calculate a beneficiary’s cost sharing requirement for a prescription drug at the point of sale based on a price that is reduced by an amount equal to at least 80 percent of all rebates received in connection with the dispensing of the prescription drug
Require pharmacy benefit managers in federal health care programs to reduce beneficiary prescription drug cost-sharing at the point of sale by passing through at least 80% of applicable rebates.
Occurrences
The bill provides that a PBM administering prescription drug benefits on behalf of a Federal health care program shall calculate a beneficiary’s cost sharing requirement at the point of sale based on a price reduced by at least 80 percent of rebates received, or by a specified 80 percent rebate proxy when the rebate cannot be determined at the point of sale.
Evidence
Congress.gov lists Jake Auchincloss as sponsor of H.R.6609, introduced December 11, 2025. Latest action: referred to House Energy and Commerce and Ways and Means. Status: Introduced, not passed or enacted.
H.R.6609 would require Medicare Part D contracts with PBMs to comply with rebate pass-through requirements. It directs the PDP sponsor, PBM, or affiliate to apply a point-of-sale reduction to beneficiary coinsurance or copayment based on the drug reimbursement amount less the manufacturer rebate, and requires PBM rebate remittance to the PDP sponsor.
Congress.gov lists H.R.7148 as Public Law 119-75, enacted February 3, 2026. The bill passed the House, passed the Senate, resolved differences, was presented to the President, and became law.
The enacted text creates Medicare Part D PBM requirements for plan years beginning in 2028, including no PBM income other than bona fide service fees and a clarification that manufacturer rebates, discounts, and other price concessions are allowed if fully passed through to the PDP sponsor and compliant with direct and indirect remuneration requirements.
Assessments
Auchincloss introduced H.R.6609, which closely matched the promised point-of-sale rebate pass-through and beneficiary cost-sharing reduction policy, but it remained introduced and was not enacted. A later enacted appropriations law included related Medicare Part D PBM pass-through requirements to plan sponsors, but it did not require the promised point-of-sale beneficiary cost-sharing reduction or the specific 80% rebate pass-through. The promised outcome therefore was not delivered, though there was a serious legislative attempt.