,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #hggi  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,may #ac1 #bjbf,mrs4  
,h>%b>g] 7= h]self1 ,mr4 ,au*9closs1    
,mr4 ,c>t] ( ,georgia1 ,mr4 ,l&sman1    
,mr4 ,nehls1 & ,mr4 ,nadl]7 introduc$ ! 
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ! ,judici>y  ,a ,,bill    
,to prohibit ph>macy b5efit manag]s &   
ph>macies f be+ "u common own]%ip1 & =  
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,pati5ts ,be=e         
,monopolies ,act or ! ,,pbm ,act4  #b4  
,f9d+s ,! ,congress f9ds ! foll[+3  7#a7
 ,ph>macy b5efit manag]s are corporate  
entities t play a dom9ant role 9        
ph>maceutical supply *a9s1 det]m9+ :i*  
drugs heal? plans w cov] = enrollees1   
:at prices pati5ts & heal? plans w pay =
 ^? drugs1 & h[ mu* heal? plans w       
reimburse ph>macies = disp5s+ !m4  7#b7 
,! m>ket = ph>macy b5efit manag] s]vices
 has become highly conc5trat$4 ,z (     
#bjbe1 ! #f l>ge/ ph>macy b5efit manag]s
 are ea* integrat$ into l>ge heal? c>e  

conglom]ates t include d[n/ream         
bus9esses su* z retail1 mail ord]1 &    
specialty ph>macies4 ,^! conglom]ates   
also process$ m ?an #ij p]c5t ( !       
prescriptions 9 ! ,unit$ ,/ates 9 #bjbc4
  7#c7 ,! #c l>ge/ ph>macy b5efit       
manag]s are also v]tically integrat$    
into heal? c>e plat=ms t include bo?    
up/ream bus9ess l9es1 l heal? insurance1
 & d[n/ream suppli]s1 l ph>macies &     
provid]s4  7#d7 ,! ,f$]al ,trade        
,commission has f\nd t v]tically        
integrat$ ph>macy b5efit manag]s h bo? !
 ability & inc5tive to /e] bus9ess to _!
 own affiliat$ ph>macies1 :i* r$uces    
competition & increases prescription    
drug co/s = pati5ts4  7#e7 ,ph>macy     
b5efit manag]s increas+ly lev]age _!    
m>ket p[] to pressure small]1           
unaffiliat$1 indep5d5t ph>macies to ent]
 into unfavorable contracts ) ! l>ge/   
ph>macy b5efit manag]s4 ,?is dynamic has
 likely contribut$ to ! closure ( m ?an 
#g1jjj ph>macies betwe5 #bjai & #bjbd4  
7#f7 ,self-pref]5c+ ( affiliat$         

ph>macies may also all[ l>ge1 v]tically 
integrat$ heal? conglom]ates to evade   
/atutory limits on pr(its kn[n z !      
,m$ical ,loss ,ratio4 ,gam+ ( ! pr(it   
con/ra9t us+ transf] pric+ te*niques may
 all[ affiliat$ heal? insurance         
bus9esses to hide pr(its 9 ! unregulat$ 
ph>macy bus9ess segm5t1 co/+ enrollees &
 taxpay]s money4  7#g7 ,pursuant to its 
p[]s "u article ,i1 section #h1 ( !     
,unit$ ,/ates ,con/itution1 ,congress   
has ! ability to create any law necess>y
 & appropriate to regulate int]/ate     
comm]ce4 ,z ph>macy b5efit manag]s are  
"p ( l>ge1 national heal? conglom]ates t
 op]ate across /ate l9es1 & engage 9    
intra/ate activities t also sub/antially
 relate to int]/ate comm]ce1 ,congress  
int5ds to regulate ph>macy b5efit       
manag]s 9 ! public int]e/4  7#h7 ,9 ord]
 to elim9ate ! conflicts ( int]e/       
describ$ 9 p>agraphs 7#a7 ?r\gh 7#g7 &  
re/ore competition to ! m>ketplace1 !   
,f$]al ,gov]nm5t %\ld--  7,a7 protect   
pati5ts1 indep5d5t ph>macies1 & taxpay]s

 by /ructurally sep>at+ v]tically       
integrat$ heal? conglom]ates2  7,b7     
require p>5t companies t own a ph>macy  
b5efit manag] or insur] to dive/ _!     
ph>macy bus9esses2  7,c7 enable ,f$]al  
ag5cies1 /ate attorneys g5]al1 & private
 citiz5s to br+ civil actions to en=ce !
 /ructural sep>ation ( ^! companies2 &  
7,d7 grant ! ,f$]al ,trade ,commission &
 ,dep>tm5t ( ,ju/ice additional au?ority
 to review & block future transactions t
 w\ld re-create ^! conflicts ( int]e/4  
#c4 ,prohibitions relat+ to             
anticompetitive ph>macy own]%ip &       
contracts  7a7 ,prohibition on ph>macy  
own]%ip by entities provid+ insurance or
 ph>macy b5efit managem5t s]vices  7#a7 
,9 g5]al ,x %all be unlawful = any p]son
 to bo?-- 7,a7 directly or indirectly   
own1 op]ate1 control1 or direct !       
op]ation ( ! :ole or any "p ( a ph>macy2
 &  7,b7 directly or indirectly own1    
op]ate1 or control ! :ole or any "p (-- 
7i7 an insurance company2 or  7ii7 a    
ph>macy b5efit manag]4  7#b7 ,dive/m5t  

,n lat] ?an #a ye> aft] ! date (        
enactm5t ( ?is ,act1 any p]son 9        
violation ( p>agraph 7#a7 %all dive/ !  
ph>macy ( su* p]son4  7b7 ,antitru/     
en=cem5t  7#a7 ,9 g5]al ,bo? ! ,f$]al   
,trade ,commission & ! ,assi/ant        
,attorney ,g5]al 9 *>ge ( ! ,antitru/   
,division %all h jurisdiction1 jo9tly or
 sep>ately1 to en=ce ?is section4  7#b7 
,p5alties = failure to dive/  7,a7      
,guidance ,n lat] ?an #cj days aft] !   
date ( enactm5t ( ?is ,act1 ! ,*air ( ! 
,f$]al ,trade ,commission & ! ,assi/ant 
,attorney ,g5]al 9 *>ge ( ! ,antitru/   
,division %all issue guidance specify+  
mile/ones = dive/m5t )9 ! deadl9e "u    
subsection 7a77#b74  7,b7 ,p5alties  7i7
 ,9 g5]al ,= any p]son t does n comply )
 ! mile/ones specifi$ "u subp>agraph    
7,a71 ! ,*air ( ! ,f$]al ,trade         
,commission or ! ,assi/ant ,attorney    
,g5]al 9 *>ge ( ! ,antitru/ ,division   
%all cause #aj p]c5t ( ! pr(its ( !     
p]son to be transf]r$ into escr[ on a   
mon?ly basis1 to be-- 7,i7 return$ to ! 

p]son if dive/m5t occurs by ! deadl9e "u
 subsection 7a77#b72 or  7,,ii7 deposit$
 into ! fund describ$ 9 subsection      
7c77#g7 if dive/m5t does n occur by !   
deadl9e "u subsection 7a77#b74  7,c7    
,tru/ee ,if dive/iture does n occur by !
 deadl9e "u subsection 7a77#b71 a       
dive/iture tru/ee %all ov]see !         
dive/iture requir$ "u t p>agraph4 ,!    
dive/iture tru/ee %all h ! au?ority to  
sell ! ph>macy4  7c7 ,civil actions     
7#a7 ,9 g5]al ,:5 ! ,inspector ,g5]al ( 
! ,dep>tm5t ( ,heal? & ,human ,s]vices1 
! ,assi/ant ,attorney ,g5]al 9 *>ge ( ! 
,antitru/ ,division ( ! ,dep>tm5t (     
,ju/ice1 ! ,f$]al ,trade ,commission1 or
 an attorney g5]al ( a ,/ate has reason 
to believe t a p]son is 9 violation (   
subsection 7a71 su* ,inspector ,g5]al1  
,assi/ant ,attorney ,g5]al1 ,f$]al      
,trade ,commission or attorney g5]al ( a
 ,/ate may br+ a civil action 9 an      
appropriate di/rict c\rt ( ! ,unit$     
,/ates4  7#b7 ,private "r ( action  7,a7
 ,9 g5]al ,an individual alleg+ damages 

z a result ( a violation ( ?is ,act may 
br+ a civil action 9 any c\rt ( compet5t
 jurisdiction1 ,/ate or ,f$]al4  7,b7   
,relief ,9 a civil action br\ght "u     
subp>agraph 7,a7 9 :i* ! pla9tiff       
prevails1 ! c\rt may aw>d-- 7i7 treble  
damages2  7ii7 reasonable attorney's    
fees & litigation co/s2 &  7iii7 any o!r
 relief1 includ+ equitable or decl>atory
 relief1 t ! c\rt det]m9es appropriate4 
7#c7 ,actions by ,/ate attorneys g5]al  
,if ! attorney g5]al ( a ,/ate has      
reason to believe t an int]e/ ( !       
resid5ts ( ! ,/ate has be5 or is be+    
?reat5$ or adv]sely affect$ by a        
practice t violates subsection 7a71 !   
attorney g5]al ( ! ,/ate may1 z p>5s    
patriae1 br+ a civil action on behalf ( 
! resid5ts ( ! ,/ate 9 an appropriate   
di/rict c\rt ( ! ,unit$ ,/ates to obta9 
appropriate relief1 includ+ monet>y     
damages4  7#d7 ,injunctive & equitable  
relief ,9 any action describ$ 9 p>agraph
 7#a71 7#b71 or 7#c71 ! applicable c\rt1
 on a f9d+ t a p]son is 9 violation (   

subsection 7a71 %all issue an ord]      
requir+ su* p]son--  7,a7 to cease &    
desi/ f su* violation1 &1 if applicable1
 dive/ ! ph>macy s]vices ( su* p]son2 & 
7,b7 to disgorge any rev5ue receiv$ f ! 
ph>macy f ! sale ( prescription drugs   
dur+ ! p]iod ( su* violation4  7#e7 ,o!r
 relief ,9 addition to any relief obta9$
 "u p>agraph 7#a71 7#b71 or 7#c71 ! c\rt
 may grant any o!r equitable relief     
necess>y to r$ress & prev5t recurr5ce ( 
! violation4  7#f7 ,"r to jury trial    
,ei!r p>ty1 ^u reque/1 %all h ! "r to a 
jury trial4  7#g7 ,deposit ,any rev5ue  
receiv$ f ! sale ( prescription drugs   
disgorg$ pursuant to an action "u       
p>agraph 7#a7 %all be deposit$ 9 a fund 
creat$ by ! ,f$]al ,trade ,commission & 
di/ribut$ by ! ,f$]al ,trade ,commission
 to be put to use 9 ! int]e/ ( s]v+ !   
heal? c>e ne$s ( ! h>m$ community1      
includ+ consum]s ov]*>g$ at v]tically   
integrat$ ph>macies4  7d7 ,,ftc & ,,doj 
review  7#a7 ,report+ requir$ ,any      
dive/m5t ( a ph>macy or ph>macy b5efit  

manag] requir$ "u subsection 7a7 %all be
 report$ to ! ,f$]al ,trade ,commission 
& ! ,assi/ant ,attorney ,g5]al 9 *>ge ( 
! ,antitru/ ,division ( ! ,dep>tm5t (   
,ju/ice "u section #g;,a ( ! ,clayton   
,act 7#ae ,u4,s4,c4 #ah;a7 )\t respect  
to ! ?re%olds "u subsection 7a77#b7 ( t 
section4  7#b7 ,toll+ ( dive/m5t p]iod  
dur+ review ,! dive/m5t p]iod "u        
subsection 7a7 %all be toll$ dur+ !     
p5d5cy ( any wait+ p]iod requir$ "u     
section #g;,a ( ! ,clayton ,act 7#ae    
,u4,s4,c4 #ah;a74  7#c7 ,review ( effect
 ( dive/iture ,) respect to ea*         
dive/iture und]tak5 pursuant to         
subsection 7a71 9 addition to any       
applicable review "u section #g;,a ( !  
,clayton ,act 7#ae ,u4,s4,c4 #ah;a71 !  
,f$]al ,trade ,commission & ! ,assi/ant 
,attorney ,g5]al 9 *>ge ( ! ,antitru/   
,division ( ! ,dep>tm5t ( ,ju/ice %all  
review ! effect on competition1 f9ancial
 viability1 & ! public int]e/--  7,a7 ( 
! dive/iture2 &  7,b7 ( ! subsequ5t     
acquisition ( ! dive/$ ph>macy by !     

acquir+ p]son4  7#d7 ,block+ ( actions  
,! ,f$]al ,trade ,commission & !        
,assi/ant ,attorney ,g5]al 9 *>ge ( !   
,antitru/ ,division ( ! ,dep>tm5t (     
,ju/ice1 jo9tly or sep>ately1 may br+ a 
civil action 9 any c\rt ( compet5t      
jurisdiction to block any action t w\ld 
h>m competition to ! detrim5t ( ! public
 int]e/ ) respect to ! conflicts (      
int]e/ describ$ 9 subsection 7a74  7e7  
,rulemak+ au?ority ,! ,f$]al ,trade     
,commission %all promulgate rules to    
c>ry out ?is section4 ,su* rules %all n 
dim9i% any obligation "u ?is section4   
7f7 ,reports requir$ ,! ,*air ( ! ,f$]al
 ,trade ,commission & ! ,assi/ant       
,attorney ,g5]al 9 *>ge ( ! ,antitru/   
,division ( ! ,dep>tm5t ( ,ju/ice %all  
submit to ! appropriate congressional   
committees qu>t]ly reports on compliance
 ) ?is ,act1 includ+ ! /atus ( any      
dive/itures requir$ "u ?is ,act4  7g7   
,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  7h7 ,sev]ability ,if  
any provision ( ?is ,act or !           
application !re( to any p]son or        
circum/ance is held invalid1 ! rema9d] (
 ?is ,act1 or ! application ( t         
provision to p]sons or circum/ances o!r 
?an ^? z to :i* x is held invalid1 %all 
n be affect$ !reby4  7i7 ,def9itions ,9 
?is section3  7#a7 ,heal? plan ,! t]m   
heal? plan means any public or private  
heal? insurance plan4  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