,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #fbhc  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,novemb] #h1          
#bjbc,mrs4 ,mill]-,meeks 7= h]self1 ,ms4
 ,b>ragn1 ,mrs4 ,*avez-,de,remer1 ,ms4  
,mann+1 ,ms4 ,malliotakis1 ,mr4         
,s*neid]1 ,mr4 ,kean ( ,new ,j]sey1 &   
,ms4 ,spanb]g]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 & ,ov]sight &  
,acc\ntability1 = 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 improve s]vices 
provid$ by ph>macy b5efit manag]s4  #a4 
,%ort title ,?is ,act may be cit$ z !   
,del9k+ ,rev5ue f ,unfair ,g\g+ ,act or 
! ,,drug ,act4  #b4 ,improv+ ph>macy    
b5efit manag] s]vices  7a7 ,public heal?
 s]vice act ,"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 ,improv+ ph>macy b5efit   
manag] s]vices  7a7 ,g5]al ,= plan ye>s 
beg9n+ on or aft] ,janu>y #a1 #bjbf1    
except z provid$ 9 subsection 7b71 a    
ph>macy b5efit manag] %all d]ive no     
remun]ation f any entity = s]vices1     
b5efit adm9i/ration1 or any o!r         
activities relat$ to prescription drugs4
  7b7 ,exception = bona fide s]vice fees
  7#a7 ,9 g5]al ,a ph>macy b5efit manag]
 may *>ge an entity a bona fide s]vice  
fee = ! provision ( s]vices to su*      
entity if su* fee is set =? 9 an        
agreem5t betwe5 ! ph>macy b5efit manag] 
& su* entity1 & ! am\nt ( any bona fide 
s]vice fee-- 7,a7 %all be a flat doll>  
am\nt2 &  7,b7 %all n be directly or    
indirectly bas$ on1 or cont+5t ^u-- 7i7 
a drug price 7su* z :olesale acquisition
 co/7 or drug b5*m>k price 7su* z av]age
 :olesale price72  7ii7 ! am\nt (       
disc\nts1 rebates1 fees1 or o!r direct  
or indirect remun]ation ) respect to    
prescription drugs prescrib$ to !       

p>ticipants1 b5efici>ies1 or enrollees 9
 ! gr\p heal? plan or cov]age involv$2  
or  7iii7 any o!r am\nts prohibit$ by ! 
,secret>y1 ! ,secret>y ( ,labor1 & !    
,secret>y ( ! ,treasury4  7#b7          
,def9itions ,9 ?is section-- 7,a7 ! t]m 
bona fide s]vice fee means fair m>ket   
value = a bona fide1 itemiz$ s]vice     
actually p]=m$ on behalf ( an entity1 t 
! entity w\ld o!rwise p]=m 7or contract 
=7 9 ! abs5ce ( ! s]vice arrangem5t & t 
are n pass$ on 9 :ole or 9 "p to a cli5t
 or cu/om]1 :e!r or n ! entity takes    
title to ! drug2 &  7,b7 ! t]m ph>macy  
b5efit manag] means any p]son1 bus9ess1 
or o!r entity su* z a ?ird-p>ty         
adm9i/rator1 reg>dless ( :e!r x         
id5tifies itself z a ph>macy b5efit     
manag]1 t1 ei!r directly or ?r\gh an    
int]m$i>y 7includ+ an affiliate1        
subsidi>y1 p>5t1 or ag5t7 or an         
arrangem5t ) a ?ird p>ty-- 7i7 acts z a 
price negotiator or gr\p pur*as] =      
prescription drugs on behalf ( a gr\p   
heal? plan or heal? insurance issu] (f]+

 gr\p or individual heal? insurance     
cov]age2 or  7ii7 manages or adm9i/]s ! 
prescription drug b5efits provid$ by a  
gr\p heal? plan or heal? insurance issu]
 (f]+ gr\p or individual heal? insurance
 cov]age1 includ+ ! process+ & paym5t ( 
claims = prescription drugs1 arrang+    
alt]native access to or fund+ =         
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]vices4  7c7        
,acc\ntability & conduct  7#a7 ,9 g5]al 
,a ph>macy b5efit manag] %all n-- 7,a7  
*>ge a gr\p heal? plan or heal?         
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age a diff]5t am\nt 
= a prescription drug's +r$i5t co/ or   
disp5s+ fee z comp>$ to ! am\nt !       
ph>macy b5efit manag] reimburses a      
ph>macy = ! prescription drug's +r$i5t  

co/ or disp5s+ fee2  7,b7 reimburse a   
network ph>macy or ph>maci/ 9 an am\nt  
less ?an ! am\nt ! ph>macy b5efit manag]
 w\ld reimburse a network ph>macy t is  
own$1 controll$ by1 or affiliat$ ) !    
ph>macy b5efit manag] = disp5s+ ! same  
drug or = provid+ ! same ph>maci/       
s]vices2 or  7,c7 directly or indirectly
 engage 9 /e]+ 7z def9$ 9 p>agraph 7#b77
 to a ph>macy t is own$1 controll$ by1  
or affiliat$ ) ! ph>macy b5efit manag]4 
7#b7 ,/e]+ ,9 p>agraph 7#a71 ! t]m /e]+ 
) respect to a ph>macy b5efit man-ag]   
includes-- 7,a7 provid+ or implem5t+ a  
b5efit design t enc\rages a p>ticipant1 
b5efici>y1 or enrollee to utilize a     
ph>macy t is own$1 controll$ by1 or     
affiliat$ ) ! ph>macy b5efit manag]1 if 
su* design increases co/s = ! plan or a 
p>ticipant1 b5efici>y1 or enrollee1     
includ+ requir+ a p>ticipant1 b5efici>y1
 or enrollee to pay high] out-(-pocket  
co/s = a prescription if ! p>ticipant1  
b5efici>y1 or enrollee *ooses n to use a
 ph>macy own$1 controll$ by1 or         

affiliat$ ) ! ph>macy b5efit manag]2    
7,b7 requir+ a p>ticipant1 b5efici>y1 or
 enrollee to use only a ph>macy t is    
own$1 controll$ by1 or affiliat$ ) !    
ph>macy b5efit manag]2  7,c7 retaliat+1 
mak+ fur!r attempts to influ5ce a       
p>ticipant1 b5efici>y1 or enrollee1 or  
treat+ a p>ticipant1 b5efici>y1 or      
enrollee or a p>ticipant1 b5efici>y1 or 
enrollee's claim any diff]5tly if a     
p>ticipant1 b5efici>y1 or enrollee      
*ooses to use a ph>macy t is n own$1    
controll$ by1 or affiliat$ ) ! ph>macy  
b5efit manag]2 or  7,d7 any o!r         
activities z def9$ by ! ,secret>y1 !    
,secret>y ( ,labor1 & ! ,secret>y ( !   
,treasury4  7d7 ,en=cem5t  7#a7 ,9 g5]al
 ,! ,secret>y1 9 consultation ) !       
,secret>y ( ,labor & ! ,secret>y ( !    
,treasury1 %all en=ce ?is section4  7#b7
 ,disgorgem5t ,! ph>macy b5efit manag]  
%all disgorge to a gr\p heal? plan or   
heal? insurance issu] (f]+ gr\p or      
individual heal? insurance cov]age any  
paym5t1 remun]ation1 or o!r am\nt       

receiv$ by ! ph>macy b5efit manag] or an
 affiliate ( su* ph>macy b5efit manag] 9
 violation ( p>agraph 7a7 or ! agreem5t 
ent]$ into ) su* plan or issu] = bona   
fide s]vice fees4  7#c7 ,p5alties ,a    
ph>macy b5efit manag] t violates        
subsection 7a71 7b71 or 7c7 %all be     
subject to a civil monet>y p5alty 9 !   
am\nt ( #aj1jjj = ea* day dur+ :i* su*  
violation cont9ues4  7#d7 ,proc$ure ,!  
provisions ( section #aabh;,a ( !       
,social ,security ,act1 o!r ?an         
subsections 7a7 & 7b7 & ! fir/ s5t5ce ( 
subsection 7c77#a7 ( su* section %all   
apply to civil monet>y p5alties "u ?is  
subsection 9 ! same mann] z su*         
provisions apply to a p5alty or proce$+ 
"u section #aabh;,a ( ! ,social         
,security ,act4  7e7 ,regulations       
,not)/&+ any o!r provision ( law1 !     
,secret>y %all initially implem5t ?is   
section ?r\gh int]im f9al regulations4  
7f7 ,rules ( con/ruction  7#a7 ,no?+ 9  
?is section %all be con/ru$ z prohibit+ 
paym5ts relat$ to reimbursem5t = +r$i5t 

co/s to entities t acquire prescription 
drugs or ph>macy disp5s+ fees4  7#b7    
,no?+ 9 ?is section %all be con/ru$ to  
prohibit rebates1 disc\nts1 or o!r price
 concessions f be+ fully pass$ ?r\gh to 
a gr\p heal? plan or heal? insurance    
issu] (f]+ gr\p or individual heal?     
insurance cov]age to l[] net co/s =     
prescription drugs4  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 ins]t+ aft] section #gbe !     
foll[+3  #gbf4 ,improv+ ph>macy b5efit  
manag] s]vices  7a7 ,9 g5]al ,= plan    
ye>s beg9n+ on or aft] ,janu>y #a1      
#bjbf1 except z provid$ 9 subsection    
7b71 a ph>macy b5efit manag] %all d]ive 
no remun]ation f any entity = s]vices1  
b5efit adm9i/ration1 or any o!r         
activities relat$ to prescription drugs4
  7b7 ,exception = bona fide s]vice fees
  7#a7 ,9 g5]al ,a ph>macy b5efit       
man-ag] may *>ge an entity a bona fide  

s]vice fee = ! provision ( s]vices to   
su* entity if su* fee is set =? 9 an    
agreem5t betwe5 ! ph>macy b5efit manag] 
& su* entity & ! am\nt ( any bona fide  
s]vice fee-- 7,a7 %all be a flat doll>  
am\nt2  7,b7 %all n be directly or      
indirectly bas$ on1 or cont+5t ^u-- 7i7 
a drug price 7su* z :olesale acquisition
 co/7 or drug b5*m>k price 7su* z av]age
 :olesale price72  7ii7 ! am\nt (       
disc\nts1 rebates1 fees1 or o!r direct  
or indirect remun]ation ) respect to    
prescription drugs prescrib$ to !       
p>ticipants1 b5efici>ies1 or enrollees 9
 ! gr\p heal? plan or cov]age involv$2  
or  7iii7 any o!r am\nts prohibit$ by ! 
,secret>y1 ! ,secret>y ( ,labor1 & !    
,secret>y ( ! ,treasury4  7#b7          
,def9itions ,9 ?is section-- 7,a7 ! t]m 
bona fide s]vice fee means fair m>ket   
value = a bona fide1 itemiz$ s]vice     
actually p]=m$ on behalf ( an entity1 t 
w\ld o!rwise p]=m 7or contract =7 9 !   
abs5ce ( ! s]vice arrangem5t & t are n  
pass$ on 9 :ole or 9 "p to a cli5t or   

cu/om]1 :e!r or n ! entity takes title  
to ! drug2  7,b7 ! t]m ph>macy b5efit   
manag] means any p]son1 bus9ess1 or o!r 
entity su* z a ?ird-p>ty adm9i/rator1   
reg>dless ( :e!r x id5tifies itself z a 
ph>macy b5efit manag]1 t1 ei!r directly 
or ?r\gh an int]m$i>y 7includ+ an       
affiliate1 subsidi>y1 or ag5t7 or an    
arrangem5t ) a ?ird p>ty-- 7i7 acts z a 
price negotiator = prescription drugs on
 behalf ( a gr\p heal? plan or heal?    
insurance issu] (f]+ gr\p heal?         
insurance cov]age2 or  7ii7 manages or  
adm9i/]s ! prescription drug b5efits    
provid$ by a gr\p heal? plan or heal?   
insurance issu] (f]+ gr\p heal?         
insurance cov]age1 includ+ ! process+ & 
paym5t ( claims = prescription drugs1   
arrang+ alt]native access to or fund+ = 
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]vices4  7c7        
,acc\ntability & conduct  7#a7 ,9 g5]al 
,a ph>macy b5efit manag] %all n-- 7,a7  
*>ge a gr\p heal? plan or heal?         
insurance issu] (f]+ gr\p heal?         
insurance cov]age a diff]5t am\nt = a   
prescription drug's +r$i5t co/ or       
disp5s+ fee z comp>$ to ! am\nt !       
ph>macy b5efit manag] reimburses a      
ph>macy = ! prescription drug's +r$i5t  
co/ or disp5s+ fee2  7,b7 reimburse a   
network ph>macy or ph>maci/ 9 an am\nt  
less ?an ! am\nt ! ph>macy b5efit manag]
 w\ld reimburse a network ph>macy t is  
own$1 controll$ by1 or affiliat$ ) !    
ph>macy b5efit manag] = disp5s+ ! same  
drug or = provid+ ! same ph>maci/       
s]vices2 or  7,c7 directly or indirectly
 engage 9 /e]+ 7z def9$ 9 p>agraph 7#b77
 to a ph>macy t is own$1 controll$ by1  
or affiliat$ ) ! ph>macy b5efit manag]4 
7#b7 ,/e]+ ,9 p>agraph 7#a71 ! t]m /e]+ 
) respect to a ph>macy b5efit manag]    
includes-- 7,a7 provid+ or implem5t+ a  

b5efit plan design t enc\rages a        
p>ticipant or b5efici>y to utilize a    
ph>macy t is own$1 controll$ by1 or     
affiliat$ ) ! ph>macy b5efit manag]1 if 
su* plan design increases co/s = ! plan 
or ! p>ticipant or b5efici>y1 includ+   
requir+ a p>ticipant or b5efici>y to pay
 high] out-(-pocket co/s = a            
prescription if ! p>ticipant or         
b5efici>y *ooses n to use a ph>macy     
own$1 controll$ by1 or affiliat$ ) !    
ph>macy b5efit manag]2  7,b7 requir+ a  
p>ticipant or b5efici>y to use only a   
ph>macy t is own$1 controll$ by1 or     
affiliat$ ) ! ph>macy b5efit manag]2    
7,c7 retaliat+1 mak+ fur!r attempts to  
influ5ce a p>ticipant or b5efici>y1 or  
treat+ a p>ticipant or b5efici>y or a   
p>ticipant or b5efici>y's claim any     
diff]5tly if a p>ticipant or b5efici>y  
*ooses to use a ph>macy t is n own$1    
controll$ by1 or affiliat$ ) ! ph>macy  
b5efit manag]2 or  7,d7 any o!r         
activities z def9$ by ! ,secret>y1 !    
,secret>y ( ,heal? & ,human ,s]vices1 & 

! ,secret>y ( ! ,treasury4  7d7         
,en=cem5t  7#a7 ,9 g5]al ,! ,secret>y1 9
 consultation ) ! ,secret>y ( ,heal? &  
,human ,s]vices & ! ,secret>y ( !       
,treasury1 %all en=ce ?is section4  7#b7
 ,disgorgem5t ,! ph>macy b5efit manag]  
%all disgorge to a gr\p heal? plan or   
heal? insurance issu] (f]+ gr\p or      
individual heal? insurance cov]age any  
paym5t1 remun]ation1 or o!r am\nt       
receiv$ by ! ph>macy b5efit manag] or an
 affiliate ( su* ph>macy b5efit manag] 9
 violation ( p>agraph 7a7 or ! agreem5t 
ent]$ into ) su* plan or issu] = bona   
fide s]vice fees4  7#c7 ,p5alties ,a    
ph>macy b5efit manag] t violates        
subsection 7a71 7b71 or 7c7 %all be     
subject to a civil monet>y p5alty 9 !   
am\nt ( #aj1jjj = ea* day dur+ :i* su*  
violation cont9ues4  7#d7 ,proc$ure ,!  
provisions ( section #aabh;,a ( !       
,social ,security ,act1 o!r ?an         
subsections 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$+ 
"u section #aabh;,a ( ! ,social         
,security ,act4  7e7 ,regulations       
,not)/&+ any o!r provision ( law1 !     
,secret>y %all initially implem5t ?is   
section ?r\gh int]im f9al regulations4  
7f7 ,rules ( con/ruction  7#a7 ,no?+ 9  
?is section %all be con/ru$ z prohibit+ 
paym5ts relat$ to reimbursem5t = +r$i5t 
co/s to entities t acquire prescription 
drugs or ph>macy disp5s+ fees4  7#b7    
,no?+ 9 ?is section %all be con/ru$ to  
prohibit rebates1 disc\nts1 or o!r price
 concessions f be+ fully pass$ ?r\gh to 
a gr\p heal? plan or heal? insurance    
issu] (f]+ gr\p or individual heal?     
insurance cov]age to l[] net co/s =     
prescription drugs4  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 ,improv+ ph>macy 

b5efit manag] s]vices4  4  7c7 ,int]nal 
rev5ue code ( #aihf ,sub-*apt] ,b (     
*apt] #ajj ( ! ,int]nal ,rev5ue ,code ( 
#aihf is am5d$ by add+ at ! end !       
foll[+3  #ihbf4 ,improv+ ph>macy b5efit 
manag] s]vices  7a7 ,9 g5]al ,= plan    
ye>s beg9n+ on or aft] ,janu>y #a1      
#bjbf1 except z provid$ 9 subsection    
7b71 a ph>macy b5efit manag] %all d]ive 
no remun]ation f any entity = s]vices1  
b5efit adm9i/ration1 or any o!r         
activities relat$ to prescription drugs4
  7b7 ,exception = bona fide s]vices    
7#a7 ,9 g5]al ,a ph>macy b5efit manag]  
may *>ge an entity a bona fide s]vice   
fee = ! provision ( s]vices to su*      
entity if su* fee is set =? 9 an        
agreem5t betwe5 ! ph>macy b5efit manag] 
& su* entity1 & ! am\nt ( any bona fide 
s]vice fee-- 7,a7 %all be a flat doll>  
am\nt2 &  7,b7 %all n be directly or    
indirectly bas$ on1 or cont+5t ^u-- 7i7 
a drug price 7su* z :olesale acquisition
 co/7 or drug b5*m>k price 7su* z av]age
 :olesale price72  7ii7 ! am\nt (       

disc\nts1 rebates1 fees1 or o!r direct  
or indirect remun]ation ) respect to    
prescription drugs prescrib$ to !       
p>ticipants1 b5efici>ies1 or enrollees 9
 ! gr\p heal? plan or cov]age involv$2  
or  7iii7 any o!r am\nts prohibit$ by ! 
,secret>y1 ! ,secret>y ( ,labor1 & !    
,secret>y ( ! ,treasury4  7#b7          
,def9itions ,9 ?is section-- 7,a7 ! t]m 
bona fide s]vice fee means fair m>ket   
value = a bona fide1 itemiz$ s]vice     
actually p]=m$ on behalf ( an entity1 t 
! entity w\ld o!rwise p]=m 7or contract 
=7 9 ! abs5ce ( ! arrangem5t & t are n  
pass$ on 9 :ole or 9 "p to a cli5t or   
cu/om]1 :e!r or n ! entity takes title  
to ! drug2 &  7,b7 ! t]m ph>macy b5efit 
manag] means any p]son1 bus9ess1 or o!r 
entity su* z a ?ird-p>ty adm9i/rator1   
reg>dless ( :e!r x id5tifies itself z a 
ph>macy b5efit manag]1 t1 ei!r directly 
or ?r\gh an int]m$i>y 7includ+ an       
affiliate1 or ag5t7 or an arrangem5t ) a
 ?ird p>ty-- 7i7 acts z a price         
negotiator = prescription drugs on      

behalf ( a gr\p heal? plan2 or  7ii7    
manages or adm9i/]s ! prescription drug 
b5efits provid$ by a gr\p heal? plan1   
includ+ ! process+ & paym5t ( claims =  
prescription drugs1 arrang+ alt]native  
access to or fund+ = 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]vices4 
7c7 ,acc\ntability & conduct  7#a7 ,9   
g5]al ,a ph>macy b5efit manag] %all n-- 
7,a7 *>ge a gr\p heal? plan or heal?    
insurance issu] (f]+ gr\p heal?         
insurance cov]age a diff]5t am\nt = a   
prescription drug's +r$i5t co/ or       
disp5s+ fee z comp>$ to ! am\nt !       
ph>macy b5efit manag] reimburses a      
ph>macy = ! prescription drug's +r$i5t  
co/ or disp5s+ fee2  7,b7 reimburse a   
network ph>macy or ph>maci/ 9 an am\nt  
less ?an ! am\nt ! ph>macy b5efit manag]

 w\ld reimburse a network ph>macy t is  
own$1 controll$ by1 or affiliat$ ) !    
ph>macy b5efit manag] = disp5s+ ! same  
drug or = provid+ ! same ph>maci/       
s]vices2 or  7,c7 directly or indirectly
 engage 9 /e]+ 7z def9$ 9 p>agraph 7#b77
 to a ph>macy t is own$1 controll$ by1  
or affiliat$ ) ! ph>macy b5efit manag]4 
7#b7 ,/e]+ ,9 p>agraph 7#a71 ! t]m /e]+ 
) respect to a ph>macy b5efit manag]    
includes-- 7,a7 provid+ or implem5t+ a  
b5efit design t enc\rages a p>ticipant  
or b5efici>y to utilize a ph>macy t is  
own$1 controll$ by1 or affiliat$ ) !    
ph>macy b5efit manag]1 if su* b5efit    
design increases co/s = ! plan or !     
p>ticipant or b5efici>y1 includ+ requir+
 a p>ticipant or b5efici>y to pay high] 
out-(-pocket co/s = a prescription if ! 
p>ticipant or b5efici>y *ooses n to use 
a ph>macy own$1 controll$ by1 or        
affiliat$ ) ! ph>macy b5efit manag]2    
7,b7 requir+ an enrollee to use only a  
ph>macy t is own$1 controll$ by1 or     
affiliat$ ) ! ph>macy b5efit manag]2    

7,c7 retaliat+1 mak+ fur!r attempts to  
influ5ce a p>ticipant or b5efici>y1 or  
treat+ a p>ticipant or b5efici>y or a   
p>ticipant or b5efici>y's claim any     
diff]5tly if a p>ticipant or b5efici>y  
*ooses to use a ph>macy t is n own$1    
controll$ by1 or affiliat$ ) ! ph>macy  
b5efit manag]2 or  7,d7 any o!r         
activities z def9$ by ! ,secret>y1 !    
,secret>y ( ,labor1 & ! ,secret>y (     
,heal? & ,human ,s]vice4  7d7 ,en=cem5t 
7#a7 ,9 g5]al ,! ,secret>y1 9           
consultation ) ! ,secret>y ( ,labor & ! 
,secret>y ( ,heal? & ,human ,s]vices1   
%all en=ce ?is section4  7#b7           
,disgorgem5t ,! ph>macy b5efit manag]   
%all disgorge to a gr\p heal? plan or   
heal? insurance issu] (f]+ gr\p or      
individual heal? insurance cov]age any  
paym5t1 remun]ation1 or o!r am\nt       
receiv$ by ! ph>macy b5efit manag] or an
 affiliate ( su* ph>macy b5efit manag] 9
 violation ( p>agraph 7a7 or ! agreem5t 
ent]$ into ) su* plan or issu] = bona   
fide s]vice fees4  7#c7 ,p5alties ,a    

ph>macy b5efit manag] t violates        
subsection 7a71 7b71 or 7c7 %all be     
subject to a civil monet>y p5alty 9 !   
am\nt ( #aj1jjj = ea* day dur+ :i* su*  
violation cont9ues4  7#d7 ,proc$ure ,!  
provisions ( section #aabh;,a ( !       
,social ,security ,act1 o!r ?an         
subsections 7a7 & 7b7 & ! fir/ s5t5ce ( 
subsection 7c77#a7 ( su* section %all   
apply to civil monet>y p5alties "u ?is  
subsection 9 ! same mann] z su*         
provisions apply to a p5alty or proce$+ 
"u section #aabh;,a ( ! ,social         
,security ,act4  7e7 ,regulations       
,not)/&+ any o!r provision ( law1 !     
,secret>y %all initially implem5t !     
am5dm5ts made by ?is ,act ?r\gh int]im  
f9al regulations4  7f7 ,rules (         
con/ruction  7#a7 ,no?+ 9 ?is section   
%all be con/ru$ z prohibit+ paym5ts     
relat$ to reimbursem5t = +r$i5t co/s to 
entities t acquire prescription drugs or
 ph>macy disp5s+ fees4  7#b7 ,no?+ 9 ?is
 section %all be con/ru$ to prohibit    
rebates1 disc\nts1 or o!r price         

concessions f be+ fully pass$ ?r\gh to a
 gr\p heal? plan or heal? insurance     
issu] (f]+ gr\p or individual heal?     
insurance cov]age to l[] net co/s =     
prescription drugs4  4  7d7 ,f$]al      
employees heal? b5efits act ,*apt] #hi (
 subp>t ,g ( "p ,,iii ( title #e ( !    
,unit$ ,/ates ,code is am5d$ by add+ at 
! end foll[+3  #hiae4 ,improv+ ph>macy  
b5efit manag] s]vices  7a7 ,9 g5]al ,=  
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjbf1 except z provid$ 9 subsection    
7b71 a ph>macy b5efit manag] %all d]ive 
no remun]ation f any entity = s]vices1  
b5efit adm9i/ration1 or any o!r         
activities relat$ to prescription drugs4
  7b7 ,exception = bona fide s]vices    
7#a7 ,9 g5]al ,a ph>macy b5efit manag]  
may *>ge an entity a bona fide s]vice   
fee = ! provision ( s]vices to su*      
entity if su* fee is set =? 9 an        
agreem5t betwe5 ! ph>macy b5efit manag] 
& su* entity1 &  7#b7 ! am\nt ( any bona
 fide s]vice fee-- 7,a7 %all be a flat  
doll> am\nt2  7,b7 %all n be directly or

 indirectly bas$ on1 or cont+5t ^u-- 7i7
 a drug price 7su* z :olesale           
acquisition co/7 or drug b5*m>k price   
7su* z av]age :olesale price72  7ii7 !  
am\nt ( disc\nts1 rebates1 fees1 or o!r 
direct or indirect remun]ation ) respect
 to prescription drugs prescrib$ to !   
p>ticipants1 b5efici>ies1 or enrollees 9
 ! gr\p heal? plan or cov]age involv$2  
or  7iii7 any o!r am\nts prohibit$ by ! 
,(fice ( ,p]sonnel ,managem5t4  7#b7    
,def9itions ,9 ?is section-- 7,a7 ! t]m 
bona fide s]vice fee means fair m>ket   
value = a bona fide1 itemiz$ s]vice     
actually p]=m$ on behalf ( an entity1 t 
! entity w\ld o!rwise p]=m 7or contract 
=7 9 ! abs5ce ( ! arrangem5t & t are n  
pass$ on 9 :ole or 9 "p to a cli5t or   
cu/om]1 :e!r or n ! entity takes title  
to ! drug2 &  7,b7 ! t]m ph>macy b5efit 
manag] means any p]son1 bus9ess1 or o!r 
entity su* z a ?ird-p>ty adm9i/rator1   
reg>dless ( :e!r x id5tifies itself z a 
ph>macy b5efit manag]1 t1 ei!r directly 
or ?r\gh an int]m$i>y 7includ+ an       

affiliate1 or ag5t7 or an arrangem5t ) a
 ?ird p>ty-- 7i7 acts z a price         
negotiator = prescription drugs on      
behalf ( a heal? b5efits plan or c>ri]2 
or  7ii7 manages or adm9i/]s !          
prescription drug b5efits provid$ by a  
heal? b5efits plan or c>ri] includ+ !   
process+ & paym5t ( claims =            
prescription drugs1 arrang+ alt]native  
access to or fund+ = 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]vices4 
7c7 ,acc\ntability & conduct  7#a7 ,9   
g5]al ,a ph>macy b5efit manag] %all n-- 
7,a7 *>ge a heal? b5efits plan or c>ri] 
diff]5t am\nt = a prescription drug's   
+r$i5t co/ or disp5s+ fee z comp>$ to ! 
am\nt ! ph>macy b5efit manag] reimburses
 a ph>macy = ! prescription drug's      
+r$i5t co/ or disp5s+ fee2  7,b7        

reimburse a network ph>macy or ph>maci/ 
9 an am\nt less ?an ! am\nt ! ph>macy   
b5efit manag] w\ld reimburse a network  
ph>macy t is own$1 controll$ by1 or     
affiliat$ ) ! ph>macy b5efit manag] =   
disp5s+ ! same drug or = provid+ ! same 
ph>maci/ s]vices2 or  7,c7 directly or  
indirectly engage 9 /e]+ 7z def9$ 9     
p>agraph 7#b77 to a ph>macy t is own$1  
controll$ by1 or affiliat$ ) ! ph>macy  
b5efit manag]4  7#b7 ,/e]+ ,9 p>agraph  
7#a71 ! t]m /e]+ ) respect to a ph>macy 
b5efit manag] includes-- 7,a7 provid+ or
 implem5t+ a b5efit design t enc\rages a
 p>ticipant or b5efici>y to utilize a   
ph>macy t is own$1 controll$ by1 or     
affiliat$ ) ! ph>macy b5efit manag]1 if 
su* b5efit design increases co/s = !    
plan or ! p>ticipant or b5efici>y1      
includ+ requir+ a p>ticipant or         
b5efici>y to pay high] out-(-pocket co/s
 = a prescription if ! p>ticipant or    
b5efici>y *ooses n to use a ph>macy     
own$1 controll$ by1 or affiliat$ ) !    
ph>macy b5efit manag]2  7,b7 requir+ an 

enrollee to use only a ph>macy t is     
own$1 controll$ by1 or affiliat$ ) !    
ph>macy b5efit manag]2  7,c7 retaliat+1 
mak+ fur!r attempts to influ5ce a       
p>ticipant or b5efici>y1 or treat+ a    
p>ticipant or b5efici>y or a p>ticipant 
or b5efici>y's claim any diff]5tly if a 
p>ticipant or b5efici>y *ooses to use a 
ph>macy t is n own$1 controll$ by1 or   
affiliat$ ) ! ph>macy b5efit manag]2 or 
7,d7 any o!r activities z def9$ by !    
,(fice ( ,p]sonnel ,managem5t4  7d7     
,en=cem5t  7#a7 ,9 g5]al ,! ,(fice (    
,p]sonnel ,managem5t %all en=ce ?is     
section4  7#b7 ,disgorgem5t ,! ph>macy  
b5efit manag] %all disgorge to a heal?  
b5efits plan or c>ri] any paym5t1       
remun]ation1 or o!r am\nt receiv$ by !  
ph>macy b5efit manag] or an affiliate ( 
su* ph>macy b5efit manag] 9 violation ( 
p>agraph 7a7 or ! agreem5t ent]$ into ) 
su* plan or c>ri] = bona fide s]vice    
fees4  7#c7 ,p5alties ,a ph>macy b5efit 
manag] t violates subsection 7a71 7b71  
or 7c7 %all be subject to a civil       

monet>y p5alty 9 ! am\nt ( #aj1jjj = ea*
 day dur+ :i* su* violation cont9ues4   
7#d7 ,proc$ure ,! provisions ( section  
#aabh;,a ( ! ,social ,security ,act1 o!r
 ?an subsections 7a7 & 7b7 & ! fir/     
s5t5ce ( sub-section 7c77#a7 ( su*      
section %all apply to civil monet>y     
p5alties "u ?is subsection 9 ! same     
mann] z su* provisions apply to a p5alty
 or proce$+ "u section #aabh;,a ( !     
,social ,security ,act1 except t = !    
purpose ( ?is p>agraph ! ,(fice (       
,p]sonnel ,managem5t is sub/itut$ :]ev] 
! t]m ,secret>y is us$ 9 section        
#aabh;,a4  7e7 ,regulations ,not)/&+ any
 o!r provision ( law1 ! ,director %all  
initially implem5t ! am5dm5ts made by   
?is ,act ?r\gh int]im f9al regulations4 
7f7 ,rules ( con/ruction  7#a7 ,no?+ 9  
?is section %all be con/ru$ z prohibit+ 
paym5ts relat$ to reimbursem5t = +r$i5t 
co/s to entities t acquire prescription 
drugs or ph>macy disp5s+ fees4  7#b7    
,no?+ 9 ?is section %all be con/ru$ to  
prohibit rebates1 disc\nts1 or o!r price

 concessions f be+ fully pass$ ?r\gh to 
a heal? b5efits plan or c>ri] to l[] net
 co/s = prescription drugs4  4