,,ib ,union ,cal5d> ,no4 #bji #aah?     
,,congress  #a/ ,session  ,h4 ,r4 #dejh 
,report ,no4 #aah-bei ,,9 ,,! ,,h\se ,,(
 ,,repres5tatives  ,july #aj1 #bjbc,mr4 
,c\rtney 7= himself & ,mrs4 ,h\*97      
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,education & ! ,work=ce
  ,novemb] #a1 #bjbc,report$ ) an       
am5dm5t1 committ$ to ! ,committee ( !   
,:ole ,h\se on ! ,/ate ( ! ,union1 &    
ord]$ to be printed,strike out all aft] 
! enact+ clause & ins]t ! "p pr9t$ 9    
italic,for text ( introduc$ bill1 see   
copy ( bill z introduc$ on ,july #aj1   
#bjbc  ,a ,,bill  ,to am5d ! ,employee  
,retirem5t ,income ,security ,act (     
#aigd to cl>ify & /r5g!n ! application (
 c]ta9 employ]-sponsor$ heal? plan      
disclosure requirem5ts4  #a4 ,%ort title
 ,?is ,act may be cit$ z ! ,hidd5 ,fee  
,disclosure ,act ( #bjbc4  #b4          
,cl>ification ( ! application ( fee     
disclosure requirem5ts to cov]$ s]vice  
provid]s  7a7 ,s]vices ,clause          
7ii77,i77bb7 ( section #djh7;b77#b77;,b7

 ( ! ,employee ,retirem5t ,income       
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#aajh7;b77#b77;,b77 is am5d$-- 7#a7 9   
subitem 7,,aa7 by /rik+ ,brok]age       
s]vices1 & ins]t+ ,s]vices 7includ+     
brok]age s]vices712 &  7#b7 9 subitem   
7,,bb7-- 7,a7 by /rik+ ,consult+1 &     
ins]t+ ,o!r s]vices12 &  7,b7 by ins]t+ 
any ( ! foll[+3 be=e plan design4  7b7  
,disclosures ,clause 7iii77,,iii7 (     
section #djh7;b77#b77;,b7 ( ! ,employee 
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aajh7;b77#b77;,b77
 is am5d$ by /rik+ 1 ei!r 9 ! aggregate 
or by s]vice1 & ins]t+ by s]vice4  #c4  
,/r5g!n+ disclosure requirem5ts )       
respect to ph>macy b5efit manag]s & ?ird
 p>ty adm9i/rators = gr\p heal? plans   
7a7 ,c]ta9 arrangem5ts = ,,pbm s]vices  
consid]$ z indirect  7#a7 ,9 g5]al      
,clause 7i7 ( section #djh7;b77#b77;,b7 
( ! ,employee ,retirem5t ,income        
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#aajh7;b77#b77;,b77 is am5d$-- 7,a7 by  
/rik+ requirem5ts ( ?is clause & ins]t+ 

requirem5ts ( ?is subp>agraph2 &  7,b7  
by add+ at ! end ! foll[+3 ,= purposes (
 apply+ section #djf7;a77#a77;,c7 )     
respect to a transaction describ$ "u ?is
 subp>agraph1 a contract or arrangem5t =
 s]vices betwe5 a cov]$ plan & a heal?  
insurance issu] provid+ heal? insurance 
cov]age 9 connection ) ! cov]$ plan 9   
:i* ! heal? insurance issu] contracts1 9
 connection ) su* plan1 ) a s]vice      
provid] = ph>macy b5efit managem5t      
s]vices %all be consid]$ to con/itute an
 indirect furni%+ ( goods1 s]vices1 or  
facilities betwe5 ! plan & ! s]vice     
provid] act+ z ! p>ty 9 int]e/44  7#b7  
,heal? insurance issu] & heal? insurance
 cov]age def9$ ,clause 7ii77,i77aa7 (   
section #djh7;b77#b77;,b7 ( ! ,employee 
,retirem5t ,income ,security ,act (     
#aigd 77#bi ,u4,s4,c4                   
#aajh7;b77#b77;,b77 is am5d$ by ins]t+  
be=e ! p]iod at ! end & ! t]ms heal?    
insurance cov]age & heal? insurance     
issu] h ! mean+s giv5 su* t]ms 9 section
 #gcc7;b74  7b7 ,specific disclosure    

requirem5ts ) respect to ph>macy b5efit 
managem5t s]vices  7#a7 ,9 g5]al ,clause
 7iii7 ( section #djh7;b77#b77;,b7 ( su*
 ,act 7#bi ,u4,s4,c4 #aajh7;b77#b77;,b77
 is am5d$ by add+ at ! end ! foll[+3    
7,,vii7 ,) respect to a contract or     
arrangem5t ) ! cov]$ plan 9 connection )
 ! provision ( ph>macy b5efit managem5t 
s]vices1 z "p ( ! description requir$ "u
 subclauses 7,,iii7 & 7,,iv7-- 7aa7 all 
comp5sation describ$ 9 clause           
7ii77,i77dd77,,aa71 includ+ fees1       
rebates1 alt]native disc\nts1 co-paym5t 
(fsets1 & o!r remun]ation expect$ to be 
receiv$ by ! cov]$ s]vice provid]1 an   
affiliate1 or a subcontractor f a       
ph>maceutical manufactur]1 di/ributor1  
rebate aggregator1 gr\p pur*as+         
organization1 or any o!r ?ird p>ty2 &   
7bb7 ! am\nt & =m ( any rebates1        
disc\nts1 or price concessions1 includ+ 
! am\nt expect$ to be pass$ ?r\gh to !  
plan sponsor or ! p>ticipants &         
b5efici>ies "u ! cov]$ plan2  7cc7 all  
comp5sation expect$ to be receiv$ by !  

cov]$ s]vice provid] z a result ( pay+ a
 l[] am\nt = ! drug ?an ! am\nt *>g$ z a
 copaym5t1 co9surance am\nt1 or         
d$uctible2  7dd7 all comp5sation expect$
 to be receiv$ by ! cov]$ s]vice provid]
 z a result ( pay+ ph>macies less ?an   
:at is *>g$ ! heal? plan1 plan sponsor1 
or p>ticipants & b5efici>ies "u ! cov]$ 
plan2  7ee7 all comp5sation expect$ to  
be receiv$ by ! cov]$ s]vice provid] f  
drug manufactur]s & any o!r ?ird p>ty 9 
ex*ange =-- 7,,aa7 adm9i/]+1 invoic+1   
allocat+1 or collect+ rebates relat$ to 
! cov]$ plan2 7,,bb7 provid+ bus9ess    
s]vices & activities1 includ+ provid+   
access to drug utilization data2 7,,cc7 
keep+ a p]c5tage ( ! li/ price ( a drug2
 or 7,,dd7 any o!r reason relat$ to !   
role ( a cov]$ s]vice provid] z a       
conduit betwe5 ! drug manufactur]s or   
any o!r ?ird p>ty & ! cov]$ plan4  4    
7#b7 ,annual disclosure  7,a7 ,clause   
7v7 ( section #djh7;b77#b77;,b7 ( su*   
,act 7#bi ,u4,s4,c4 #aajh7;b77#b77;,b77 
is am5d$ by add+ at ! end ! foll[+3     

7,,iii7 ,a cov]$ s]vice provid]1 )      
respect to a contract or arrangem5t ) ! 
cov]$ plan 9 connection ) provid+       
ph>macy b5efit managem5t s]vices1 %all  
disclose1 on an annual basis n lat] ?an 
#fj days aft] ! beg9n+ ( ! curr5t plan  
ye>1 to a responsible plan fiduci>y1 9  
writ+1 ! foll[+ ) respect to ! twelve   
mon?s prec$+ ! curr5t plan ye>3 7aa7    
,all direct comp5sation describ$ 9      
subclause 7,,iii7 ( clause 7iii7 &      
indirect comp5sation describ$ 9         
subclause 7,,iv7 ( clause 7iii7 receiv$ 
by ! cov]$ s]vice provid] 7includ+ su*  
comp5sation describ$ 9 subclause 7,,vii7
 ( clause 7iii774  7bb7 ,= ea* drug     
cov]$ "u ! cov]$ plan1 ! am\nt by :i* ! 
price = ! drug paid by ! plan exce$s !  
am\nt paid to ph>macies by ! cov]$      
s]vice provid]4  7cc7 ,! total gross    
sp5d+ by ! cov]$ plan on drugs 7exclud+ 
rebates1 disc\nts1 or o!r price         
concessions74  7dd7 ,! total net sp5d+  
by ! cov]$ plan on drugs4  7ee7 ,! total
 gross sp5d+ at all ph>macies :olly or  

p>tially own$ by ! cov]$ s]vice provid]1
 includ+ mail-ord]1 specialty & retail  
ph>macies1 ) a breakd[n by individual   
ph>macy location4  7ff7 ,! aggregate    
am\nt ( clawback f ph>macies1 includ+   
mail-ord]1 specialty1 & retail          
ph>macies4 7,,aa7 categorical           
explanations 7gr\p$ by ! reason =       
clawback1 su* z contractual true-up     
provisions1 ov]paym5ts1 or non-cov]$    
m$ication disp5s$1 & includ+ in=mation  
on ! am\nt 9 ea* category t 0 pass$     
?r\gh to ! cov]$ plan & to p>ticipants &
 b5efici>ies ( ! cov]$ plan72 or 7,,bb7 
individual explanations = su* clawbacks4
  7gg7 ,total aggregate am\nts ( fees   
collect$ by ! cov]$ s]vice provid] 9    
connection ) ! provision ( ph>macy      
b5efit managem5t s]vices to ! cov]$     
plan4  7hh7 ,any o!r in=mation specifi$ 
by ! ,secret>y ?r\gh regulations or     
guidance t may be necess>y = a          
responsible plan fiduci>y to consid] !  
m]its ( ! contract or arrangem5t ) !    
cov]$ s]vice provid] & any conflicts (  

int]e/ t may exi/4  4  7#c7 ,ph>macy    
b5efit managem5t s]vices def9$ ,clause  
7ii77,i7 ( section #djh7;b77#b77;,b7 (  
su* ,act 7#bi ,u4,s4,c4                 
#aajh7;b77#b77;,b77 is am5d$ by add+ at 
! end ! foll[+3  7gg7 ,! t]m ph>macy    
b5efit managem5t s]vices includes any   
s]vices provid$ by a cov]$ s]vice       
provid] to a cov]$ plan ) respect to !  
adm9i/ration ( prescription drug b5efits
 "u ! cov]$ plan1 includ+-- 7,,aa7 !    
process+ & paym5t ( claims2 7,,bb7      
design ( ph>macy networks2 7,,cc7       
negotiation1 aggregation1 & di/ribution 
( rebates1 disc\nts1 & o!r price        
concessions2 7,,dd7 =mul>y design &     
ma9t5ance2 7,,ee7 op]ation ( ph>macies  
7:e!r retail1 mail ord]1 specialty drug1
 or o!rwise72 recordkeep+2 7,,ff7       
utilization review2 7,,gg7 adjudication 
( claims2 & 7,,hh7 any o!r s]vices      
specifi$ by ! ,secret>y ?r\gh guidance  
or rulemak+4  4  7#d7 ,clawback def9$   
,clause 7ii77,i7 ( section              
#djh7;b77#b77;,b7 ( su* ,act 7#bi       

,u4,s4,c4 #aajh7;b77#b77;,b771 z am5d$  
by p>agraph 7#c71 is am5d$ by add+ at ! 
end ! foll[+3  7hh7 ,! t]m clawback     
means am\nts collect$ by a ph>macy      
b5efit manag] f a ph>macy = copaym5ts   
collect$ f a p>ticipant or b5efici>y 9  
excess ( ! contract$ rate4  4  7c7      
,specific disclosure requirem5ts )      
respect to ?ird p>ty adm9i/ration       
s]vices = gr\p heal? plans  7#a7 ,9     
g5]al ,clause 7iii7 ( section           
#djh7;b77#b77;,b7 ( su* ,act 7#bi       
,u4,s4,c4 #aajh7;b77#b77;,b771 z am5d$  
by subsection 7b77#a71 is am5d$ by add+ 
at ! end ! foll[+3  7,,viii7 ,) respect 
to a contract or arrangem5t ) ! cov]$   
plan 9 connection ) ! provision ( ?ird  
p>ty adm9i/ration s]vices = gr\p heal?  
plans1 z "p ( ! description requir$ "u  
subclauses 7,,iii7 & 7,,iv7-- 7aa7 !    
am\nt & =m ( any rebates1 disc\nts1     
sav+s fees1 refunds1 or am\nts receiv$ f
 provid]s & facilities1 includ+ ! am\nts
 t w be reta9$ by ! cov]$ s]vice provid]
 z a fee2  7bb7 ! am\nt & =m ( fees     

expect$ to be receiv$ f o!r s]vice      
provid]s 9 relation to ! cov]$ plan1    
includ+ ! am\nts t w be reta9$ by !     
cov]$ s]vice provid] z a fee2 &  7cc7 ! 
am\nt & =m ( expect$ recov]ies by !     
cov]$ s]vice provid]1 includ+ ! am\nts t
 w be reta9$ by ! cov]$ s]vice provid] z
 a fee 7disaggregat$ by category71 z a  
result (-- 7,,aa7 ov]paym5ts2 7,,bb7    
errone\s paym5ts2 7,,cc7 unca%$ *ecks or
 incomplete paym5ts2 7,,dd7 bill+       
errors2 7,,ee7 subrogation2 7,,ff7      
fraud2 or 7,,gg7 any o!r reason on      
behalf ( ! cov]$ plan4  4  7#b7 ,annual 
disclosure ,clause 7v7 ( section        
#djh7;b77#b77;,b7 ( su* ,act 7#bi       
,u4,s4,c4 #aajh7;b77#b77;,b771 z am5d$  
by subsection 7b77#b71 is am5d$ by add+ 
at ! end ! foll[+3  7,,iv7 ,a cov]$     
s]vice provid]1 ) respect to a contract 
or arrangem5t ) ! cov]$ plan 9          
connection ) provid+ ?ird p>ty          
adm9i/ration s]vices = gr\p heal? plans1
 %all disclose1 on an annual basis n    
lat] ?an #fj days aft] ! beg9n+ ( !     

curr5t plan ye>1 to a responsible plan  
fiduci>y1 9 writ+1 ! foll[+ ) respect to
 ! twelve mon?s prec$+ ! curr5t plan    
ye>3 7aa7 ,all direct comp5sation       
describ$ 9 subclause 7,,iii7 ( clause   
7iii74  7bb7 ,all indirect comp5sation  
describ$ 9 subclause 7,,iv7 ( clause    
7iii7 receiv$ by ! cov]$ s]vice provid] 
7includ+ su* comp5sation describ$ 9     
subclause 7,,viii7 ( clause 7iii774     
7cc7 ,! aggregate am\nt = :i* ! cov]$   
s]vice provid] receiv$ indirect         
comp5sation & ! e/imat$ am\nt ( co/-%>+ 
incurr$ by plan p>ticipants &           
b5efici>ies z a result4  7dd7 ,! total  
gross sp5d+ by ! cov]$ plan on all co/s 
& fees aris+ "u or paid "u !            
adm9i/rative s]vices agreem5t ) !       
?ird-p>ty adm9i/rator 7n includ+ any    
am\nts describ$ 9 items 7aa7 ?r\gh 7cc7 
( clause 7iii77,,viii74  7ee7 ,! total  
net sp5d+ by ! cov]$ plan on all co/s & 
fees aris+ "u or paid "u ! adm9i/rative 
s]vices agreem5t ) ! cov]$ s]vice       
provid]4  7ff7 ,! aggregate fees        

collect$ by ! cov]$ s]vice provid]4     
7gg7 ,any o!r in=mation specifi$ by !   
,secret>y ?r\gh regulations or guidance 
t may be necess>y = a responsible plan  
fiduci>y to consid] ! m]its ( ! contract
 or arrangem5t ) ! cov]$ s]vice provid] 
& any conflicts ( int]e/ t may exi/4  4 
7#c7 ,?ird p>ty adm9i/ration s]vices =  
gr\p heal? plans def9$ ,clause 7ii77,i7 
( section #djh7;b77#b77;,b7 ( su* ,act  
7#bi ,u4,s4,c4 #aajh7;b77#b77;,b771 z   
am5d$ by p>agraphs 7#c7 & 7#d7 (        
subsection 7b71 is am5d$ by add+ at !   
end ! foll[+3  7ii7 ,! t]m ?ird p>ty    
adm9i/ration s]vices = gr\p heal? plans 
includes any s]vices provid$ by a cov]$ 
s]vice provid] to a cov]$ plan ) respect
 to ! adm9i/ration ( heal? b5efits "u ! 
cov]$ plan1 includ+-- 7,,aa7 ! process+1
 repric+1 & paym5t ( claims2 7,,bb7     
design1 creation1 & ma9t5ance ( provid] 
networks2 7,,cc7 negotiation ( disc\nts 
(f gross rates2 7,,dd7 b5efit & plan    
design2 negotiation ( paym5t rates2     
7,,ee7 recordkeep+2 7,,ff7 utilization  

review2 7,,gg7 adjudication ( claims2   
7,,hh7 regulatory compliance2 & 7,,ii7  
any o!r s]vices set =? 9 an adm9i/rative
 s]vices agreem5t or simil> agreem5t or 
specifi$ by ! ,secret>y ?r\gh guidance  
or rulemak+4  4  7d7 ,rule ( con/ruction
 ,no?+ 9 ! am5dm5ts made by ?is section 
%all be con/ru$ to imply t a practice 9 
relation to :i* a cov]$ s]vice provid]  
is requir$ to provide in=mation z a     
result ( su* am5dm5ts is p]missible "u  
,f$]al law4  7e7 ,effective date ,!     
am5dm5ts made by ?is section %all take  
effect on ,janu>y #a1 #bjbe4  #d4       
,implem5tation ,n lat] ?an #a ye> aft] !
 date ( enactm5t ( ?is ,act1 ! ,secret>y
 ( ,labor %all issue notice & comm5t    
rulemak+ z necess>y to implem5t !       
provisions ( ?is ,act4 ,! ,secret>y %all
 ensure t su* rulemak+-- 7#a7 acc\nts = 
! v>i$ comp5sation practices ( cov]$    
s]vice provid]s 7z def9$ "u section     
#djh7;b77#b77;,b72 &  7#b7 e/abli%es    
/&>ds = ! disclosure ( expect$          
comp5sation by su* cov]$ s]vice         

provid]s4  ,novemb] #a1 #bjbc,report$ ) 
an am5dm5t1 committ$ to ! ,committee ( !
 ,:ole ,h\se on ! ,/ate ( ! ,union1 &   
ord]$ to be pr9t$