,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ajedi  ,,9 ,,! ,,h\se ,,(         
,,repres5tatives  ,septemb] #bd1        
#bjbf,mr4 ,dunn ( ,florida 7= himself & 
,mr4 ,wilson ( ,s\? ,c>ol9a7 introduc$ !
 foll[+ bill2 :i* 0 ref]r$ to !         
,committee on ,en]gy & ,comm]ce  ,a     
,,bill  ,to am5d title ,,xxvii ( !      
,public ,heal? ,s]vice ,act to prohibit 
c]ta9 gr\p heal? plans & heal? insurance
 issu]s f limit+ *oice 9 specialty      
ph>macies4  #a4 ,%ort title  ,?is ,act  
may be cit$ z ! ,pati5ts ,*oice 9       
,specialty ,ph>macy ,act4  #b4          
,prohibit+ c]ta9 gr\p heal? plans &     
heal? insurance issu]s f limit+ *oice 9 
specialty ph>macies  7a7 ,9 g5]al       
,subp>t ,,ii ( "p ,a ( title ,,xxvii ( !
 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #cjj;gg-#aa et seq47 is am5d$ 
by add+ at ! end ! foll[+ new section3  
#bgcj4 ,prohibition on limit+ specialty 
ph>macy *oice  7a7 ,prohibition on /e]+ 
to affiliat$ specialty ph>macies ,a gr\p
 heal? plan 7o!r ?an a self-insur$ gr\p 

heal? plan7 or a heal? insurance issu]  
(f]+ gr\p or individual heal? insurance 
cov]age may n require1 /e]1 or induce an
 enrollee 9 ! plan or cov]age to obta9 a
 prescription drug = :i* b5efits are    
available "u ! plan or cov]age f an     
affiliat$ specialty ph>macy1 includ+    
by--  7#a7 impos+ high] co/ %>+1 includ+
 copaym5ts1 co9surance1 or d$uctibles1  
:5 su* drug is disp5s$ by a specialty   
ph>macy t is n an affiliat$ specialty   
ph>macy2  7#b7 (f]+ a disc\nt1 rebate1  
or o!r f9ancial inc5tive t is condition$
 on ! enrollee obta9+ su* drug f an     
affiliat$ specialty ph>macy2 or  7#c7   
impos+ a p5alty1 delay1 or o!r          
adm9i/rative burd5 on an enrollee 7or ! 
heal? c>e provid] prescrib+ su* drug to 
su* enrollee7 :o obta9s 7or directs su* 
enrollee to obta97 su* drug f a         
specialty ph>macy t is n an affiliat$   
specialty ph>macy4  7b7 ,limitation on  
exclud+ qualifi$ specialty ph>macies f  
network  7#a7 ,9 g5]al ,subject to      
p>agraph 7#b71 a gr\p heal? plan 7o!r   

?an a self-insur$ gr\p heal? plan7 or a 
heal? insurance issu] (f]+ gr\p or      
individual heal? insurance cov]age may n
 refuse to contract )1 or o!rwise       
exclude f ! network ( ! plan or cov]age1
 any specialty ph>macy t--  7,a7 is     
lic5s$ & 9 good /&+ "u ! laws ( ! ,/ate 
9 :i* x disp5ses ! drug2  7,b7 agrees to
 meet all t]ms & conditions ( network   
p>ticipation t are uni=mly appli$ to all
 specialty ph>macies 9 ! network ( !    
plan or cov]age1 :i* may include1 at !  
option ( ! plan or issu]1 a requirem5t t
 ! specialty ph>macy ma9ta9 accr$itation
 f a nationally recogniz$ accr$it+      
organization2 &  7,c7 is will+ to accept
 ! same reimbursem5t rates z o!r        
specialty ph>macies 9 ! network ( ! plan
 or cov]age4  7#b7 ,exclusion all[$ =   
good cause ,! requirem5t "u p>agraph    
7#a7 %all n apply ) respect to a gr\p   
heal? plan 7o!r ?an a self-insur$ gr\p  
heal? plan7 or a heal? insurance issu]  
(f]+ gr\p or individual heal? insurance 
cov]age & a specialty ph>macy 9 ! case  

t--  7,a7 su* specialty ph>macy-- 7i7   
has be5 convict$ "u ,f$]al or ,/ate law 
( an (f5se relat$ to fraud or abuse2 or 
7ii7 has be5 subject$ to discipl9>y     
action by a ,/ate bo>d ( ph>macy 9      
connection ) activities relat$ to fraud 
or abuse2  7,b7 su* specialty ph>macy   
has be5 exclud$ or susp5d$ f            
p>ticipation 9 ! ,m$ic>e program "u     
title ,,xviii ( ! ,social ,security     
,act1 or a ,/ate heal? c>e program 7z   
def9$ 9 section #aabh7;h7 ( su* ,act72  
or  7,c7 ! plan or issu] demon/rates to 
! ,/ate bo>d ( ph>macy or o!r compet5t  
regulatory au?ority t contract+ ) su*   
specialty ph>macy poses an imm95t risk (
 pati5t h>m4  7c7 ,def9itions ,9 ?is    
section3  7#a7 ,affiliat$ specialty     
ph>macy ,! t]m affiliat$ specialty      
ph>macy means1 ) respect to a gr\p heal?
 plan 7o!r ?an a self-insur$ gr\p heal? 
plan7 or a heal? insurance issu] (f]+   
gr\p or individual heal? insurance      
cov]age1 a specialty ph>macy-- 7,a7 )   
respect to :i* su* plan or issu] 7or an 

entity provid+ ph>macy b5efit managem5t 
s]vices on behalf ( su* plan or issu]7  
is a p]son ) an own]%ip or control      
int]e/ 7z def9$ 9 section #aabd7;a77#c7 
( ! ,social ,security ,act72 or  7,b7 ) 
respect to :i* su* plan or issu] 7or an 
entity provid+ ph>macy b5efit managem5t 
s]vices on behalf ( su* plan or issu]7  
o!rwise ex]cises 7directly or           
indirectly7 op]ational1 f9ancial1 or    
manag]ial control4  7#b7 ,nationally    
recogniz$ accr$it+ organization ,! t]m  
nationally recogniz$ accr$it+           
organization means--  7,a7 ! ,jo9t      
,commission on ,heal? ,c>e              
,organizations2  7,b7 ! ,utilization    
,review ,accr$itation ,commission2 or   
7,c7 ! ,accr$itation ,commission =      
,heal? ,c>e4  7#c7 ,specialty ph>macy ,!
 t]m specialty ph>macy means a ph>macy  
t--  7,a7 is lic5s$ & 9 good /&+ "u !   
laws ( ! ,/ate 9 :i* x disp5ses drugs2  
7,b7 disp5ses drugs t--  7i7 require    
h&l+1 /orage1 adm9i/ration1 or monitor+ 
exce$+ t cu/om>ily requir$ = mo/ retail 

prescription drugs2 or  7ii7 are us$ 9 !
 treatm5t ( complex1 exp5sive1 or r>e   
heal? conditions2 &  7,c7 has !         
capability1 consi/5t ) applicable ,/ate 
law1 to provide cl9ical & pati5t support
 s]vices appropriate to ! disp5s+ (     
drugs describ$ 9 subp>agraph 7,b71 :i*  
may include pati5t education1 adh]5ce   
support1 c>e coord9ation ) ! prescrib+  
provid]1 & monitor+ = adv]se ev5ts4  4  
7b7 ,effective date ,! am5dm5ts made by 
?is section %all apply ) respect to plan
 ye>s beg9n+ on or aft] ,janu>y #a1     
#bjbi4