,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #dhdf  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #be1 #bjbc,mr4  
,arr+ton 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 am5d ! ,int]nal ,rev5ue    
,code ( #aihf1 title ,,xxvii ( ! ,public
 ,heal? ,s]vice ,act1 & ! ,employee     
,retirem5t ,income ,security ,act (     
#aigd to provide = ov]sight ( ph>macy   
b5efit manag] s]vices4  #a4 ,%ort title 
,?is ,act may be cit$ z ! ,bett] ,deals 
& ,l[] ,prices ,act4  #b4 ,ov]sight (   
ph>macy b5efits manag] s]vices  7a7     
,,irc  7#a7 ,9 g5]al ,sub*apt] ,b (     
*apt] #ajj ( ! ,int]nal ,rev5ue ,code ( 
#aihf is am5d$ by add+ at ! end !       
foll[+3  #ihbf4 ,ov]sight ( ph>macy     
b5efits manag] s]vices  7a7 ,9 g5]al ,= 

plan ye>s beg9n+ on or aft] ! date t is 
#c ye>s aft] ! date ( enactm5t ( ?is    
section1 a gr\p heal? plan1 or an entity
 or subsidi>y provid+ ph>macy b5efits   
managem5t s]vices on behalf ( su* a     
plan1 %all n ent] into a contract ) a   
drug manufactur]1 di/ributor1 :olesal]1 
subcontractor1 rebate aggregator1 or any
 associat$ ?ird p>ty t limits !         
disclosure ( in=mation to plan sponsors 
9 su* a mann] t prev5ts ! plan1 or an   
entity or subsidi>y provid+ ph>macy     
b5efits managem5t s]vices on behalf ( a 
plan1 f mak+ ! report describ$ 9        
subsection 7b74  7b7 ,annual report     
7#a7 ,9 g5]al ,) respect to plan ye>s   
beg9n+ on or aft] ! date t is #c ye>s   
aft] ! date ( enactm5t ( ?is section1 = 
ea* su* plan ye>1 a gr\p heal? plan1 or 
an entity provid+ ph>macy b5efits       
managem5t s]vices on behalf ( su* a     
plan1 %all submit to ! plan sponsor 7z  
def9$ 9 section #c7af77;,b7 ( !         
,employee ,retirem5t ,income ,security  
,act ( #aigd7 ( su* plan a report 9 a   

ma*9e-readable =mat4 ,ea* su* report    
%all include1 ) respect to su* plan     
provid$ = su* plan ye>-- 7,a7 to ! ext5t
 feasible1 in=mation collect$ f drug    
manufactur]s 7or an entity adm9i/]+     
copay assi/ance on behalf ( su*         
manufactur]s7 by su* plan on ! total    
am\nt ( copaym5t assi/ance doll>s paid1 
or copaym5t c>ds appli$1 t 7 fund$ by ! 
drug manufactur] ) respect to !         
p>ticipants & b5efici>ies 9 su* plan2   
7,b7 a li/ ( ea* drug cov]$ by su* plan 
t 0 disp5s$ dur+ ! plan ye>1 includ+1 ) 
respect to ea* su* drug dur+ su* plan   
ye>-- 7i7 ! br& "n1 *emical entity1 &   
,national ,drug ,code2  7ii7 ! numb] (  
p>ticipants & b5efici>ies = :om ! drug 0
 disp5s$ dur+ ! plan ye>1 ! total numb] 
( prescription claims = ! drug 7includ+ 
orig9al prescriptions & refills71 & !   
total numb] ( dosage units ( ! drug     
disp5s$ across ! plan ye>1 disaggregat$ 
by disp5s+ *annel 7su* z retail1 mail   
ord]1 or specialty ph>macy72  7iii7 !   
:olesale acquisition co/1 li/$ z co/ p] 

days supply & co/ p] pill1 or 9 ! case (
 a drug 9 ano!r =m1 p] dosage unit2     
7iv7 ! total out-(-pocket sp5d+ by      
p>ticipants & b5efici>ies on su* drug1  
includ+ p>ticipant & b5efici>y sp5d+    
?r\gh copaym5ts1 co9surance1 &          
d$uctibles2  7v7 = any drug = :i* gross 
sp5d+ ( ! gr\p heal? plan exce$$ #aj1jjj
 dur+ ! plan ye>-- 7,i7 a li/ ( all o!r 
drugs 9 ! same !rapeutic category or    
class1 includ+ br& "n drugs & biological
 products & g5]ic drugs or biosimil>    
biological products t are 9 ! same      
!rapeutic category or class z su* drug2 
&  7,,ii7 ! rationale = ! =mul>y        
placem5t ( su* drug 9 t !rapeutic       
category or class1 if applicable2  7vi7 
! am\nt receiv$1 or expect$ to be       
receiv$1 f drug manufactur]s 9 rebates1 
fees1 alt]native disc\nts1 or o!r       
remun]ation = claims incurr$ = su* drug 
dur+ ! plan ye>2  7vii7 ! total net     
sp5d+1 aft] d$uct+ rebates1 price       
concessions1 alt]native disc\nts or o!r 
remun]ation f drug manufactur]s1 by !   

heal? plan on su* drug2 &  7viii7 ! net 
price p] c\rse ( treatm5t or s+le fill1 
su* z a #cj-;day supply or #ij-;day     
supply1 incurr$ by ! heal? plan & its   
p>ticipants & b5efici>ies aft]          
manufactur] rebates1 fees1 & o!r        
remun]ation = su* drug disp5s$ dur+ !   
plan ye>2  7,c7 a li/ ( ea* !rapeutic   
category or class ( drugs t 7 disp5s$ "u
 ! heal? plan dur+ ! plan ye>1 &1 )     
respect to ea* su* !rapeutic category or
 class ( drugs1 dur+ ! plan ye>-- 7i7   
total gross sp5d+ by ! plan1 be=e       
manufactur] rebates1 fees1 or o!r       
manufactur] remun]ation2  7ii7 ! numb] (
 p>ticipants & b5efici>ies :o 7 disp5s$ 
a drug cov]$ by su* plan 9 t category or
 class1 brok5 d[n by ea* su* drug       
7id5tifi$ by ,national ,drug ,code72    
7iii7 if applicable to t category or    
class1 a description ( ! =mul>y ti]s &  
utilization managem5t 7su* z prior      
au?orization or /ep !rapy7 employ$ =    
drugs 9 t category or class2 &  7iv7 !  
total out-(-pocket sp5d+ by p>ticipants 

& b5efici>ies1 includ+ p>ticipant &     
b5efici>y sp5d+ ?r\gh copaym5ts1        
co9surance1 & d$uctibles2  7,d7 total   
gross sp5d+ on prescription drugs by !  
plan dur+ ! plan ye>1 be=e rebates & o!r
 manufactur] fees or remun]ation2  7,e7 
total am\nt receiv$1 or expect$ to be   
receiv$1 by ! heal? plan 9 drug         
manufactur] rebates1 fees1 alt]native   
disc\nts1 & all o!r remun]ation receiv$ 
f ! manufactur] or any ?ird p>ty1 o!r   
?an ! plan sponsor1 relat$ to           
utilization ( drug or drug sp5d+ "u t   
heal? plan dur+ ! plan ye>2  7,f7 !     
total net sp5d+ on prescription drugs by
 ! heal? plan dur+ ! plan ye>2 &  7,g7  
am\nts paid directly or indirectly 9    
rebates1 fees1 or any o!r type (        
remun]ation to brok]s1 consultants1     
advisors1 or any o!r individual or firm 
= ! ref]ral ( ! gr\p heal? plan's       
bus9ess to ! ph>macy b5efits manag]4    
7#b7 ,privacy requirem5ts ,entities     
provid+ ph>macy b5efits managem5t       
s]vices on behalf ( a gr\p heal? plan   

%all provide in=mation "u p>agraph 7#a7 
9 a mann] consi/5t ) ! privacy1         
security1 & brea* notification          
regulations promulgat$ "u section       
#bfd7;c7 ( ! ,heal? ,insurance          
,portability & ,acc\ntability ,act (    
#aiif1 & %all re/rict ! use & disclosure
 ( su* in=mation accord+ to su* privacy 
regulations4  7#c7 ,disclosure &        
r$isclosure  7,a7 ,limitation to bus9ess
 associates ,a gr\p heal? plan receiv+ a
 report "u p>agraph 7#a7 may disclose   
su* in=mation only to bus9ess associates
 ( su* plan z def9$ 9 section #afj4ajc (
 title #de1 ,code ( ,f$]al ,regulations 
7or successor regulations74  7,b7       
,cl>ification reg>d+ public disclosure (
 in=mation ,no?+ 9 ?is section prev5ts  
an entity provid+ ph>macy b5efits       
managem5t s]vices on behalf ( a gr\p    
heal? plan f plac+ reasonable           
re/rictions on ! public disclosure ( !  
in=mation conta9$ 9 a report describ$ 9 
p>agraph 7#a71 except t su* entity may n
 re/rict disclosure ( su* report to !   

,dep>tm5t ( ,heal? & ,human ,s]vices1 ! 
,dep>tm5t ( ,labor1 ! ,dep>tm5t ( !     
,treasury1 ! ,comptroll] ,g5]al ( !     
,unit$ ,/ates1 or applicable ,/ate      
ag5cies4  7,c7 ,limit$ =m ( report ,!   
,secret>y %all def9e ?r\gh rulemak+ a   
limit$ =m ( ! report "u p>agraph 7#a7   
requir$ ( plan sponsors :o are drug     
manufactur]s1 drug :olesal]s1 or o!r    
direct p>ticipants 9 ! drug supply *a91 
9 ord] to prev5t anti-competitive       
behavior4  7#d7 ,report to ,,gao ,a gr\p
 heal? plan1 or an entity provid+       
ph>macy b5efits managem5t s]vices on    
behalf ( a gr\p heal? plan1 %all submit 
to ! ,comptroll] ,g5]al ( ! ,unit$      
,/ates ea* ( ! fir/ #d reports submitt$ 
to a plan sponsor "u p>agraph 7#a7 )    
respect to su* plan1 & o!r su* reports z
 reque/$1 9 accordance ) ! privacy      
requirem5ts "u p>agraph 7#b71 !         
disclosure & r$isclosure /&>ds "u       
p>agraph 7#c71 ! /&>ds specifi$ pursuant
 to p>agraph 7#e71 & su* o!r in=mation t
 ! ,comptroll] ,g5]al det]m9es necess>y 

to c>ry out ! /udy "u section #b7;d7 ( !
 ,bett] ,deals & ,l[] ,prices ,act4     
7#e7 ,/&>d =mat ,n lat] ?an #ah mon?s   
aft] ! date ( enactm5t ( ?is section1 ! 
,secret>y %all specify ?r\gh rulemak+   
/&>ds = entities requir$ to submit      
reports "u p>agraph 7#d7 to submit su*  
reports 9 a /&>d =mat4  7c7 ,rule (     
con/ruction ,no?+ 9 ?is section %all be 
con/ru$ to p]mit a gr\p heal? plan or   
o!r entity to re/rict disclosure to1 or 
o!rwise limit ! access (1 ! ,secret>y ( 
! ,treasury to a report describ$ 9      
subsection 7b77#a7 or in=mation relat$  
to compliance ) subsection 7a7 or 7b7 by
 su* plan or o!r entity subject to su*  
subsections4  7d7 ,def9ition ,9 ?is     
section1 ! t]m :olesale acquisition co/ 
has ! mean+ giv5 su* t]m 9 section      
#ahdg;,a7c77#f77;,b7 ( ! ,social        
,security ,act4  4  7#b7 ,cl]ical       
am5dm5t ,! table ( sections = sub*apt]  
,b ( *apt] #ajj ( ! ,int]nal ,rev5ue    
,code ( #aihf is am5d$ by add+ at ! end 
! foll[+ new item3  ,sec4 #ihbf4        

,ov]sight ( ph>macy b5efits manag]      
s]vices4  4  7b7 ,,phsa ,title ,,xxvii (
 ! ,public ,heal? ,s]vice ,act 7#db     
,u4,s4,c4 #cjj;gg et seq47 is am5d$--   
7#a7 9 "p ,d 7#db ,u4,s4,c4 #cjj;gg-#aaa
 et seq471 by add+ at ! end ! foll[+ new
 section3  #bgii;,a-#aa4 ,ov]sight (    
ph>macy b5efits manag] s]vices  7a7 ,9  
g5]al ,= plan ye>s beg9n+ on or aft] !  
date t is #c ye>s aft] ! date ( enactm5t
 ( ?is section1 a gr\p heal? plan or    
heal? insurance issu] (f]+ gr\p heal?   
insurance cov]age1 or an entity or      
subsidi>y provid+ ph>macy b5efits       
managem5t s]vices on behalf ( su* a plan
 or issu]1 %all n ent] into a contract )
 a drug manufactur]1 di/ributor1        
:olesal]1 subcontractor1 rebate         
aggregator1 or any associat$ ?ird p>ty t
 limits ! disclosure ( in=mation to plan
 sponsors 9 su* a mann] t prev5ts ! plan
 or issu]1 or an entity or subsidi>y    
provid+ ph>macy b5efits managem5t       
s]vices on behalf ( a plan or issu]1 f  
mak+ ! report describ$ 9 subsection 7b74

  7b7 ,annual report  7#a7 ,9 g5]al ,)  
respect to plan ye>s beg9n+ on or aft] !
 date t is #c ye>s aft] ! date (        
enactm5t ( ?is section1 = ea* su* plan  
ye>1 a gr\p heal? plan or heal?         
insurance issu] (f]+ gr\p heal?         
insurance cov]age1 or an entity provid+ 
ph>macy b5efits managem5t s]vices on    
behalf ( su* a plan or an issu]1 %all   
submit to ! plan sponsor 7z def9$ 9     
section #c7af77;,b7 ( ! ,employee       
,retirem5t ,income ,security ,act (     
#aigd7 ( su* plan or cov]age a report 9 
a ma*9e-readable =mat4 ,ea* su* report  
%all include1 ) respect to su* plan or  
cov]age provid$ = su* plan ye>-- 7,a7 to
 ! ext5t feasible1 in=mation collect$ f 
drug manufactur]s 7or an entity adm9i/]+
 copay assi/ance on behalf ( su*        
manufactur]s7 by su* plan or issu] on ! 
total am\nt ( copaym5t assi/ance doll>s 
paid1 or copaym5t c>ds appli$1 t 7 fund$
 by ! drug manufactur] ) respect to !   
p>ticipants1 b5efici>ies1 & enrollees 9 
su* plan or cov]age2  7,b7 a li/ ( ea*  

drug cov]$ by su* plan or cov]age t 0   
disp5s$ dur+ ! plan ye>1 includ+1 )     
respect to ea* su* drug dur+ su* plan   
ye>-- 7i7 ! br& "n1 *emical entity1 &   
,national ,drug ,code2  7ii7 ! numb] (  
p>ticipants1 b5efici>ies1 & enrollees = 
:om ! drug 0 disp5s$ dur+ ! plan ye>1 ! 
total numb] ( prescription claims = !   
drug 7includ+ orig9al prescriptions &   
refills71 & ! total numb] ( dosage units
 ( ! drug disp5s$ across ! plan ye>1    
disaggregat$ by disp5s+ *annel 7su* z   
retail1 mail ord]1 or specialty         
ph>macy72  7iii7 ! :olesale acquisition 
co/1 li/$ z co/ p] days supply & co/ p] 
pill1 or 9 ! case ( a drug 9 ano!r =m1  
p] dosage unit2  7iv7 ! total           
out-(-pocket sp5d+ by p>ticipants1      
b5efici>ies1 & enrollees on su* drug1   
includ+ p>ticipant1 b5efici>y1 &        
enrollee sp5d+ ?r\gh copaym5ts1         
co9surance1 & d$uctibles2  7v7 = any    
drug = :i* gross sp5d+ ( ! gr\p heal?   
plan or heal? insurance cov]age exce$$  
#aj1jjj dur+ ! plan ye>-- 7,i7 a li/ (  

all o!r drugs 9 ! same !rapeutic        
category or class1 includ+ br& "n drugs 
& biological products & g5]ic drugs or  
biosimil> biological products t are 9 ! 
same !rapeutic category or class z su*  
drug2 &  7,,ii7 ! rationale = ! =mul>y  
placem5t ( su* drug 9 t !rapeutic       
category or class1 if applicable2  7vi7 
! am\nt receiv$1 or expect$ to be       
receiv$1 f drug manufactur]s 9 rebates1 
fees1 alt]native disc\nts1 or o!r       
remun]ation = claims incurr$ = su* drug 
dur+ ! plan ye>2  7vii7 ! total net     
sp5d+1 aft] d$uct+ rebates1 price       
concessions1 alt]native disc\nts or o!r 
remun]ation f drug manufactur]s1 by !   
heal? plan or heal? insurance cov]age on
 su* drug2 &  7viii7 ! net price p]     
c\rse ( treatm5t or s+le fill1 su* z a  
#cj-;day supply or #ij-;day supply1     
incurr$ by ! heal? plan or heal?        
insurance cov]age & its p>ticipants1    
b5efici>ies1 & enrollees1 aft]          
manufactur] rebates1 fees1 & o!r        
remun]ation = su* drug disp5s$ dur+ !   

plan ye>2  7,c7 a li/ ( ea* !rapeutic   
category or class ( drugs t 7 disp5s$ "u
 ! heal? plan or heal? insurance cov]age
 dur+ ! plan ye>1 &1 ) respect to ea*   
su* !rapeutic category or class ( drugs1
 dur+ ! plan ye>-- 7i7 total gross sp5d+
 by ! plan or cov]age1 be=e manufactur] 
rebates1 fees1 or o!r manufactur]       
remun]ation2  7ii7 ! numb] (            
p>ticipants1 b5efici>ies1 & enrollees :o
 7 disp5s$ a drug cov]$ by su* plan or  
cov]age 9 t category or class1 brok5 d[n
 by ea* su* drug 7id5tifi$ by ,national 
,drug ,code72  7iii7 if applicable to t 
category or class1 a description ( !    
=mul>y ti]s & utilization managem5t 7su*
 z prior au?orization or /ep !rapy7     
employ$ = drugs 9 t category or class2 &
  7iv7 ! total out-(-pocket sp5d+ by    
p>ticipants1 b5efici>ies1 & enrollees1  
includ+ p>ticipant1 b5efici>y1 &        
enrollee sp5d+ ?r\gh copaym5ts1         
co9surance1 & d$uctibles2  7,d7 total   
gross sp5d+ on prescription drugs by !  
plan or cov]age dur+ ! plan ye>1 be=e   

rebates & o!r manufactur] fees or       
remun]ation2  7,e7 total am\nt receiv$1 
or expect$ to be receiv$1 by ! heal?    
plan or heal? insurance cov]age 9 drug  
manufactur] rebates1 fees1 alt]native   
disc\nts1 & all o!r remun]ation receiv$ 
f ! manufactur] or any ?ird p>ty1 o!r   
?an ! plan sponsor1 relat$ to           
utilization ( drug or drug sp5d+ "u t   
heal? plan or heal? insurance cov]age   
dur+ ! plan ye>2  7,f7 ! total net sp5d+
 on prescription drugs by ! heal? plan  
or heal? insurance cov]age dur+ ! plan  
ye>2 &  7,g7 am\nts paid directly or    
indirectly 9 rebates1 fees1 or any o!r  
type ( remun]ation to brok]s1           
consultants1 advisors1 or any o!r       
individual or firm = ! ref]ral ( ! gr\p 
heal? plan's or heal? insurance issu]'s 
bus9ess to ! ph>macy b5efits manag]4    
7#b7 ,privacy requirem5ts ,heal?        
insurance issu]s (f]+ gr\p heal?        
insurance cov]age & entities provid+    
ph>macy b5efits managem5t s]vices on    
behalf ( a gr\p heal? plan %all provide 

in=mation "u p>agraph 7#a7 9 a mann]    
consi/5t ) ! privacy1 security1 & brea* 
notification regulations promulgat$ "u  
section #bfd7;c7 ( ! ,heal? ,insurance  
,portability & ,acc\ntability ,act (    
#aiif1 & %all re/rict ! use & disclosure
 ( su* in=mation accord+ to su* privacy 
regulations4  7#c7 ,disclosure &        
r$isclosure  7,a7 ,limitation to bus9ess
 associates ,a gr\p heal? plan receiv+ a
 report "u p>agraph 7#a7 may disclose   
su* in=mation only to bus9ess associates
 ( su* plan z def9$ 9 section #afj4ajc (
 title #de1 ,code ( ,f$]al ,regulations 
7or successor regulations74  7,b7       
,cl>ification reg>d+ public disclosure (
 in=mation ,no?+ 9 ?is section prev5ts a
 heal? insurance issu] (f]+ gr\p heal?  
insurance cov]age or an entity provid+  
ph>macy b5efits managem5t s]vices on    
behalf ( a gr\p heal? plan f plac+      
reasonable re/rictions on ! public      
disclosure ( ! in=mation conta9$ 9 a    
report describ$ 9 p>agraph 7#a71 except 
t su* issu] or entity may n re/rict     

disclosure ( su* report to ! ,dep>tm5t (
 ,heal? & ,human ,s]vices1 ! ,dep>tm5t (
 ,labor1 ! ,dep>tm5t ( ! ,treasury1 !   
,comptroll] ,g5]al ( ! ,unit$ ,/ates1 or
 applicable ,/ate ag5cies4  7,c7 ,limit$
 =m ( report ,! ,secret>y %all def9e    
?r\gh rulemak+ a limit$ =m ( ! report "u
 p>agraph 7#a7 requir$ ( plan sponsors  
:o are drug manufactur]s1 drug          
:olesal]s1 or o!r direct p>ticipants 9 !
 drug supply *a91 9 ord] to prev5t      
anti-competitive behavior4  7#d7 ,report
 to ,,gao ,a gr\p heal? plan or heal?   
insurance issu] (f]+ gr\p heal?         
insurance cov]age1 or an entity provid+ 
ph>macy b5efits managem5t s]vices on    
behalf ( a gr\p heal? plan %all submit  
to ! ,comptroll] ,g5]al ( ! ,unit$      
,/ates ea* ( ! fir/ #d reports submitt$ 
to a plan sponsor "u p>agraph 7#a7 )    
respect to su* cov]age or plan1 & o!r   
su* reports z reque/$1 9 accordance ) ! 
privacy requirem5ts "u p>agraph 7#b71 ! 
disclosure & r$isclosure /&>ds "u       
p>agraph 7#c71 ! /&>ds specifi$ pursuant

 to p>agraph 7#e71 & su* o!r in=mation t
 ! ,comptroll] ,g5]al det]m9es necess>y 
to c>ry out ! /udy "u section #b7;d7 ( !
 ,bett] ,deals & ,l[] ,prices ,act4     
7#e7 ,/&>d =mat ,n lat] ?an #ah mon?s   
aft] ! date ( enactm5t ( ?is section1 ! 
,secret>y %all specify ?r\gh rulemak+   
/&>ds = heal? insurance issu]s &        
entities requir$ to submit reports "u   
p>agraph 7#d7 to submit su* reports 9 a 
/&>d =mat4  7c7 ,en=cem5t  7#a7 ,9 g5]al
 ,not)/&+ section #bgbc1 ! ,secret>y1 9 
consultation ) ! ,secret>y ( ,labor & ! 
,secret>y ( ! ,treasury1 %all en=ce ?is 
section4  7#b7 ,failure to provide      
timely in=mation ,a heal? insurance     
issu] or an entity provid+ ph>macy      
b5efits managem5t s]vices t violates    
subsection 7a7 or fails to provide      
in=mation requir$ "u subsection 7b7 %all
 be subject to a civil monet>y p5alty 9 
! am\nt ( #aj1jjj = ea* day dur+ :i* su*
 violation cont9ues or su* in=mation is 
n disclos$ or report$4  7#c7 ,false     
in=mation ,a heal? insurance issu] or   

entity provid+ ph>macy b5efits managem5t
 s]vices t kn[+ly provides false        
in=mation "u ?is section %all be subject
 to a civil money p5alty 9 an am\nt n to
 exce$ #ajj1jjj = ea* item ( false      
in=mation4 ,su* civil money p5alty %all 
be 9 addition to o!r p5alties z may be  
prescrib$ by law4  7#d7 ,proc$ure ,!    
provisions ( section #aabh;,a ( !       
,social ,security ,act1 o!r ?an         
subsection 7a7 & 7b7 & ! fir/ s5t5ce (  
subsection 7c77#a7 ( su* section %all   
apply to civil monet>y p5alties "u ?is  
subsection 9 ! same mann] z su*         
provisions apply to a p5alty or proce$+ 
"u section #aabh;,a ( ! ,social         
,security ,act4  7#e7 ,waiv]s ,!        
,secret>y may waive p5alties "u p>agraph
 7#b71 or ext5d ! p]iod ( "t =          
compliance ) a requirem5t ( ?is section1
 = an entity 9 violation ( ?is section t
 has made a good-fai? ef=t to comply )  
?is section4  7d7 ,rule ( con/ruction   
,no?+ 9 ?is section %all be con/ru$ to  
p]mit a heal? insurance issu]1 gr\p     

heal? plan1 or o!r entity to re/rict    
disclosure to1 or o!rwise limit ! access
 (1 ! ,secret>y ( ,heal? & ,human       
,s]vices to a report describ$ 9         
subsection 7b77#a7 or in=mation relat$  
to compliance ) subsection 7a7 or 7b7 by
 su* issu]1 plan1 or o!r entity subject 
to su* subsections4  7e7 ,def9ition ,9  
?is section1 ! t]m :olesale acquisition 
co/ has ! mean+ giv5 su* t]m 9 section  
#ahdg;,a7c77#f77;,b7 ( ! ,social        
,security ,act4  2 &  7#b7 9 section    
#bgbc 7#db ,u4,s4,c4 #cjj;gg-#bb7-- 7,a7
 9 subsection 7a7-- 7i7 9 p>agraph 7#a71
 by ins]t+ 7o!r ?an subsections 7a7 &   
7b7 ( section #bgii;,a-#aa7 aft] "p ,d2 
&  7ii7 9 p>agraph 7#b71 by ins]t+ 7o!r 
?an subsections 7a7 & 7b7 ( section     
#bgii;,a-#aa7 aft] "p ,d2 &  7,b7 9     
subsection 7b7-- 7i7 9 p>agraph 7#a71 by
 ins]t+ 7o!r ?an subsections 7a7 & 7b7 (
 section #bgii;,a-#aa7 aft] "p ,d2  7ii7
 9 p>agraph 7#b77;,a71 by ins]t+ 7o!r   
?an subsections 7a7 & 7b7 ( section     
#bgii;,a-#aa7 aft] "p ,d2 &  7iii7 9    

p>agraph 7#b77;,c77ii71 by ins]t+ 7o!r  
?an subsections 7a7 & 7b7 ( section     
#bgii;,a-#aa7 aft] "p ,d4  7c7 ,,erisa  
7#a7 ,9 g5]al ,subtitle ,b ( title ,i ( 
! ,employee ,retirem5t ,income ,security
 ,act ( #aigd 7#bi ,u4,s4,c4 #ajba et   
seq47 is am5d$-- 7,a7 9 subp>t ,b ( "p  
#g 7#bi ,u4,s4,c4 #aahe et seq471 by    
add+ at ! end ! foll[+3  #gbf4 ,ov]sight
 ( ph>macy b5efits manag] s]vices  7a7  
,9 g5]al ,= plan ye>s beg9n+ on or aft] 
! date t is #c ye>s aft] ! date (       
enactm5t ( ?is section1 a gr\p heal?    
plan or heal? insurance issu] (f]+ gr\p 
heal? insurance cov]age1 or an entity or
 subsidi>y provid+ ph>macy b5efits      
managem5t s]vices on behalf ( su* a plan
 or issu]1 %all n ent] into a contract )
 a drug manufactur]1 di/ributor1        
:olesal]1 subcontractor1 rebate         
aggregator1 or any associat$ ?ird p>ty t
 limits ! disclosure ( in=mation to plan
 sponsors 9 su* a mann] t prev5ts ! plan
 or issu]1 or an entity or subsidi>y    
provid+ ph>macy b5efits managem5t       

s]vices on behalf ( a plan or issu]1 f  
mak+ ! report describ$ 9 subsection 7b74
  7b7 ,annual report  7#a7 ,9 g5]al ,)  
respect to plan ye>s beg9n+ on or aft] !
 date t is #c ye>s aft] ! date (        
enactm5t ( ?is section1 = ea* su* plan  
ye>1 a gr\p heal? plan or heal?         
insurance issu] (f]+ gr\p heal?         
insurance cov]age1 or an entity provid+ 
ph>macy b5efits managem5t s]vices on    
behalf ( su* a plan or an issu]1 %all   
submit to ! plan sponsor 7z def9$ 9     
section #c7af77;,b77 ( su* plan or      
cov]age a report 9 a ma*9e-readable     
=mat4 ,ea* su* report %all include1 )   
respect to su* plan or cov]age provid$ =
 su* plan ye>-- 7,a7 to ! ext5t         
feasible1 in=mation collect$ f drug     
manufactur]s 7or an entity adm9i/]+     
copay assi/ance on behalf ( su*         
manufactur]s7 by su* plan or issu] on ! 
total am\nt ( copaym5t assi/ance doll>s 
paid1 or copaym5t c>ds appli$1 t 7 fund$
 by ! drug manufactur] ) respect to !   
p>ticipants1 b5efici>ies1 & enrollees 9 

su* plan or cov]age2  7,b7 a li/ ( ea*  
drug cov]$ by su* plan or cov]age t 0   
disp5s$ dur+ ! plan ye>1 includ+1 )     
respect to ea* su* drug dur+ su* plan   
ye>-- 7i7 ! br& "n1 *emical entity1 &   
,national ,drug ,code2  7ii7 ! numb] (  
p>ticipants1 b5efici>ies1 & enrollees = 
:om ! drug 0 disp5s$ dur+ ! plan ye>1 ! 
total numb] ( prescription claims = !   
drug 7includ+ orig9al prescriptions &   
refills71 & ! total numb] ( dosage units
 ( ! drug disp5s$ across ! plan ye>1    
disaggregat$ by disp5s+ *annel 7su* z   
retail1 mail ord]1 or specialty         
ph>macy72  7iii7 ! :olesale acquisition 
co/1 li/$ z co/ p] days supply & co/ p] 
pill1 or 9 ! case ( a drug 9 ano!r =m1  
p] dosage unit2  7iv7 ! total           
out-(-pocket sp5d+ by p>ticipants1      
b5efici>ies1 & enrollees on su* drug1   
includ+ p>ticipant1 b5efici>y1 &        
enrollee sp5d+ ?r\gh copaym5ts1         
co9surance1 & d$uctibles2  7v7 = any    
drug = :i* gross sp5d+ ( ! gr\p heal?   
plan or heal? insurance cov]age exce$$  

#aj1jjj dur+ ! plan ye>-- 7,i7 a li/ (  
all o!r drugs 9 ! same !rapeutic        
category or class1 includ+ br& "n drugs 
& biological products & g5]ic drugs or  
biosimil> biological products t are 9 ! 
same !rapeutic category or class z su*  
drug2 &  7,,ii7 ! rationale = ! =mul>y  
placem5t ( su* drug 9 t !rapeutic       
category or class1 if applicable2  7vi7 
! am\nt receiv$1 or expect$ to be       
receiv$1 f drug manufactur]s 9 rebates1 
fees1 alt]native disc\nts1 or o!r       
remun]ation = claims incurr$ = su* drug 
dur+ ! plan ye>2  7vii7 ! total net     
sp5d+1 aft] d$uct+ rebates1 price       
concessions1 alt]native disc\nts or o!r 
remun]ation f drug manufactur]s1 by !   
heal? plan or heal? insurance cov]age on
 su* drug2 &  7viii7 ! net price p]     
c\rse ( treatm5t or s+le fill1 su* z a  
#cj-;day supply or #ij-;day supply1     
incurr$ by ! heal? plan or heal?        
insurance cov]age & its p>ticipants1    
b5efici>ies1 & enrollees1 aft]          
manufactur] rebates1 fees1 & o!r        

remun]ation = su* drug disp5s$ dur+ !   
plan ye>2  7,c7 a li/ ( ea* !rapeutic   
category or class ( drugs t 7 disp5s$ "u
 ! heal? plan or heal? insurance cov]age
 dur+ ! plan ye>1 &1 ) respect to ea*   
su* !rapeutic category or class ( drugs1
 dur+ ! plan ye>-- 7i7 total gross sp5d+
 by ! plan or cov]age1 be=e manufactur] 
rebates1 fees1 or o!r manufactur]       
remun]ation2  7ii7 ! numb] (            
p>ticipants1 b5efici>ies1 & enrollees :o
 7 disp5s$ a drug cov]$ by su* plan or  
cov]age 9 t category or class1 brok5 d[n
 by ea* su* drug 7id5tifi$ by ,national 
,drug ,code72  7iii7 if applicable to t 
category or class1 a description ( !    
=mul>y ti]s & utilization managem5t 7su*
 z prior au?orization or /ep !rapy7     
employ$ = drugs 9 t category or class2 &
  7iv7 ! total out-(-pocket sp5d+ by    
p>ticipants1 b5efici>ies1 & enrollees1  
includ+ p>ticipant1 b5efici>y1 &        
enrollee sp5d+ ?r\gh copaym5ts1         
co9surance1 & d$uctibles2  7,d7 total   
gross sp5d+ on prescription drugs by !  

plan or cov]age dur+ ! plan ye>1 be=e   
rebates & o!r manufactur] fees or       
remun]ation2  7,e7 total am\nt receiv$1 
or expect$ to be receiv$1 by ! heal?    
plan or heal? insurance cov]age 9 drug  
manufactur] rebates1 fees1 alt]native   
disc\nts1 & all o!r remun]ation receiv$ 
f ! manufactur] or any ?ird p>ty1 o!r   
?an ! plan sponsor1 relat$ to           
utilization ( drug or drug sp5d+ "u t   
heal? plan or heal? insurance cov]age   
dur+ ! plan ye>2  7,f7 ! total net sp5d+
 on prescription drugs by ! heal? plan  
or heal? insurance cov]age dur+ ! plan  
ye>2 &  7,g7 am\nts paid directly or    
indirectly 9 rebates1 fees1 or any o!r  
type ( remun]ation to brok]s1           
consultants1 advisors1 or any o!r       
individual or firm = ! ref]ral ( ! gr\p 
heal? plan's or heal? insurance issu]'s 
bus9ess to ! ph>macy b5efits manag]4    
7#b7 ,privacy requirem5ts ,heal?        
insurance issu]s (f]+ gr\p heal?        
insurance cov]age & entities provid+    
ph>macy b5efits managem5t s]vices on    

behalf ( a gr\p heal? plan %all provide 
in=mation "u p>agraph 7#a7 9 a mann]    
consi/5t ) ! privacy1 security1 & brea* 
notification regulations promulgat$ "u  
section #bfd7;c7 ( ! ,heal? ,insurance  
,portability & ,acc\ntability ,act (    
#aiif1 & %all re/rict ! use & disclosure
 ( su* in=mation accord+ to su* privacy 
regulations4  7#c7 ,disclosure &        
r$isclosure  7,a7 ,limitation to bus9ess
 associates ,a gr\p heal? plan receiv+ a
 report "u p>agraph 7#a7 may disclose   
su* in=mation only to bus9ess associates
 ( su* plan z def9$ 9 section #afj4ajc (
 title #de1 ,code ( ,f$]al ,regulations 
7or successor regulations74  7,b7       
,cl>ification reg>d+ public disclosure (
 in=mation ,no?+ 9 ?is section prev5ts a
 heal? insurance issu] (f]+ gr\p heal?  
insurance cov]age or an entity provid+  
ph>macy b5efits managem5t s]vices on    
behalf ( a gr\p heal? plan f plac+      
reasonable re/rictions on ! public      
disclosure ( ! in=mation conta9$ 9 a    
report describ$ 9 p>agraph 7#a71 except 

t su* issu] or entity may n re/rict     
disclosure ( su* report to ! ,dep>tm5t (
 ,heal? & ,human ,s]vices1 ! ,dep>tm5t (
 ,labor1 ! ,dep>tm5t ( ! ,treasury1 !   
,comptroll] ,g5]al ( ! ,unit$ ,/ates1 or
 applicable ,/ate ag5cies4  7,c7 ,limit$
 =m ( report ,! ,secret>y %all def9e    
?r\gh rulemak+ a limit$ =m ( ! report "u
 p>agraph 7#a7 requir$ ( plan sponsors  
:o are drug manufactur]s1 drug          
:olesal]s1 or o!r direct p>ticipants 9 !
 drug supply *a91 9 ord] to prev5t      
anti-competitive behavior4  7#d7 ,report
 to ,,gao ,a gr\p heal? plan or heal?   
insurance issu] (f]+ gr\p heal?         
insurance cov]age1 or an entity provid+ 
ph>macy b5efits managem5t s]vices on    
behalf ( a gr\p heal? plan %all submit  
to ! ,comptroll] ,g5]al ( ! ,unit$      
,/ates ea* ( ! fir/ #d reports submitt$ 
to a plan sponsor "u p>agraph 7#a7 )    
respect to su* cov]age or plan1 & o!r   
su* reports z reque/$1 9 accordance ) ! 
privacy requirem5ts "u p>agraph 7#b71 ! 
disclosure & r$isclosure /&>ds "u       

p>agraph 7#c71 ! /&>ds specifi$ pursuant
 to p>agraph 7#e71 & su* o!r in=mation t
 ! ,comptroll] ,g5]al det]m9es necess>y 
to c>ry out ! /udy "u section #b7;d7 ( !
 ,bett] ,deals & ,l[] ,prices ,act4     
7#e7 ,/&>d =mat ,n lat] ?an #ah mon?s   
aft] ! date ( enactm5t ( ?is section1 ! 
,secret>y %all specify ?r\gh rulemak+   
/&>ds = heal? insurance issu]s &        
entities requir$ to submit reports "u   
p>agraph 7#d7 to submit su* reports 9 a 
/&>d =mat4  7c7 ,en=cem5t  7#a7 ,9 g5]al
 ,not)/&+ section #ejb1 ! ,secret>y1 9  
consultation ) ! ,secret>y ( ,heal? &   
,human ,s]vices & ! ,secret>y ( !       
,treasury1 %all en=ce ?is section4  7#b7
 ,failure to provide timely in=mation ,a
 heal? insurance issu] or an entity     
provid+ ph>macy b5efits managem5t       
s]vices t violates subsection 7a7 or    
fails to provide in=mation requir$ "u   
subsection 7b7 %all be subject to a     
civil monet>y p5alty 9 ! am\nt ( #aj1jjj
 = ea* day dur+ :i* su* violation       
cont9ues or su* in=mation is n disclos$ 

or report$4  7#c7 ,false in=mation ,a   
heal? insurance issu] or entity provid+ 
ph>macy b5efits managem5t s]vices t     
kn[+ly provides false in=mation "u ?is  
section %all be subject to a civil money
 p5alty 9 an am\nt n to exce$ #ajj1jjj =
 ea* item ( false in=mation4 ,su* civil 
money p5alty %all be 9 addition to o!r  
p5alties z may be prescrib$ by law4     
7#d7 ,proc$ure ,! provisions ( section  
#aabh;,a ( ! ,social ,security ,act1 o!r
 ?an subsection 7a7 & 7b7 & ! fir/      
s5t5ce ( subsection 7c77#a7 ( su*       
section %all apply to civil monet>y     
p5alties "u ?is subsection 9 ! same     
mann] z su* provisions apply to a p5alty
 or proce$+ "u section #aabh;,a ( !     
,social ,security ,act4  7#e7 ,waiv]s ,!
 ,secret>y may waive p5alties "u        
p>agraph 7#b71 or ext5d ! p]iod ( "t =  
compliance ) a requirem5t ( ?is section1
 = an entity 9 violation ( ?is section t
 has made a good-fai? ef=t to comply )  
?is section4  7d7 ,rule ( con/ruction   
,no?+ 9 ?is section %all be con/ru$ to  

p]mit a heal? insurance issu]1 gr\p     
heal? plan1 or o!r entity to re/rict    
disclosure to1 or o!rwise limit ! access
 (1 ! ,secret>y ( ,labor to a report    
describ$ 9 subsection 7b77#a7 or        
in=mation relat$ to compliance )        
subsection 7a7 or 7b7 by su* issu]1     
plan1 or o!r entity subject to su*      
subsections4  7e7 ,def9ition ,9 ?is     
section1 ! t]m :olesale acquisition co/ 
has ! mean+ giv5 su* t]m 9 section      
#ahdg;,a7c77#f77;,b7 ( ! ,social        
,security ,act4  2 &  7,b7 9 section    
#ejb 7#bi ,u4,s4,c4 #aacb7-- 7i7 9      
subsection 7a7-- 7,i7 9 p>agraph 7#f71  
by /rik+ or 7#i7 & ins]t+ 7#i71 or      
7#ac72  7,,ii7 9 p>agraph 7#aj71 by     
/rik+ at ! end or2  7,,iii7 9 p>agraph  
7#aa71 at ! end by /rik+ ! p]iod &      
ins]t+ 2 or2 &  7,,iv7 by add+ at ! end 
! foll[+ new p>agraph3  7#ab7 by !      
,secret>y1 9 consultation ) ! ,secret>y 
( ,heal? & ,human ,s]vices1 & !         
,secret>y ( ! ,treasury1 to en=ce       
section #gbf4  2  7ii7 9 subsection     

7b77#c71 by ins]t+ & subsections        
7a77#ab7 & 7c77#ac7 be=e 1 ! ,secret>y  
is n2 &  7iii7 9 subsection 7c71 by add+
 at ! end ! foll[+ new p>agraph3  7#ac7 
,secret>ial en=cem5t au?ority relat+ to 
ov]sight ( ph>macy b5efits manag]       
s]vices  7,a7 ,failure to provide timely
 in=mation ,! ,secret>y1 9 consultation 
) ! ,secret>y ( ,heal? & ,human ,s]vices
 & ! ,secret>y ( ! ,treasury1 may impose
 a p5alty aga9/ any heal? insurance     
issu] or entity provid+ ph>macy b5efits 
managem5t s]vices t violates section    
#gbf7;a7 or fails to provide in=mation  
requir$ "u section #gbf7;b7 9 ! am\nt ( 
#aj1jjj = ea* day dur+ :i* su* violation
 cont9ues or su* in=mation is n disclos$
 or report$4  7,b7 ,false in=mation ,!  
,secret>y1 9 consultation ) ! ,secret>y 
( ,heal? & ,human ,s]vices & ! ,secret>y
 ( ! ,treasury1 may impose a p5alty     
aga9/ a heal? insurance issu] or entity 
provid+ ph>macy b5efits managem5t       
s]vices t kn[+ly provides false         
in=mation "u section #gbf 9 an am\nt n  

to exce$ #ajj1jjj = ea* item ( false    
in=mation4 ,su* p5alty %all be 9        
addition to o!r p5alties z may be       
prescrib$ by law4  7,c7 ,waiv]s ,!      
,secret>y may waive p5alties "u         
subp>agraph 7,a71 or ext5d ! p]iod ( "t 
= compliance ) a requirem5t ( section   
#gbf1 = an entity 9 violation ( su*     
section t has made a good-fai? ef=t to  
comply ) su* section4  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[+   
new item3  ,sec4 #gbf4 ,ov]sight (      
ph>macy b5efits manag] s]vices4  4  7d7 
,,gao /udy  7#a7 ,9 g5]al ,n lat] ?an #c
 ye>s aft] ! date ( enactm5t ( ?is ,act1
 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates 
%all submit to ,congress a report on--  
7,a7 ph>macy networks ( gr\p heal?      
plans1 heal? insurance issu]s1 &        
entities provid+ ph>macy b5efits        
managem5t s]vices "u su* gr\p heal? plan

 or gr\p or individual heal? insurance  
cov]age1 includ+ networks t h ph>macies 
t are "u common own]%ip 79 :ole or "p7 )
 gr\p heal? plans1 heal? insurance      
issu]s1 or entities provid+ ph>macy     
b5efits managem5t s]vices or ph>macy    
b5efits adm9i/rative s]vices "u gr\p    
heal? plan or gr\p or individual heal?  
insurance cov]age2  7,b7 z x relates to 
ph>macy networks t include ph>macies "u 
common own]%ip describ$ 9 subp>agraph   
7,a7-- 7i7 :e!r su* networks are design$
 to enc\rage enrollees ( a plan or      
cov]age to use su* ph>macies ov] o!r    
network ph>macies = specific s]vices or 
drugs1 & if s1 ! reasons ! networks give
 = enc\rag+ use ( su* ph>macies2 &  7ii7
 :e!r su* ph>macies are us$ by enrollees
 disproportionately m 9 ! aggregate or =
 specific s]vices or drugs comp>$ to o!r
 network ph>macies2  7,c7 :e!r gr\p     
heal? plans & heal? insurance issu]s    
(f]+ gr\p or individual heal? insurance 
cov]age h options to elect diff]5t      
network pric+ arrangem5ts 9 ! m>ketplace

 ) entities t provide ph>macy b5efits   
managem5t s]vices1 ! preval5ce ( elect+ 
su* diff]5t network pric+ arrangem5ts2  
7,d7 ph>macy network design p>amet]s t  
enc\rage enrollees 9 ! plan or cov]age  
to fill prescriptions at mail ord]1     
specialty1 or retail ph>macies t are    
:olly or p>tially-own$ by t issu] or    
entity2 &  7,e7 ! degree to :i* mail    
ord]1 specialty1 or retail ph>macies t  
disp5se prescription drugs to an        
enrollee 9 a gr\p heal? plan or heal?   
insurance cov]age t are "u common       
own]%ip 79 :ole or "p7 ) gr\p heal?     
plans1 heal? insurance issu]s1 or       
entities provid+ ph>macy b5efits        
managem5t s]vices or ph>macy b5efits    
adm9i/rative s]vices "u gr\p heal? plan 
or gr\p or individual heal? insurance   
cov]age receive reimbursem5t t is great]
 ?an ! m$ian price *>g$ to ! gr\p heal? 
plan or heal? insurance issu] :5 ! same 
drug is disp5s$ to enrollees 9 ! plan or
 cov]age by o!r ph>macies includ$ 9 !   
ph>macy network ( t plan1 issu]1 or     

entity t are n :olly or p>tially own$ by
 ! heal? insurance issu] or entity      
provid+ ph>macy b5efits managem5t       
s]vices4  7#b7 ,requirem5t ,!           
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all ensure t ! report "u p>agraph 7#a7 
does n conta9 in=mation t w\ld all[ a   
read] to id5tify a specific plan or     
entity provid+ ph>macy b5efits managem5t
 s]vices or o!rwise conta9 comm]cial or 
f9ancial in=mation t is privileg$ or    
confid5tial4  7#c7 ,def9itions ,9 ?is   
subsection1 ! t]ms gr\p heal? plan1     
heal? insurance cov]age1 & heal?        
insurance issu] h ! mean+s giv5 su* t]ms
 9 section #bgia ( ! ,public ,heal?     
,s]vice ,act 7#db ,u4,s4,c4             
#cjj;gg-#ia74