,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #ddji  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #ae1 #bjbe,mr4  
,kri%namoor?i 7= himself & ,mrs4        
,h>%b>g]7 introduc$ ! foll[+ bill2 :i* 0
 ref]r$ to ! ,committee on ,ov]sight &  
,gov]nm5t ,re=m  ,a ,,bill  ,to prohibit
 ! common own]%ip ph>macy b5efit manag]s
 & ph>macies t provide s]vices "u       
contracts ) ,f$]al heal? plans = ,f$]al 
employees4  #a4 ,%ort title ,?is ,act   
may be cit$ z ! ,fair ,ph>macies =      
,f$]al ,employees ,act ( #bjbe4  #b4    
,prohibitions relat+ to anticompetitive 
ph>macy own]%ip & contracts  7a7        
,prohibition on ph>macy or ph>macy      
b5efit manag] own]%ip by entities       
provid+ insurance "u ,f$]al employee    
heal? plans ,x %all be unlawful = !     
,(fice ( ,p]sonnel ,managem5t to        
contract ) a ,f$]al employee heal?      
b5efit qualifi$ c>ri] :o--  7#a7        
directly or indirectly owns1 op]ates1   
controls1 or directs ! op]ation ( ! :ole
 or any "p ( a ph>macy2 or  7#b7        

directly or indirectly owns1 op]ates1 or
 controls ! :ole or any "p ( a ph>macy  
b5efit manag]1 or is directly or        
indirectly own$1 op]at$1 or has its     
op]ation direct$ by ! :ole or 9 any "p  
by a ph>macy b5efit manag]4  7b7        
,prohibition on ph>macy own]%ip by      
entities provid+ ph>macy b5efit         
managem5t s]vices "u ,f$]al employee    
heal? plans  ,x %all be unlawful ( !    
,(fice ( ,p]sonnel ,managem5t or a      
,f$]al employee heal? b5efit qualifi$   
c>ri] to contract or subcontract ) a    
ph>macy b5efit manag] :o directly or    
indirectly owns1 op]ates1 controls1 or  
directs ! op]ation ( ! :ole or any "p ( 
a ph>macy4  7c7 ,rule ( con/ruction     
,no?+ 9 ?is section %all be con/ru$ to  
limit ! au?ority ( ! ,f$]al ,trade      
,commission1 ! ,inspector ,g5]al ( !    
,dep>tm5t ( ,ju/ice1 ! ,dep>tm5t (      
,heal? & ,human ,s]vices1 or ! attorney 
g5]al ( a ,/ate "u any o!r provision (  
law4  7d7 ,def9itions ,9 ?is section3   
7#a7 ,heal? plan ,! t]m heal? plan means

 a gr\p insurance policy or contract1   
m$ical or hospital s]vice agreem5t1     
memb]%ip or subscription contract1 or   
simil> gr\p arrangem5t provid$ by a     
c>ri] = ! purpose ( provid+1 pay+ =1 or 
reimburs+ exp5ses = heal? s]vices4  7#b7
 ,p]son ,! t]m p]son has ! mean+ giv5 ! 
t]m 9 section #h ( ! ,%]man ,act 7#ae   
,u4,s4,c4 #g74  7#c7 ,ph>macy  7,a7 ,9  
g5]al ,! t]m ph>macy means any p]son1   
bus9ess1 or entity lic5s$1 regi/]$1 or  
o!rwise p]mitt$ by a ,/ate or a t]ritory
 ( ! ,unit$ ,/ates to disp5se1 deliv]1  
or di/ribute a controll$ sub/ance1      
prescription drug1 or o!r m$ication--   
7i7 to ! g5]al public2 or  7ii7 to a b$ 
pati5t = imm$iate adm9i/ration4  7,b7   
,inclusions ,! t]m ph>macy includes--   
7i7 a mail-ord] ph>macy2  7ii7 a        
specialty ph>macy2  7iii7 a retail      
ph>macy2  7iv7 a nurs+ home ph>macy2    
7v7 a long-t]m c>e ph>macy2  7vi7 a     
hospital ph>macy2  7vii7 an infusion or 
o!r outpati5t treatm5t ph>macy2  7viii7 
any organization ! ,national ,provid]   

,id5tifi] 7,,npi7 regi/ration ( :i* has 
#a or m taxonomy codes "u ! ph>macy     
section ( ! ,national ,uni=m ,claim     
,committee 7or a subsequ5t              
organization72 &  7ix7 any o!r type (   
ph>macy4  7#d7 ,ph>macy b5efit manag] ,!
 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 
su* p]son1 bus9ess1 or entity id5tifies 
itself z a ph>macy b5efit manag]1 t1    
ei!r directly or indirectly ?r\gh an    
int]m$i>y 7includ+ an affiliate1        
subsidi>y1 or ag5t7 or an arrangem5t ) a
 ?ird p>ty--  7,a7 acts z a negotiator (
 prices1 rebates1 fees1 or disc\nts =   
prescription drugs on behalf ( a heal?  
plan or heal? plan sponsor2  7,b7       
contracts ) ph>macies to create ph>macy 
networks & designs & manages su*        
networks2 or  7,c7 manages or adm9i/]s !
 prescription drug b5efits provid$ by a 
heal? plan1 includ+ ! process+ & paym5t 
( claims = prescription drugs1 arrang+  
alt]native access to or fund+ =         

prescription drugs1 ! p]=mance (        
utilization managem5t s]vices1 includ+  
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  7#e7       
,qualifi$ c>ri] ,! t]m qualifi$ c>ri]   
means a volunt>y association1           
corporation1 p>tn]%ip1 or o!r           
nongov]nm5tal organization :i* is       
lawfully engag$ 9 provid+1 pay+ =1 or   
reimburs+ ! co/ (1 heal? s]vices "u gr\p
 insurance policies or contracts1 m$ical
 or hospital s]vice agreem5ts1 memb]%ip 
or subscription contracts1 or simil>    
gr\p arrangem5ts1 9 consid]ation (      
premiums or o!r p]iodic *>ges payable to
 ! c>ri]1 includ+ a heal? b5efits plan  
duly sponsor$ or und]writt5 by an       
employee organization & an association (
 organizations or o!r entities describ$ 
9 ?is p>agraph sponsor+ a heal? b5efits 

plan4