independent and chain pharmacies receive the reimbursement for their pharmacy services that will allow them to be profitable. Many small independent pharmacies have had to close their doors. These pieces of legislation will help reverse that trend.”
The Utah Pharmacy Association issued the following statement: “The Utah Pharmacy Association supports the Pharmacists Fight Back Acts currently before Congress and urges swift action to advance these critical reforms. Community and independent pharmacies across Utah are facing mounting financial pressure due to unfair and opaque pharmacy benefit manager (PBM) practices, including below-cost reimbursement, retroactive fees, and patient steering. These practices threaten patient access to medications and essential pharmacy services, particularly in rural and underserved communities. The Pharmacists Fight Back Acts would bring much-needed transparency and accountability to the prescription drug marketplace while ensuring pharmacies are fairly reimbursed for the care they provide. Pharmacists are among the most accessible healthcare providers, and these reforms will help preserve patient choice, protect local pharmacies, and strengthen the healthcare system for Utah families.”
The bills apply exclusively to federal health programs and do not affect private commercial insurance plans.
