Prairieville, Louisiana – October 29, 2026 -- Hope Charities is backing H.R. 10549, a House bill that would bar commercial health plans from steering patients toward insurer- or PBM-owned specialty pharmacies, with the rules taking effect for plan years beginning on or after January 1, 2029.
Rep. Neal Dunn (R-FL) introduced the Patients Choice in Specialty Pharmacy Act on September 24, 2026, with Rep. Joe Wilson (R-SC) as an original cosponsor. The bill is with the House Committee on Energy and Commerce. Hope Charities is urging Congress to act and is asking members to cosponsor.
Bill bans penalties and incentives tied to affiliated pharmacies
The bill amends the Public Health Service Act. It applies to health insurance issuers offering group or individual coverage and to group health plans that are not self-insured. Plans could not require, steer, or induce patients to use a plan- or PBM-affiliated specialty pharmacy. The prohibited tactics include:
- higher copays, coinsurance, or deductibles at other pharmacies;
- discounts or rebates tied to using an affiliated pharmacy;
- penalties, delays, or paperwork imposed on patients or their prescribers.
Plans must admit any licensed specialty pharmacy that accepts network terms
Plans could not exclude a licensed specialty pharmacy in good standing that accepts the plan's uniform network terms and the same reimbursement rates as other network specialty pharmacies. Plans could still require accreditation from the Joint Commission, URAC, or the Accreditation Commission for Health Care. They could also exclude pharmacies with fraud or abuse convictions or related board discipline, pharmacies excluded from Medicare or state health programs, and pharmacies shown to pose an imminent risk of patient harm.
Self-insured employer plans stay outside the bill's scope
H.R. 10549 does not require any patient to switch pharmacies, so patients can stay with a plan-owned pharmacy. It does not ban or break up any pharmacy and does not set prices. Self-insured employer plans are exempt. The 2029 effective date gives plans time to adjust.
Sponsors extend the Medicare Part D any-willing-pharmacy standard to commercial coverage
Medicare Part D plans have long been required to contract with any pharmacy that meets their standard terms and conditions (42 CFR 423.120(a)(8)). Congress strengthened that standard in the Consolidated Appropriations Act, 2026. H.R. 10549 applies the same principle to commercial plans.
Hope Charities President and CEO Jonathan James said many insurers and PBMs own or control the specialty pharmacies they direct patients to, which gives plans a financial incentive to pick their own pharmacy even when another would suit the patient's condition better. He tied delivery errors and prior authorization delays to preventable hospitalizations and higher overall healthcare costs. "If a plan-owned pharmacy offers the best care, patients will choose it," James said.
Congressional offices interested in cosponsoring can contact Palmer Van Tuyl in Rep. Dunn's office.