,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #bhhj  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,april #bf1 #bjbc,mr4 
,c>t] ( ,georgia 7= himself1 ,ms4 ,blunt
 ,ro*e/]1 ,ms4 ,malliotakis1 & ,mr4     
,au*9closs7 introduc$ ! foll[+ bill2 :i*
 0 ref]r$ to ! ,committee on ,en]gy &   
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
e/abli% c]ta9 requirem5ts = ph>macy     
b5efit manag]s "u "p ,d ( ! ,m$ic>e     
program4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,protect+ ,pati5ts ,aga9/   
,,pbm ,abuses ,act4  #b4 ,e/abli%+ c]ta9
 requirem5ts = ph>macy b5efit manag]s "u
 "p ,d ( ! ,m$ic>e program  7a7         
,prescription drug plans ,section       
#ahfj;,d-#ab7;b7 ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #aciew-#aab7;b77 is 
am5d$ by add+ at ! end ! foll[+ new     

p>agraph3  7#i7 ,responsibility (       
ph>macy b5efit manag]s  7,a7 ,9 g5]al   
,ea* contract ent]$ into ) a ,,pdp      
sponsor "u ?is "p ) respect to a        
prescription drug plan (f]$ by su*      
sponsor %all provide t any ph>macy      
b5efit manag] act+ on behalf ( su*      
sponsor complies ) ! foll[+ provisions3 
7i7 ,! ph>macy b5efit manag] d]ives no  
income ) respect to any s]vices provid$ 
9 connection ) cov]$ "p ,d drugs furni%$
 "u su* plan f any entity o!r ?an flat  
doll> am\nt s]vice fees4  7ii7 ,!       
ph>macy b5efit manag] receives su*      
s]vice fees only pursuant to a writt5   
agreem5t betwe5 ! manag] & su* sponsor t
 sets =? ! am\nt ( any su* fees4 ,any   
su* fee may n be directly or indirectly 
bas$ on1 or cont+5t ^u-- 7,i7 ! price ( 
any cov]$ "p ,d drug2  7,,ii7 disc\nts1 
rebates1 fees1 or o!r remun]ation )     
respect to su* drugs2 or  7,,iii7 any   
o!r circum/ance specifi$ by ! ,secret>y4
  7iii7 ,) respect to a cov]$ "p ,d drug
 disp5s$ by a ph>macy1 ! ph>macy b5efit 

manag] may n *>ge su* sponsor a diff]5t 
am\nt = su* drug's +r$i5t co/ or disp5s+
 fee ?an ! am\nt ! ph>macy b5efit manag]
 reimburses su* ph>macy = su* drug's    
+r$i5t co/ or disp5s+ fee4  7iv7 ,)     
respect to a cov]$ "p ,d drug disp5s$ by
 a network ph>macy1 ! ph>macy b5efit    
manag] may n reimburse su* ph>macy an   
am\nt less ?an ! am\nt ! ph>macy b5efit 
manag] w\ld reimburse an affiliat$      
ph>macy = su* drug4  7v7 ,) respect to  
ea* cov]$ "p ,d drug includ$ on ! =mul>y
 ( su* plan = :i* !re is a drug t is n  
includ$ on su* =mul>y ) a !rapeutic     
equival5ce rat+ ( ,,ab 7z e/abli%$      
pursuant to section #eje7;j77#g7 ( !    
,f$]al ,food1 ,drug1 & ,cosmetic ,act7 9
 ! same !rapeutic class or category (   
su* cov]$ "p ,d drug1 ! ph>macy b5efit  
manag] %all submit to su* plan a report 
specify+ ! diff]5ce betwe5 ! national   
av]age drug acquisition co/ 7z publi%$  
by ! ,secret>y7 = su* drug n includ$ 9  
su* =mul>y & ! negotiat$ prices = su*   
drug t is includ$ 9 su* =mul>y4  7,b7   

,c]tification ,ea* ,,pdp sponsor 7& ea* 
ph>macy b5efit manag] provid+ s]vices "u
 a prescription drug plan furni%$ by su*
 sponsor7 %all furni% to ! ,secret>y 79 
a "t & mann] specifi$ by ! ,secret>y7 an
 annual c]tification ( compliance ) ?is 
p>agraph1 z well z su* in=mation z !    
,secret>y det]m9es necess>y to c>ry out 
?is p>agraph4  7,c7 ,disgorgem5t (      
prohibit$ paym5ts ,a ph>macy b5efit     
manag] %all disgorge to ! ,secret>y any 
paym5t1 remun]ation1 or o!r am\nt       
receiv$ 9 violation ( ?is p>agraph or ! 
contract ent]$ into ) a ,,pdp sponsor "u
 ?is "p ) respect to a prescription drug
 plan4 ,a ,,pdp sponsor %all susp5d     
paym5ts to a ph>macy b5efit manag] =    
failure to disgorge su* am\nts pursuant 
to ! prec$+ s5t5ce or = o!r violations (
 ?is p>agraph4  7,d7 ,cl>ification ,!   
requirem5ts ( ?is p>agraph %all apply   
reg>dless ( :e!r a ,,pdp sponsor is act+
 z its own ph>macy b5efit manag] &      
reg>dless ( :e!r a ph>macy b5efit manag]
 is "u common own]%ip or control ( !    

,,pdp sponsor ) respect to :i* ! manag] 
is furni%+ s]vices4  7,e7 ,def9itions ,=
 purposes ( ?is p>agraph3 7i7 ,affiliat$
 ph>macy ,! t]m affiliat$ ph>macy means1
 ) respect to a ph>macy b5efit manag]1 a
 ph>macy t directly or indirectly ?r\gh 
"o or m int]m$i>ies is own$ by1         
controll$ by1 or is "u common own]%ip or
 control ( su* manag]1 or a ph>macy 9   
:i* su* manag] has a f9ancial int]e/4   
7ii7 ,ph>macy b5efit manag] ,! t]m      
ph>macy b5efit manag] means any entity  
7& any affiliate1 subsidi>y1 or ag5t (  
su* entity7 t1 pursuant to an agreem5t )
 a ,,pdp sponsor ei!r directly or ?r\gh 
an int]m$i>y acts z a price negotiator  
or gr\p pur*as] on behalf ( su* sponsor1
 or manages ! prescription drug b5efits 
provid$ by su* sponsor1 includ+ by      
process+ & pay+ claims = cov]$ "p ,d    
drugs1 p]=m+ drug utilization review1   
process+ drug prior au?orization        
reque/s1 adjudicat+ appeals or          
grievances relat$ to cov]$ "p ,d drugs1 
contract+ ) network ph>macies1 controll+

 ! co/ ( su* drugs1 or provid+ any      
relat$ s]vices4  7,f7 ,nondisclosure (  
c]ta9 in=mation ,no?+ 9 ?is p>agraph    
%all be con/ru$ to require public       
disclosure ( any in=mation t is a trade 
secret or confid5tial in=mation 7z      
describ$ 9 section #eeb7;b77#d7 ( title 
#e1 ,unit$ ,/ates ,code74  4  7b7       
,,ma-,,pd plans ,section #aheg7;f77#c7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciew-#bg7;f77#c77 is am5d$ by add+ at
 ! end ! foll[+ new subp>agraph3  7,f7  
,responsibility ( ph>macy b5efit manag]s
 ,section #ahfj;,d-#ab7;b77#i74  4  #c4 
,conflict ( int]e/ ,section             
#ahfj;,d-#d7;b77#c77;,a77ii77,i7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ajd7;b77#c77;,a77ii77,i77 is    
am5d$ by /rik+ ) respect to ! sponsor & 
plan & replac+ x ) ) respect to !       
sponsor1 plan1 & any ph>macy b5efit     
manag] furni%+ s]vices to su* sponsor or
 plan4  #d4 ,,pbm transp>5cy ,section   
#aaej;,a ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #acbj;b-#bc7 is am5d$-- 7#a7 

9 subsection 7b71 by add+ at ! end !    
foll[+ new p>agraph3  7#d7 ,9 ! case ( !
 provision ( in=mation by a ,,pbm t     
manages prescription drug cov]age "u a  
contract ) a sponsor describ$ 9         
subsection 7a77#a7 = a plan s describ$--
 7,a7 ! aggregate doll> am\nt ( all     
rebates t ! ,,pbm receiv$ ) respect to  
drugs furni%$ "u su* plan f drug        
manufactur]s2  7,b7 ! aggregate doll>   
am\nt ( all adm9i/rative fees t ! ,,pbm 
receiv$ ) respect to drugs furni%$ "u   
su* plan f drug manufactur]s2  7,c7 !   
aggregate doll> am\nt ( all rebates     
describ$ 9 subp>agraph 7,a7 t ! ,,pbm   
did n pass ?r\gh to su* sponsor2  7,d7 !
 p]c5tage ( ! aggregate doll> am\nt (   
all rebates describ$ 9 subp>agraph 7,a7 
t ! ,,pbm did n pass ?r\gh to su*       
sponsor2 &  7,e7 ) respect to all plans 
describ$ 9 subsection 7a77#a7 = :i* !   
,,pbm manages prescription drug cov]age1
 ! highe/ p]c5tage calculat$ "u         
subp>agraph 7,d7 & ! l[e/ su* p]c5tage4 
2  7#b7 by r$esignat+ subsections 7c7 & 

7d7 z subsections 7d7 & 7e71            
respectively2 &  7#c7 by ins]t+ aft]    
subsection 7b71 ! foll[+ new subsection3
  7c7 ,publication ( "p d in=mation ,!  
,secret>y %all publi%1 n less frequ5tly 
?an annually1 ! in=mation report$ "u    
subsection 7b7 by or on behalf (        
sponsors describ$ 9 subsection 7a77#a7  
on a publicly available website1 provid$
 t su* in=mation %all be made available 
9 a =m t does n disclose ! id5tity ( a  
specific plan1 ! prices *>g$ = specific 
drugs or classes ( drugs1 or ! am\nt (  
any rebates provid$ = specific drugs or 
classes ( drugs4  4  #e4 ,effective date
 ,! am5dm5ts made by ?is ,act %all take 
effect ,janu>y #a1 #bjbd4  #f4          
,regulations ,not)/&+ any o!r provision 
( law1 ! ,secret>y %all initially       
implem5t ! am5dm5ts made by ?is ,act    
?r\gh int]im f9al regulations4