,,ii  #aah? ,,congress  #a/ ,session    
,s4 #aedb  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #aj1 #bjbc,mr4    
,m>%all 7= himself1 ,mr4 ,te/]1 ,mr4    
,braun1 ,mr4 ,ka9e1 & ,mrs4 ,capito7    
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,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 n *>ge or    
receive fees f any entity = s]vices     
provid$ to su* entity4  7b7 ,exception =

 flat s]vice fees  7#a7 ,9 g5]al ,a     
ph>macy b5efit manag] may *>ge an entity
 a flat s]vice fee = ! provision (      
s]vices to su* entity if su* fee is set 
=? 9 an agreem5t betwe5 ! ph>macy b5efit
 manag] & su* entity4  7#b7 ,def9itions 
,9 ?is section-- 7,a7 ! t]m flat s]vice 
fee means a flat doll> am\nt t is n     
directly or indirectly bas$ on1 or      
cont+5t ^u1 or o!rwise relat$ to-- 7i7 a
 drug price 7su* z :olesale acquisition 
co/7 or drug b5*m>k price 7su* z av]age 
:olesale price72  7ii7 disc\nts1        
rebates1 fees1 or o!r remun]ation )     
respect to prescription drugs prescrib$ 
to ! p>ticipants1 b5efici>ies1 or       
enrollees 9 ! gr\p heal? plan or cov]age
 involv$2 or  7iii7 any o!r am\nts      
specifi$ by ! ,secret>y1 ! ,secret>y (  
,labor1 & ! ,secret>y ( ! ,treasury2 &  
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$i>y 7includ+ an affiliate1    
subsidi>y1 or ag5t7 or an arrangem5t ) a
 ?ird p>ty-- 7i7 acts z a price         
negotiator = prescription drugs on      
behalf ( a gr\p heal? plan or heal?     
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age2 or  7ii7       
manages or adm9i/]s ! prescription drug 
b5efits provid$ 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 manag]    
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

 ,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#c7  
,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 implem5t ?is    
section ?r\gh int]im f9al regulations4  
4  7b7 ,employee ,retirem5t ,income     
,security ,act ( #aigd  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      

,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 n *>ge or receive fees f any entity
 = s]vices provid$ to su* entity4  7b7  
,exception = flat s]vice fees  7#a7 ,9  
g5]al ,a ph>macy b5efit manag] may *>ge 
an entity a flat s]vice fee = !         
provision ( s]vices to su* entity if su*
 fee is set =? 9 an agreem5t betwe5 !   
ph>macy b5efit manag] & su* entity4     
7#b7 ,def9itions ,9 ?is section-- 7,a7 !
 t]m flat s]vice fee means a flat doll> 
am\nt t is n directly or indirectly bas$
 on1 or cont+5t ^u1 or o!rwise relat$   
to-- 7i7 a drug price 7su* z :olesale   
acquisition co/7 or drug b5*m>k price   
7su* z av]age :olesale price72  7ii7    
disc\nts1 rebates1 fees1 or o!r         
remun]ation ) respect to prescription   
drugs prescrib$ to p>ticipants or       
b5efici>ies 9 ! gr\p heal? plan or      
cov]age involv$2 or  7iii7 any o!r      
am\nts specifi$ by ! ,secret>y1 !       
,secret>y ( ,heal? & ,human ,s]vices1 & 

! ,secret>y ( ! ,treasury2 &  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
 ,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#c7  
,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 implem5t ?is    
section ?r\gh int]im f9al regulations4  
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  7#a7 ,9 g5]al ,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 ,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 n *>ge or    
receive fees f any entity = s]vices     
provid$ to su* entity4  7b7 ,exception =
 flat s]vice fees  7#a7 ,9 g5]al ,a     
ph>macy b5efit manag] may *>ge an entity
 a flat s]vice fee = ! provision (      
s]vices to su* entity if su* fee is set 
=? 9 an agreem5t betwe5 ! ph>macy b5efit
 manag] & su* entity4  7#b7 ,def9itions 
,9 ?is section-- 7,a7 ! t]m flat s]vice 
fee means a flat doll> am\nt t is n     
directly or indirectly bas$ on1 or      
cont+5t ^u1 or o!rwise relat$ to-- 7i7 a

 drug price 7su* z :olesale acquisition 
co/7 or drug b5*m>k price 7su* z av]age 
:olesale price72  7ii7 disc\nts1        
rebates1 fees1 or o!r remun]ation )     
respect to prescription drugs prescrib$ 
to p>ticipants or b5efici>ies 9 ! gr\p  
heal? plan or cov]age involv$2 or  7iii7
 any o!r am\nts specifi$ by ! ,secret>y1
 ! ,secret>y ( ,labor1 & ! ,secret>y (  
,heal? & ,human ,s]vices2 &  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 or 
7,c7 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
 ,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#c7  
,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 implem5t !      
am5dm5ts made by ?is ,act ?r\gh int]im  
f9al regulations4  4