,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #cbhe  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #ae1 #bjbc ,mr4  
,griffi? introduc$ ! foll[+ bill2 :i* 0 
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce1 & 9 addition to ! ,committees 
on ,education & ! ,work=ce1 & ,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 e/abli% pati5t protections 
) respect to highly rebat$ drugs4  #a4  
,%ort title ,?is ,act may be cit$ z !   
,fairness = ,pati5t ,m$ications ,act4   
#b4 ,requirem5ts ) respect to co/-%>+ = 
highly rebat$ drugs  7a7 ,,phsa ,"p ,d (
 title ,,xxvii ( ! ,public ,heal?       
,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aaa
 et seq47 is am5d$ by add+ at ! end !   
foll[+3  #bgii;,a-#aa4 ,requirem5ts )   
respect to co/-%>+ = highly rebat$ drugs
  7a7 ,9 g5]al ,no lat] ?an ,april #a1  
#bjbd1 & annually !reaft]1 ! ,secret>y  
%all c]tify 7or rec]tify1 if applicable7

 z a highly rebat$ drug any drug        
id5tifi$ 9 reports submitt$ "u sections 
#bgii;,a-#aj1 #gbe ( ! ,employee        
,retirem5t ,income ,security ,act1 &    
#ihbe ( ! ,int]nal ,rev5ue ,code ( #aihf
 = :i* total rebates1 r$uctions 9 price1
 & o!r =ms ( remun]ation 9 ! previ\s ye>
 aggregat$ across all comm]cial m>kets  
exce$$ #ej p]c5t ( total annual sp5d+ on
 su* drug 9 su* ye>4  7b7 ,d$uctible &  
co/-,%>+ limitations = c]tifi$ drugs ,= 
plan ye>s t beg9 on or aft] ,janu>y #a1 
#bjbe1 a gr\p heal? plan or a heal?     
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age 7or entity t    
provides ph>macy b5efits managem5t      
s]vices on behalf ( su* a plan or issu]7
 t provides cov]age ( any highly rebat$ 
drug %all n impose co/-%>+ 9 excess (1  
p] #cj-;day supply1 ! quoti5t ( ! annual
 net price paid by su* gr\p heal? plan  
or heal? insurance issu] 7or entity t   
provides ph>macy b5efits managem5t      
s]vices on behalf ( su* a plan or       
issu]71 9 ! mo/ rec5t cal5d> ye> = :i* a

 f9al net price has be5 calculat$ by su*
 plan or cov]age 7or entity t provides  
ph>macy b5efit managem5t s]vices on     
behalf ( su* plan or issu]71 p] #cj-;day
 supply ( su* specific highly rebat$    
drug1 divid$ by #ab4  7c7 ,highly rebat$
 drug previ\sly subject to =mul>y       
exclusion ,beg9n+ on ,janu>y #a1 #bjbe1 
9 ! case ( a specific highly rebat$ drug
 cov]$ by a gr\p heal? plan or heal?    
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age 7or entity t    
provides ph>macy b5efits managem5t      
s]vices on behalf ( su* plan or issu]7 t
 provides cov]age ( a specific highly   
rebat$ drug t 0 n cov]$ 9 ! previ\s ye>1
 su* gr\p heal? plan or heal? insurance 
issu] %all n receive f a drug           
manufactur] a r$uction 9 price or o!r   
remun]ation ) respect to su* specific   
highly rebat$ drug receiv$ by an        
enrollee 9 ! plan or cov]age & cov]$ by 
! plan or cov]age1 unless-- 7#a7 any su*
 r$uction 9 price is reflect$ at ! po9t 
( sale to ! enrollee2 &  7#b7 any su*   

o!r remun]ation is a flat fee-bas$      
s]vice fee n cont+5t on total volume (  
sales t a manufactur] ( prescription    
drugs pays to an entity t provides      
ph>macy b5efits managem5t s]vices4  7d7 
,def9itions ,9 ?is section3  7#a7       
,entity t provides ph>macy b5efits      
managem5t s]vices ,! t]m entity t       
provides ph>macy b5efits managem5t      
s]vices means-- 7,a7 any entity t1      
pursuant to a writt5 agreem5t ) a gr\p  
heal? plan or a heal? insurance issu]   
(f]+ gr\p or individual heal? insurance 
cov]age1 directly or ?r\gh an           
int]m$i>y--  7i7 acts z a price         
negotiator on behalf ( ! plan or        
cov]age2 or  7ii7 manages ! prescription
 drug b5efits provid$ by ! plan or      
cov]age1 :i* may include ! process+ &   
paym5t ( claims = prescription drugs1 ! 
p]=mance ( drug utilization review1 !   
process+ ( drug prior au?orization      
reque/s1 ! adjudication ( appeals or    
grievances relat$ to ! prescription drug
 b5efit1 contract+ ) network ph>macies1 

controll+ ! co/ ( cov]$ prescription    
drugs1 or ! provision ( relat$ s]vices2 
or  7,b7 any entity t is own$1          
affiliat$1 or relat$ "u a common own]%ip
 /ructure ) an entity describ$ 9        
subp>agraph 7,a74  7#b7 ,net price ,!   
t]m net price1 ) respect to a           
prescription drug1 means ! f9al price   
paid by a gr\p heal? plan or heal?      
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age 7or entity t    
provides ph>macy b5efits managem5t      
s]vices on behalf ( su* a plan or issu]7
 aft] apply+ any rebates & o!r          
remun]ation "u ! plan or cov]age f drug 
manufactur]s dur+ ! plan ye>4  7e7      
,specification ,a heal? insurance plan w
 n fail to be treat$ z an ,,hdhp =      
comply+ ) ! co/-%>+ cap 9 ?is section4  
4  7b7 ,,erisa  7#a7 ,9 g5]al ,subp>t ,b
 ( "p #g ( subtitle ,b ( title ,i ( !   
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#bi ,u4,s4,c4 #aahe et    
seq47 is am5d$ by add+ at ! end !       
foll[+3  #gbe4 ,requirem5ts ) respect to

 co/-%>+ = highly rebat$ drugs  7a7 ,9  
g5]al ,no lat] ?an ,april #a1 #bjbd1 &  
annually !reaft]1 ! ,secret>y %all      
c]tify 7or rec]tify1 if applicable7 z a 
highly rebat$ drug any drug id5tifi$ 9  
reports submitt$ "u sections #gbe1      
#bgii;,a-#aj ( ! ,public ,heal? ,s]vice 
,act1 & #ihbe ( ! ,int]nal ,rev5ue ,code
 ( #aihf = :i* total rebates1 r$uctions 
9 price1 & o!r =ms ( remun]ation 9 !    
previ\s ye> aggregat$ across all        
comm]cial m>kets exce$$ #ej p]c5t (     
total annual sp5d+ on su* drug 9 su*    
ye>4  7b7 ,d$uctible & co/-,%>+         
limitations = c]tifi$ drugs ,= plan ye>s
 t beg9 on or aft] ,janu>y #a1 #bjbe1 a 
gr\p heal? plan or a heal? insurance    
issu] (f]+ gr\p heal? insurance cov]age 
7or entity t provides ph>macy b5efits   
managem5t s]vices on behalf ( su* a plan
 or issu]7 t provides cov]age ( any     
highly rebat$ drug %all n impose co/-%>+
 9 excess (1 p] #cj-;day supply1 !      
quoti5t ( ! annual net price paid by su*
 gr\p heal? plan or heal? insurance     

issu] 7or entity t provides ph>macy     
b5efits managem5t s]vices on behalf (   
su* a plan or issu]71 9 ! mo/ rec5t     
cal5d> ye> = :i* a f9al net price has   
be5 calculat$ by su* plan or cov]age 7or
 entity t provides ph>macy b5efit       
managem5t s]vices on behalf ( su* plan  
or issu]71 p] #cj-;day supply ( su*     
specific highly rebat$ drug1 divid$ by  
#ab4  7c7 ,highly rebat$ drug previ\sly 
subject to =mul>y exclusion ,beg9n+ on  
,janu>y #a1 #bjbe1 9 ! case ( a specific
 highly rebat$ drug cov]$ by a gr\p     
heal? plan or heal? insurance issu] (f]+
 gr\p heal? insurance cov]age 7or entity
 t provides ph>macy b5efits managem5t   
s]vices on behalf ( su* plan or issu]7 t
 provides cov]age ( a specific highly   
rebat$ drug t 0 n cov]$ 9 ! previ\s ye>1
 su* gr\p heal? plan or heal? insurance 
issu] %all n receive f a drug           
manufactur] a r$uction 9 price or o!r   
remun]ation ) respect to su* specific   
highly rebat$ drug receiv$ by an        
enrollee 9 ! plan or cov]age & cov]$ by 

! plan or cov]age1 unless-- 7#a7 any su*
 r$uction 9 price is reflect$ at ! po9t 
( sale to ! enrollee2 &  7#b7 any su*   
o!r remun]ation is a flat fee-bas$      
s]vice fee n cont+5t on total volume (  
sales t a manufactur] ( prescription    
drugs pays to an entity t provides      
ph>macy b5efits managem5t s]vices4  7d7 
,def9itions ,9 ?is section3  7#a7       
,entity t provides ph>macy b5efits      
managem5t s]vices ,! t]m entity t       
provides ph>macy b5efits managem5t      
s]vices means-- 7,a7 any entity t1      
pursuant to a writt5 agreem5t ) a gr\p  
heal? plan or a heal? insurance issu]   
(f]+ gr\p heal? insurance cov]age1      
directly or ?r\gh an int]m$i>y--  7i7   
acts z a price negotiator on behalf ( ! 
plan or cov]age2 or  7ii7 manages !     
prescription drug b5efits provid$ by !  
plan or cov]age1 :i* may include !      
process+ & paym5t ( claims =            
prescription drugs1 ! p]=mance ( drug   
utilization review1 ! process+ ( drug   
prior au?orization reque/s1 !           

adjudication ( appeals or grievances    
relat$ to ! prescription drug b5efit1   
contract+ ) network ph>macies1 controll+
 ! co/ ( cov]$ prescription drugs1 or ! 
provision ( relat$ s]vices2 or  7,b7 any
 entity t is own$1 affiliat$1 or relat$ 
"u a common own]%ip /ructure ) an entity
 describ$ 9 subp>agraph 7,a74  7#b7 ,net
 price ,! t]m net price1 ) respect to a 
prescription drug1 means ! f9al price   
paid by a gr\p heal? plan or heal?      
insurance issu] (f]+ gr\p heal?         
insurance cov]age 7or entity t provides 
ph>macy b5efits managem5t s]vices on    
behalf ( su* a plan or issu]7 aft]      
apply+ any rebates & o!r remun]ation "u 
! plan or cov]age f drug manufactur]s   
dur+ ! plan ye>4  7e7 ,specification ,a 
heal? insurance plan w n fail to be     
treat$ z an ,,hdhp = comply+ ) ! co/-%>+
 cap 9 ?is section4  4  7#b7 ,cl]ical   
am5mdnet ,! table ( cont5ts 9 section #a
 ( ! ,employee ,retirem5t ,income       
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#ajja et seq47 is am5d$ by ins]t+ aft] !

 item relat$ to section #gbe ! foll[+3  
,sec4 #gbe4 ,requirem5ts ) respect to   
co/-%>+ = highly rebat$ drugs4  4  7c7  
,,irc  7#a7 ,9 g5]al ,sub*apt] ,b (     
*apt] #ajj ( ! ,int]nal ,rev5ue ,code ( 
#aihf is am5d$ by add+ at ! end ! foll[+
 new section3  #ihbf4 ,requirem5ts )    
respect to co/-%>+ = highly rebat$ drugs
  7a7 ,9 g5]al ,no lat] ?an ,april #a1  
#bjbd1 & annually !reaft]1 ! ,secret>y  
%all c]tify 7or rec]tify1 if applicable7
 z a highly rebat$ drug any drug        
id5tifi$ 9 reports submitt$ "u sections 
#ihbe1 #bgii;,a-#aj ( ! ,public ,heal?  
,s]vice ,act1 & #gbe ( ! ,employee      
,retirem5t ,income ,security ,act = :i* 
total rebates1 r$uctions 9 price1 & o!r 
=ms ( remun]ation 9 ! previ\s ye>       
aggregat$ across all comm]cial m>kets   
exce$$ #ej p]c5t ( total annual sp5d+ on
 su* drug 9 su* ye>4  7b7 ,d$uctible &  
co/-,%>+ limitations = c]tifi$ drugs ,= 
plan ye>s t beg9 on or aft] ,janu>y #a1 
#bjbe1 a gr\p heal? plan 7or entity t   
provides ph>macy b5efits managem5t      

s]vices on behalf ( su* a plan7 t       
provides cov]age ( any highly rebat$    
drug %all n impose co/-%>+ 9 excess (1  
p] #cj-;day supply1 ! quoti5t ( ! annual
 net price paid by su* gr\p heal? plan  
7or entity t provides ph>macy b5efits   
managem5t s]vices on behalf ( su* a     
plan71 9 ! mo/ rec5t cal5d> ye> = :i* a 
f9al net price has be5 calculat$ by su* 
plan 7or entity t provides ph>macy      
b5efit managem5t s]vices on behalf ( su*
 plan71 p] #cj-;day supply ( su*        
specific highly rebat$ drug1 divid$ by  
#ab4  7c7 ,highly rebat$ drug previ\sly 
subject to =mul>y exclusion ,beg9n+ on  
,janu>y #a1 #bjbe1 9 ! case ( a specific
 highly rebat$ drug cov]$ by a gr\p     
heal? plan 7or entity t provides ph>macy
 b5efits managem5t s]vices on behalf (  
su* plan7 t provides cov]age ( a        
specific highly rebat$ drug t 0 n cov]$ 
9 ! previ\s ye>1 su* gr\p heal? plan    
%all n receive f a drug manufactur] a   
r$uction 9 price or o!r remun]ation )   
respect to su* specific highly rebat$   

drug receiv$ by an enrollee 9 ! plan &  
cov]$ by ! plan1 unless--  7#a7 any su* 
r$uction 9 price is reflect$ at ! po9t (
 sale to ! enrollee2 &  7#b7 any su* o!r
 remun]ation is a flat fee-bas$ s]vice  
fee n cont+5t on total volume ( sales t 
a manufactur] ( prescription drugs pays 
to an entity t provides ph>macy b5efits 
managem5t s]vices4  7d7 ,def9itions ,9  
?is section3 7#a7 ,entity t provides    
ph>macy b5efits managem5t s]vices ,! t]m
 entity t provides ph>macy b5efits      
managem5t s]vices means--  7,a7 any     
entity t1 pursuant to a writt5 agreem5t 
) a gr\p heal? plan1 directly or ?r\gh  
an int]m$i>y-- 7i7 acts z a price       
negotiator on behalf ( ! plan2 or  7ii7 
manages ! prescription drug b5efits     
provid$ by ! plan1 :i* may include !    
process+ & paym5t ( claims =            
prescription drugs1 ! p]=mance ( drug   
utilization review1 ! process+ ( drug   
prior au?orization reque/s1 !           
adjudication ( appeals or grievances    
relat$ to ! prescription drug b5efit1   

contract+ ) network ph>macies1 controll+
 ! co/ ( cov]$ prescription drugs1 or ! 
provision ( relat$ s]vices2 or  7,b7 any
 entity t is own$1 affiliat$1 or relat$ 
"u a common own]%ip /ructure ) an entity
 describ$ 9 subp>agraph 7,a74  7#b7 ,net
 price ,! t]m net price1 ) respect to a 
prescription drug1 means ! f9al price   
paid by a gr\p heal? plan 7or entity t  
provides ph>macy b5efits managem5t      
s]vices on behalf ( su* a plan7 aft]    
apply+ any rebates & o!r remun]ation "u 
! plan f drug manufactur]s dur+ ! plan  
ye>4  7e7 ,specification ,a heal?       
insurance plan w n fail to be treat$ z  
an ,,hdhp = comply+ ) ! co/-%>+ cap 9   
?is section4  4  7#b7 ,cl]ical am5dm5t  
,! table ( sections = sub*apt] ,b (     
*apt] #ajj ( su* ,code is am5d$ by add+ 
at ! end ! foll[+ new item3  ,sec4      
#ihbf4 ,requirem5ts ) respect to co/-%>+
 = highly rebat$ drugs4  4