,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #bbad  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,m>* #ah1 #bjbe,mrs4  
,mill]-,meeks 7= h]self1 ,ms4 ,b>ragn1  
,ms4 ,malliotakis1 ,mr4 ,s*neid]1 ,mr4  
,all51 & ,mr4 ,norcross7 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      
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 ,9 g5]al ,beg9n+ on ,janu>y #a1     
#bjbg1 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 drug  
b5efits "u a gr\p heal? plan or gr\p or 
individual heal? insurance cov]age4  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 only 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 is a flat doll>      
am\nt2 &  7,b7 is n 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 heal? insurance   
cov]age involv$2 or  7iii7 any o!r      
am\nts specifi$ by ! ,secret>y1 !       
,secret>y ( ,labor1 & ! ,secret>y ( !   
,treasury2  7#b7 ,def9itions ,9 ?is     
section--  7,a7 ! t]m bona fide s]vice  
fee means a fee t is equal to ! fair    
m>ket value ( a bona fide1 itemiz$      
s]vice t is actually p]=m$ on behalf (  
an entity1 t ! entity w\ld o!rwise p]=m 
7or contract =7 9 ! abs5ce ( ! s]vice   
arrangem5t1 & t is 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 entity1 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 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+ creat+ =mul>ies1 ! 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>macies 7includ+  
retail & mail ph>macies71 controll+ !   
co/ ( cov]$ prescription drugs1 or !    
provision ( relat$ s]vices4  7c7        
,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] f su* plan or issu] 9 violation (
 subsection 7a7 or1 pursuant to         
subsection 7b71 ! agreem5t ent]$ into ) 
su* plan or issu] = bona fide s]vice    
fees4  7#c7 ,p5alties ,a ph>macy b5efit 
manag] t violates subsection 7a7 or 7b7 
%all be subject to a civil monet>y      
p5alty 9 ! am\nt ( #aj1jjj = ea* day    
dur+ :i* su* violation cont9ues4  7#d7  
,proc$ure ,not)/&+ section #bgbc1 !     
provisions ( section #aabh;,a ( !       
,social ,security ,act1 o!r ?an         
subsection 7a7 & 7b7 & ! fir/ s5t5ce (  
subsection 7c77#a7 ( su* section1 %all  
apply to civil monet>y p5alties "u ?is  
subsection 9 ! same mann] z su*         
provisions apply to a p5alty or proce$+ 
"u section #aabh;,a ( ! ,social         
,security ,act4  7d7 ,regulations       
,not)/&+ any o!r provision ( law1 !     
,secret>y1 9 consultation ) ! ,secret>y 
( ,labor & ! ,secret>y ( ! ,treasury1   
%all implem5t ?is section ?r\gh int]im  

f9al regulations4  7e7 ,rules (         
con/ruction ,no?+ 9 ?is section %all be 
con/ru$--  7#a7 z prohibit+ paym5ts     
relat$ to reimbursem5t = +r$i5t co/s to 
entities t acquire prescription drugs or
 ph>macy disp5s+ fees2 &  7#b7 to       
prohibit rebates1 disc\nts1 or o!r price
 concessions f be+ fully pass$ ?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 ,g5]al ,beg9n+ on   
,janu>y #a1 #bjbg1 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   
drug b5efits "u a gr\p heal? plan or    

gr\p heal? insurance cov]age4  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 an entity only 
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 is a flat doll> am\nt2 &     
7,b7 is n 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 heal? insurance cov]age        
involv$2 or  7iii7 any o!r am\nts       
specifi$ by ! ,secret>y1 ! ,secret>y (  
,heal? & ,human ,s]vices1 & ! ,secret>y 
( ! ,treasury4  7#b7 ,def9itions ,9 ?is 
section-- 7,a7 ! t]m bona fide s]vice   
fee means a fee t is equal to ! fair    

m>ket value ( a bona fide1 itemiz$      
s]vice t is actually p]=m$ on behalf (  
an entity1 t ! entity w\ld o!rwise p]=m 
7or contract =7 9 ! abs5ce ( ! s]vice   
arrangem5t1 & t is 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 entity1 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$i>y 7includ+ an affiliate1        
subsidi>y1 or ag5t7 or an arrangem5t ) a
 ?ird-p>ty-- 7i7 acts a price negotiator
 = prescription drugs on behalf ( a gr\p
 heal? plan or heal? insurance issu]    
(f]+ gr\p heal? insurance cov]age2 or   
7ii7 manages or adm9i/]s ! prescription 
drug b5efits provid$ by a gr\p heal?    
plan or heal? insurance issu] (f]+ gr\p 
heal? insurance cov]age1 includ+ creat+ 
=mul>ies1 ! 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>macies  
7includ+ retail & mail ph>macies71      
controll+ ! co/ ( cov]$ prescription    
drugs1 or ! provision ( relat$ s]vices4 
7c7 ,en=cem5t ,! ,secret>y %all en=ce   
?is section z provid$ = 9 section       
#ejb7;c77#ac74  7d7 ,regulations        
,not)/&+ any o!r provision ( law1 !     
,secret>y1 9 consultation ) ! ,secret>y 
( ,heal? & ,human ,s]vices & ! ,secret>y
 ( ! ,treasury1 %all implem5t ?is       
section ?r\gh int]im f9al regulations4  
7e7 ,rules ( con/ruction ,no?+ 9 ?is    
section %all be con/ru$--  7#a7 z       
prohibit+ paym5ts relat$ to reimbursem5t
 = +r$i5t co/s to entities t acquire    
prescription drugs or ph>macy disp5s+   
fees2 &  7#b7 to prohibit rebates1      
disc\nts1 or o!r price concessions f be+
 fully pass$ ?r\gh to a gr\p heal? plan 
or heal? insurance issu] (f]+ gr\p heal?

 insurance cov]age to l[] net co/s =    
prescription drugs4  4  7#b7 ,en=cem5t  
,section #ejb ( ! ,employee ,retirem5t  
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aacb7 is am5d$-- 7,a7 9      
subsection 7a77#f71 by /rik+ or 7#i7 &  
ins]t+ 7#i71 or 7#ac72 &  7,b7 9        
subsection 7c71 by add+ at ! end !      
foll[+3  7#ac7 ,secret>ial en=cem5t     
au?ority relat+ to ph>macy b5efit manag]
 s]vices  7,a7 ,disgorgem5t ,) respect  
to a violation ( section #gbf by a      
ph>macy b5efit manag]1 su* ph>macy      
b5efit manag] %all disgorge to a gr\p   
heal? plan or heal? insurance issu] (f]+
 gr\p heal? insurance cov]age any       
paym5t1 remun]ation1 or o!r am\nt       
receiv$ by ! ph>macy b5efit manag] or an
 affiliate ( su* ph>macy b5efit manag] f
 su* plan or issu] 9 violation (        
subsection 7a7 ( su* section or1        
pursuant to subsection 7b7 ( su*        
section1 ! agreem5t ent]$ into ) su*    
plan or issu] = bona fide s]vice fees4  
7,b7 ,p5alties ,a ph>macy b5efit manag] 

t violates subsection 7a7 or 7b7 (      
section #gbf %all be subject to a civil 
monet>y p5alty 9 ! am\nt ( #aj1jjj = ea*
 day dur+ :i* su* violation cont9ues4   
7,c7 ,proc$ure ,except z provid$ 9 ?is  
p>agraph1 ! provisions ( ?is section    
%all apply to civil monet>y p5alties "u 
?is p>agraph 9 ! same mann] z su*       
provisions apply to o!r civil p5alties  
"u ?is section4  7,d7 ,rule (           
con/ruction ,no?+ 9 ?is p>agraph %all   
effect ! au?ority ( ! ,secret>y "u      
subsection 7a77#e74  4  7#c7 ,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  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 ,9   

g5]al ,beg9n+ on ,janu>y #a1 #bjbg1     
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 drug  
b5efits "u a gr\p heal? plan4  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 only
 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 is a flat doll> am\nt2 &     
7,b7 is n 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 involv$2 or  7iii7 any o!r am\nts 

specifi$ by ! ,secret>y1 ! ,secret>y (  
,heal? & ,human ,s]vices1 & ! ,secret>y 
( ! ,labor4  7#b7 ,def9itions ,9 ?is    
section-- 7,a7 ! t]m bona fide s]vice   
fee means a fee t is equal to ! fair    
m>ket value ( a bona fide1 itemiz$      
s]vice t is actually p]=m$ on behalf (  
an entity1 t ! entity w\ld o!rwise p]=m 
7or contract =7 9 ! abs5ce ( ! s]vice   
arrangem5t1 & t is 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$i>y 7includ+ an affiliate1        
subsidi>y1 or ag5t7 or an arrangem5t ) a
 ?ird-p>ty-- 7i7 acts z a price         
negotiator = prescription drugs on      
behalf ( a gr\p heal? plan2 or  7ii7    
manages or adm9i/]s ! prescription drug 
b5efits provid$ by a gr\p heal? plan1   
includ+ creat+ =mul>ies1 ! 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        
,en=cem5t  7#a7 ,9 g5]al ,! ,secret>y1 9
 consultation ) ! ,secret>y ( ,heal? &  
,human ,s]vices & ! ,secret>y ( ,labor1 
%all en=ce ?is section4  7#b7           
,disgorgem5t ,! ph>macy b5efit manag]   
%all disgorge to a gr\p heal? plan any  
paym5t1 remun]ation1 or o!r am\nt       
receiv$ by ! ph>macy b5efit manag] or an
 affiliate ( su* ph>macy b5efit manag] f
 su* plan or issu] 9 violation (        
subsection 7a7 or1 pursuant to          
subsection 7b71 ! agreem5t ent]$ into ) 
su* plan = bona fide s]vice fees4  7#c7 
,p5alties ,a ph>macy b5efit manag] t    
violates subsection 7a7 or 7b7 %all be  

subject to a civil monet>y p5alty 9 !   
am\nt ( #aj1jjj = ea* day dur+ :i* su*  
violation cont9ues4  7#d7 ,proc$ure ,!  
provisions ( section #aabh;,a ( !       
,social ,security ,act1 o!r ?an         
subsection 7a7 & 7b7 & ! fir/ s5t5ce (  
subsection 7c77#a7 ( su* section1 %all  
apply to civil monet>y p5alties "u ?is  
subsection 9 ! same mann] z su*         
provisions apply to a p5alty or proce$+ 
"u section #aabh;,a ( ! ,social         
,security ,act4  7d7 ,regulations       
,not)/&+ any o!r provision ( law1 !     
,secret>y1 9 consultation ) ! ,secret>y 
( ,heal? & ,human ,s]vices & ! ,secret>y
 ( ,labor1 %all implem5t ?is section    
?r\gh int]im f9al regulations4  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 ,improv+ ph>macy b5efit manag]   
s]vices4  4