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Consolidated Appropriations Act, 2026Section 6224 › Proposal

Rebates fully passed through to the sponsor are not a violation

Making further consolidated appropriations for the fiscal year ending September 30, 2026, and for other purposes, section 6224, Sec. 6224. Written by .

Rebates fully passed through to the sponsor are not a violation

The document says “shall notWho acts: pharmacy benefit managersHow: statuteSec. 6224 in the PDF
What the document says

“even if such price concessions are calculated as a percentage of a drug's price, shall not be considered a violation of the requirements of clause (i) if they are fully passed through to a PDP sponsor and are compliant with all regulatory and subregulatory requirements related to direct and indirect remuneration”

Making further consolidated appropriations for the fiscal year ending September 30, 2026, and for other purposes, Sec. 6224

Rebates, discounts and other price concessions a manager or affiliate receives from manufacturers do not violate the fee rule, even where they are figured as a percentage of a drug's price, so long as they are fully passed through to the sponsor and comply with the direct and indirect remuneration requirements, including where a sponsor is acting as its own manager.

What the document actually says

“even if such price concessions are calculated as a percentage of a drug's price, shall not be considered a violation of the requirements of clause (i) if they are fully passed through to a PDP sponsor and are compliant with all regulatory and subregulatory requirements related to direct and indirect remuneration”

Making further consolidated appropriations for the fiscal year ending September 30, 2026, and for other purposes, Sec. 6224
That sentence, in plain words

A cut of a drug's price does not break the rule above. It must be handed on to the plan in full. It must also follow the other rules.

What this is about

A rebate is money a drug maker gives back. If the middleman keeps it, it is income. If it goes to the plan, the plan can lower costs.

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