,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #dgab  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #ah1 #bjbc,mrs4 
,h>%b>g] 7= h]self & ,ms4 ,mann+7       
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committees on ,ways &    
,means1 & ,education & ! ,work=ce1 = 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      
provide = increas$ ov]sight ( entities t
 provide ph>macy b5efit managem5t       
s]vices on behalf ( gr\p heal? plans &  
heal? insurance cov]age4  #a4 ,%ort     
title ,?is ,act may be cit$ z ! ,pati5t 
,"r to ,%op ,act4  #b4 ,prohibition on  
block+ consum] decision-support tools   
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 ,prohibition on block+    
consum] decision-support tools  7a7 ,9  

g5]al ,a gr\p heal? plan or a heal?     
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age %all n ent] into
 a contract ) an entity t provides      
ph>macy b5efit managem5t s]vices )      
respect to su* plan or cov]age if su*   
contract includes any t]ms1 conditions1 
or co/s t w\ld prev5t or re/rict a cov]$
 ?ird p>ty f access+ or us+ in=mation1 =
 purposes ( ! consum] decision-support  
tool1 relevant to ! op]ability1         
implem5tation1 & utilization ( !        
consum]-decision support tool reg>d+    
prescription drug b5efits "u ! plan or  
cov]age t are adm9i/]$ by ! entity      
provid+ ph>macy b5efit managem5t s]vices
 9 contract ) ! plan or issu]4  7b7     
,def9itions ,9 ?is section3  7#a7       
,consum] decision-support tool ,! t]m   
consum] decision-support tool means a   
tool design$ to in=m enrollees 9 a gr\p 
heal? plan or heal? insurance cov]age   
ab\t all co/s to ! enrollee =           
prescription drugs cov]$ by ! plan or   
cov]age1 includ+ out-(-pocket1 copaym5t1

 & co9surance responsibility1 z well z  
co/s to ! enrollee1 su* z pur*as+ at !  
ca% price or pur*as+ ?r\gh mail ord]    
ph>macy b5efits4  7#b7 ,cov]$ ?ird p>ty 
,! t]m cov]$ ?ird p>ty means a ?ird p>ty
 t is 9 contract1 z a bus9ess associate 
7z def9$ 9 section #afj4ajc ( title #de1
 ,code ( ,f$]al ,regulations 7or        
successor regulations771 ) a gr\p heal? 
plan or a heal? insurance issu] (f]+    
gr\p or individual heal? insurance      
cov]age to provide a consum]            
decision-support tool4  7c7 ,rules (    
con/ruction reg>d+ privacy  7#a7 ,no?+ 9
 ?is section %all be con/ru$ to alt]    
exi/+ obligations ( a cov]$ entity or   
bus9ess associate "u ! privacy1         
security1 & brea* notification          
regulations 9 p>ts #afj & #afd ( title  
#de1 ,code ( ,f$]al ,regulations 7or    
successor regulations74  7#b7 ,no?+ 9   
?is section %all be con/ru$ to require a
 gr\p heal? plan1 a heal? insurance     
issu] (f]+ gr\p or individual heal?     
insurance cov]age1 or an entity provid+ 

ph>macy b5efit managem5t s]vices to %>e 
protect$ heal? in=mation1 z def9$ 9     
section #afj4ajc ( title #de1 ,code (   
,f$]al ,regulations 7or successor       
regulations71 ) a cov]$ ?ird p>ty4  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[+
 new section3  #gbf4 ,prohibition on    
block+ consum] decision-support tools   
7a7 ,9 g5]al ,a gr\p heal? plan or a    
heal? insurance issu] (f]+ gr\p heal?   
insurance cov]age %all n ent] into a    
contract ) an entity t provides ph>macy 
b5efit managem5t s]vices ) respect to   
su* plan or cov]age if su* contract     
includes any t]ms1 conditions1 or co/s t
 w\ld prev5t or re/rict a cov]$ ?ird    
p>ty f access+ or us+ in=mation1 =      
purposes ( ! consum] decision-support   
tool1 relevant to ! op]ability1         
implem5tation1 & utilization ( !        
consum]-decision support tool reg>d+    

prescription drug b5efits "u ! plan or  
cov]age t are adm9i/]$ by ! entity      
provid+ ph>macy b5efit managem5t s]vices
 9 contract ) ! plan or issu]4  7b7     
,def9itions ,9 ?is section3 7#a7        
,consum] decision-support tool ,! t]m   
consum] decision-support tool means a   
tool design$ to in=m p>ticipants &      
b5efici>ies 9 a gr\p heal? plan or heal?
 insurance cov]age ab\t all co/s to !   
p>ticipant or b5efici>y = prescription  
drugs cov]$ by ! plan or cov]age1       
includ+ out-(-pocket1 copaym5t1 &       
co9surance responsibility1 z well z co/s
 to ! p>ticipant or b5efici>y1 su* z    
pur*as+ at ! ca% price or pur*as+ ?r\gh 
mail ord] ph>macy b5efits4  7#b7 ,cov]$ 
?ird p>ty ,! t]m cov]$ ?ird p>ty means a
 ?ird p>ty t is 9 contract1 z a bus9ess 
associate 7z def9$ 9 section #afj4ajc ( 
title #de1 ,code ( ,f$]al ,regulations  
7or successor regulations771 ) a gr\p   
heal? plan or a heal? insurance issu]   
(f]+ gr\p heal? insurance cov]age to    
provide a consum] decision-support tool4

  7c7 ,rules ( con/ruction  7#a7 ,no?+ 9
 ?is section %all be con/ru$ to alt]    
exi/+ obligations ( a cov]$ entity or   
bus9ess associate "u ! privacy1         
security1 & brea* notification          
regulations 9 p>ts #afj & #afd ( title  
#de1 ,code ( ,f$]al ,regulations 7or    
successor regulations74  7#b7 ,no?+ 9   
?is section %all be con/ru$ to require a
 gr\p heal? plan1 a heal? insurance     
issu] (f]+ gr\p heal? insurance cov]age1
 or an entity provid+ ph>macy b5efit    
managem5t s]vices to %>e protect$ heal? 
in=mation1 z def9$ 9 section #afj4ajc ( 
title #de1 ,code ( ,f$]al ,regulations  
7or successor regulations71 ) a cov]$   
?ird p>ty4  4  7#b7 ,cl]ical am5dm5t ,! 
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 
#gbf4 ,prohibition on block+ consum]    
decision-support tools4  4  7c7 ,int]nal
 ,rev5ue ,code  7#a7 ,9 g5]al ,sub*apt] 

,b ( *apt] #ajj ( ! ,int]nal ,rev5ue    
,code ( #aihf1 z am5d$ by section #b1 is
 fur!r am5d$ by add+ at ! end ! foll[+  
new section3  #ihbf4 ,prohibition on    
block+ consum] decision-support tools   
7a7 ,9 g5]al ,a gr\p heal? plan (f]+    
gr\p heal? insurance cov]age %all n ent]
 into a contract ) an entity t provides 
ph>macy b5efit managem5t s]vices )      
respect to su* plan if su* contract     
includes any t]ms1 conditions1 or co/s t
 w\ld prev5t or re/rict a cov]$ ?ird    
p>ty f access+ or us+ in=mation1 =      
purposes ( ! consum] decision-support   
tool1 relevant to ! op]ability1         
implem5tation1 & utilization ( !        
consum]-decision support tool reg>d+    
prescription drug b5efits "u ! plan t   
are adm9i/]$ by ! entity provid+ ph>macy
 b5efit managem5t s]vices 9 contract ) !
 plan4  7b7 ,def9itions ,9 ?is section3 
7#a7 ,consum] decision-support tool ,!  
t]m consum] decision-support tool means 
a tool design$ to in=m p>ticipants &    
b5efici>ies 9 a gr\p heal? plan ab\t all

 co/s to ! p>ticipant or b5efici>y =    
prescription drugs cov]$ by ! plan1     
includ+ out-(-pocket1 copaym5t1 &       
co9surance responsibility1 z well z co/s
 to ! p>ticipant or b5efici>y1 su* z    
pur*as+ at ! ca% price or pur*as+ ?r\gh 
mail ord] ph>macy b5efits4  7#b7 ,cov]$ 
?ird p>ty ,! t]m cov]$ ?ird p>ty means a
 ?ird p>ty t is 9 contract1 z a bus9ess 
associate 7z def9$ 9 section #afj4ajc ( 
title #de1 ,code ( ,f$]al ,regulations  
7or successor regulations771 ) a gr\p   
heal? plan or a heal? insurance issu]   
(f]+ gr\p heal? insurance cov]age to    
provide a consum] decision-support tool4
  7c7 ,rules ( con/ruction  7#a7 ,no?+ 9
 ?is section %all be con/ru$ to alt]    
exi/+ obligations ( a cov]$ entity or   
bus9ess associate "u ! privacy1         
security1 & brea* notification          
regulations 9 p>ts #afj & #afd ( title  
#de1 ,code ( ,f$]al ,regulations 7or    
successor regulations74  7#b7 ,no?+ 9   
?is section %all be con/ru$ to require a
 gr\p heal? plan or an entity provid+   

ph>macy b5efit managem5t s]vices to %>e 
protect$ heal? in=mation1 z def9$ 9     
section #afj4ajc ( title #de1 ,code (   
,f$]al ,regulations 7or successor       
regulations71 ) a cov]$ ?ird p>ty4  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          
,prohibition on block+ consum]          
decision-support tools4  4  7d7         
,application ,! am5dm5ts made by        
subsections 7a71 7b71 & 7c7 %all apply )
 respect to plan ye>s beg9n+ on or aft] 
! date t is #b ye>s aft] ! date (       
enactm5t ( ?is ,act4  7e7 ,regulations  
,! ,secret>y ( ,heal? & ,human ,s]vices1
 ! ,secret>y ( ,labor1 & ! ,secret>y ( !
 ,treasury %all jo9tly promulgate       
regulations to c>ry out ! am5dm5ts made 
by subsections 7a71 7b71 & 7c71 & %all  
issue draft regulations n lat] ?an #a   
ye> aft] ! date ( enactm5t ( ?is ,act4