A Republican bill with 1 Republican cosponsor · See the cosponsor
Last activity — Referred to the House Committee on Energy and Commerce.
In committee
Introduced and handed to a committee in the chamber it started in.
The committee holds it, and most bills are never heard from again. A hearing or a committee vote would be news; silence is the usual outcome, and it kills the bill without anyone voting against it.
Its path through Congress
- Introduced
- In Committee
What this bill would do
This bill stops certain group health plans and health insurance issuers from forcing or pushing people into using an affiliated specialty pharmacy. It prevents these plans from charging higher costs or giving special financial perks just to steer enrollees toward a specific affiliated pharmacy. The legislation also stops health plans from unfairly shutting qualified, licensed specialty pharmacies out of their networks. However, health plans are still allowed to exclude specialty pharmacies for good cause, such as fraud, prior suspension from Medicare, or if they pose an imminent risk of patient harm. The rules laid out in this bill will apply to plan years starting on or after January 1, 2029.
Yes· 3 of 12
- Scored +6
Does this make it easier to run a small business?
The bill protects independent specialty pharmacies from being unfairly excluded from health plan networks.
- Scored +6
Does this give people more protection from unfair business practices?
The legislation protects health plan enrollees by prohibiting insurers from steering them toward affiliated pharmacies through financial penalties.
- Scored +5
Would business owners be better off under this?
Independent specialty pharmacy owners benefit from rules prohibiting health plans from unfairly excluding qualified providers from networks.
The opposite
No question was scored the opposite.
Who it would affect, and how
Potential Positive Impacts for People
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More Pharmacy Choices: Under Section 2 (adding new section 2730(a)), health plans cannot force, steer, or induce enrollees to use an affiliated specialty pharmacy. This is a positive outcome because it stops plans from using higher cost sharing, financial perks, or penalties to dictate where people get their prescription drugs.
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Fair Network Inclusion: Under Section 2 (adding new section 2730(b)(1)), health plans are prohibited from refusing to contract with any qualified specialty pharmacy that is licensed, agrees to uniform rules, and accepts the same reimbursement rates. This benefits the public by making sure qualified local or independent specialty pharmacies can stay in insurance networks.
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Protections Against Bad Actors: Under Section 2 (adding new section 2730(b)(2)), health plans are still allowed to exclude specialty pharmacies that have been convicted of fraud or abuse, kicked out of Medicare, or pose an imminent risk of patient harm. This protects the public by keeping dangerous or fraudulent pharmacies out of insurance networks.
Potential Negative Impacts for People
Based on the provided text, there are no explicitly stated negative impacts or burdens for individuals or groups of people in the United States.
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Tap or hover a score for the reason it gave.
- Demographic And Interest Groups
- Would business owners be better off under this? — Independent specialty pharmacy owners benefit from rules prohibiting health plans from unfairly excluding qualified providers from networks. Would people with disabilities be better off under this? — Individuals with chronic or complex health conditions requiring specialized care benefit from secure access to non-affiliated specialty pharmacies. Would children be better off under this? — Children requiring specialized medications benefit from expanded choice and network inclusion of specialty pharmacies. Would households on low incomes be better off under this? — Low-income households are protected from financial penalties and higher cost-sharing designed to steer them to specific pharmacies. Would people in middle age be better off under this? — Middle-aged individuals managing complex health conditions benefit from broader specialty pharmacy access. Would middle-income households be better off under this? — Middle-class families benefit from prohibitions against plans imposing higher costs for using non-affiliated specialty pharmacies. Would people over 65 be better off under this? — Seniors with group health plan coverage gain protections ensuring fair access to specialty medications. Would people in their twenties and thirties be better off under this? — Young adults enrolled in group health plans gain protection against unfair steering and restricted pharmacy networks.
- Economy And Finance
- Does this give people more protection from unfair business practices? — The legislation protects health plan enrollees by prohibiting insurers from steering them toward affiliated pharmacies through financial penalties. Does this make it easier to run a small business? — The bill protects independent specialty pharmacies from being unfairly excluded from health plan networks.
- Healthcare
- Does this make health care easier to get in general? — By ensuring qualified specialty pharmacies can participate in insurance networks, the bill improves patients' access to necessary specialized care.
- Governance And Ideology
- Does this give the federal government more power? — The bill establishes federal requirements for group health plans and health insurance issuers regarding specialty pharmacy networks.
- 9/24/2026
- Referred to the House Committee on Energy and Commerce.
- 1 Cosponsor added.
- Introduced in House
Joe WilsonRepublican · South Carolina