Patients Choice in Specialty Pharmacy Act would end plan steering toward insurer- and PBM-owned specialty pharmacies while letting patients keep the pharmacy they have

PRAIRIEVILLE, La., Oct. 28, 2026 /PRNewswire/ — Hope Charities today announced its support for H.R. 10549, the Patients Choice in Specialty Pharmacy Act. The bill would give patients with complex and rare conditions the freedom to use any qualified specialty pharmacy that accepts their health plan’s standard terms and rates. Introduced on September 24, 2026, by Rep. Neal Dunn (R-FL) with Rep. Joe Wilson (R-SC) as an original cosponsor, the bill has been referred to the House Committee on Energy and Commerce. Hope Charities urges Congress to take immediate action on H.R. 10549 to protect vulnerable patients and ensure they are never delayed from using the specialty pharmacies they trust.

Many insurers and pharmacy benefit managers (PBMs) now own or control the specialty pharmacies they direct patients to. This structure creates a built-in financial incentive for the plan to choose its own pharmacy, even when an alternative pharmacy would be a better fit for the patient’s condition.

“When a specialty medication or its administration is misunderstood, delayed by delivery errors, or stuck in prior authorization, patients often have nowhere else to turn,” said Jonathan James, President and CEO of Hope Charities. “People living with complex chronic conditions already carry higher costs and spend countless hours on treatment and specialist visits. When medication doesn’t arrive on time, patients suffer needlessly, preventable hospitalizations arise, and overall healthcare costs increase for everyone.”

James said restoring competition would put patients back in the driver’s seat. “Patients should be able to choose a pharmacy that knows their condition, delivers to their door, and provides the education, supplies, and in-home nursing support they need. This bill doesn’t tell anyone which pharmacy to use; it makes sure the patient gets to choose.”

Key Benefits of H.R. 10549

The bill amends the Public Health Service Act and applies to health insurance issuers offering group or individual coverage, as well as group health plans that are not self-insured. Under the bill:

• Choice without penalty. Plans may not require, steer, or induce patients to use a plan- or PBM-affiliated specialty pharmacy. That includes higher copays, coinsurance, or deductibles at other pharmacies, discounts or rebates tied to using an affiliated pharmacy, and penalties, delays, or paperwork imposed on patients or their prescribers.
   
• Open network on equal terms. Plans may not exclude a licensed specialty pharmacy in good standing that agrees to the plan’s uniform network terms and accepts the same reimbursement rates as other network specialty pharmacies.
   
• Quality and integrity protected. Plans may require accreditation from the Joint Commission, URAC, or the Accreditation Commission for Health Care. They may 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.

What it does not do

H.R. 10549 does not require any patient to change pharmacies. Patients who are satisfied with their current pharmacy, including a plan-owned one, can stay. The bill does not ban or break up any pharmacy, does not set prices, and does not apply to self-insured employer plans. It takes effect for plan years beginning on or after January 1, 2029, giving plans time to adjust.

Building on a proven Medicare standard

The approach is not new. Medicare Part D plans have long been required to contract with any pharmacy that meets their standard terms and conditions, and Congress strengthened that standard in the Consolidated Appropriations Act, 2026. H.R. 10549 brings the same principle to commercial coverage.

“If a plan-owned pharmacy offers the best care, patients will choose it,” James said. “This bill lets every qualified pharmacy compete on service and quality, on equal terms. That’s something everyone can stand behind, no matter their political party. Patient rights should be a bipartisan issue, and we hope Congress will make the right decision to put people above corporate control, profit, or politics.”

Hope Charities urges Members of Congress to cosponsor H.R. 10549. Congressional offices interested in cosponsoring may contact Palmer Van Tuyl in Rep. Dunn’s office at Palmer.VanTuyl@mail.house.gov. Patients and advocates who want to share their experiences or contact their representatives can reach Hope Charities at advocacy@hope-charities.org.

Resources

• H.R. 10549 bill text: congress.gov/bill/119th-congress/house-bill/10549/text
• Medicare Part D any willing pharmacy requirement, 42 CFR 423.120(a)(8): govinfo.gov
• CMS notice on Consolidated Appropriations Act, 2026, Sec. 6223: Federal Register

About the Hope Charities
Hope Charities, Inc. is a national 501(c)(3) nonprofit based in Prairieville, Louisiana. Since 2009, Hope Charities has helped people with bleeding disorders through patient support, education, and advocacy, and works more broadly to improve access to care for people living with rare and complex conditions. Learn more at hope-charities.org.

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SOURCE Hope Charities