This bill, titled the "Pharmacists Fight Back [in Federal Employee Health Benefit Plans Act]," seeks to amend chapter 89 of title 5, United States Code, to impose significant regulations on Pharmacy Benefit Managers (PBMs) operating within Federal Employee Health Benefit (FEHB) plans. Its primary goal is to limit the costs associated with PBMs and ensure more transparent and equitable practices for pharmacies and beneficiaries. The legislation aims to protect in-network pharmacies from unfair reimbursement practices and prevent PBMs from engaging in anti-competitive behaviors.

Specifically, the bill mandates that PBMs reimburse in-network pharmacies for prescription drugs based on the national average drug acquisition cost (NADAC) plus a professional dispensing fee, which must be equal to the fee paid by the State under Medicaid. Crucially, it requires PBMs to apply manufacturer rebates at the point of sale, reducing the coinsurance or copayment owed by the beneficiary based on the drug's net cost. This provision aims to ensure that savings from rebates directly benefit the consumer rather than being retained by the PBM.

Furthermore, the legislation prohibits PBMs and their affiliates from directing or requiring individuals to use specific pharmacies, especially those affiliated with the PBM. It also bans advertising or promoting one pharmacy over another and creating networks that exclude in-network pharmacies or restrict their ability to fill prescriptions. PBMs are also forbidden from influencing manufacturers to limit drug distribution to certain pharmacies or from lowering or adjusting pharmacy reimbursements after a claim has been adjudicated.

To enforce these new requirements, the bill establishes a system of civil monetary penalties for violations, with a fine of $10,000 per violation. If a PBM accumulates multiple violations, the carrier providing the health plan may also face penalties and must develop a remediation plan. The Office of Personnel Management (OPM) is tasked with overseeing compliance and conducting inspections.

Repeated severe non-compliance can lead to the debarment of a PBM from administering prescription drug benefits under the FEHB program. PBMs and carriers are afforded due process, including reasonable notice, the opportunity for a hearing, and judicial review before any adverse determination becomes final. These measures are designed to ensure accountability and fairness in the PBM industry within federal health plans.

The amendments made by this Act are set to take effect one year after the date of its enactment.