II 

118TH CONGRESS 

2D SESSION S. 5503 

To prohibit pharmacy benefit managers and pharmacies from being under 

common ownership, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 12, 2024 

Ms. WARREN (for herself and Mr. HAWLEY) introduced the following bill; 

which was read twice and referred to the Committee on the Judiciary 

A BILL 

To prohibit pharmacy benefit managers and pharmacies from 

being under common ownership, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Patients Before Mo5 nopolies Act’’ or the ‘‘PBM Act’’. 

6 SEC. 2. PROHIBITIONS RELATING TO ANTICOMPETITIVE 

7 PHARMACY OWNERSHIP AND CONTRACTS. 

8 (a) PROHIBITION ON PHARMACY OWNERSHIP BY EN9 TITIES PROVIDING INSURANCE OR PHARMACY BENEFIT

10 MANAGEMENT SERVICES.— 


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•S 5503 IS

1 (1) IN GENERAL.—It shall be unlawful for any 

2 person to both— 

3 (A) directly or indirectly own, operate, con4 trol, or direct the operation of the whole or any 

5 part of a pharmacy; and 

6 (B) directly or indirectly own, operate, or 

7 control the whole or any part of— 

8 (i) an insurance company; or 

9 (ii) a pharmacy benefit manager. 

10 (2) DIVESTMENT.—Not later than 3 years after 

11 the date of enactment of this Act, any person in vio12 lation of paragraph (1) shall divest the pharmacy of 

13 such person. 

14 (b) CIVIL ACTIONS.— 

15 (1) IN GENERAL.—When the Inspector General 

16 of the Department of Health and Human Services, 

17 the Assistant Attorney General in charge of the 

18 Antitrust Division of the Department of Justice, the 

19 Federal Trade Commission, or an attorney general 

20 of a State has reason to believe that a person is in 

21 violation of subsection (a), such Inspector General, 

22 Assistant Attorney General, Federal Trade Commis23 sion or attorney general of a State may bring a civil 

24 action in an applicable district court of the United 

25 States for the relief described in paragraph (2). 


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1 (2) INJUNCTIVE AND EQUITABLE RELIEF.—In 

2 any action described in paragraph (1), the applicable 

3 court, on a finding that a person is in violation of 

4 subsection (a), shall issue an order requiring such 

5 person— 

6 (A) to cease and desist from such violation, 

7 and, if applicable, divest the pharmacy services 

8 of such person; and 

9 (B) to disgorge any revenue received from 

10 the pharmacy from the sale of prescription 

11 drugs during the period of such violation. 

12 (3) OTHER RELIEF.—In addition to any relief 

13 obtained under paragraph (2), the court may grant 

14 any other equitable relief necessary to redress and 

15 prevent recurrence of the violation. 

16 (4) DEPOSIT.—Any revenue received from the 

17 sale of prescription drugs disgorged pursuant to an 

18 action under this subsection shall be deposited in a 

19 fund created by the Federal Trade Commission and 

20 distributed by the Federal Trade Commission to be 

21 put to use in the interest of serving the health care 

22 needs of the harmed community, including con23 sumers overcharged at vertically integrated phar24 macies. 

25 (c) FTC REVIEW.— 


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1 (1) REPORTING REQUIRED.—Any divestment of 

2 a pharmacy or pharmacy benefit manager required 

3 under subsection (a) shall be reported to the Federal 

4 Trade Commission and the Assistant Attorney Gen5 eral in charge of the Antitrust Division of the De6 partment of Justice under section 7A of the Clayton 

7 Act (15 U.S.C. 18a) without respect to the thresh8 olds under subsection (a)(2) of that section. 

9 (2) TOLLING OF DIVESTMENT PERIOD DURING

10 REVIEW.—The divestment period under subsection 

11 (a) shall be tolled during the pendency of any wait12 ing period required under section 7A of the Clayton 

13 Act (15 U.S.C. 18a). 

14 (3) REVIEW OF EFFECT OF DIVESTITURE.— 

15 With respect to each divestiture undertaken pursu16 ant to subsection (a), in addition to any applicable 

17 review under section 7A of the Clayton Act (15 

18 U.S.C. 18a), the Federal Trade Commission and the 

19 Assistant Attorney General in charge of the Anti20 trust Division of the Department of Justice shall re21 view the effect on competition, financial viability, 

22 and the public interest— 

23 (A) of the divestiture; and 

24 (B) of the subsequent acquisition of the di25 vested pharmacy by the acquiring person. 


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1 (d) RULEMAKING AUTHORITY.—The Federal Trade 

2 Commission shall promulgate rules to carry out this sec3 tion. Such rules shall not diminish any obligation under 

4 this section. 

5 (e) RULE OF CONSTRUCTION.—Nothing in this sec6 tion shall be construed to limit the authority of the Fed7 eral Trade Commission, the Inspector General of the De8 partment of Justice, the Department of Health and 

9 Human Services, or the attorney general of a State under 

10 any other provision of law. 

11 (f) DEFINITIONS.—In this section: 

12 (1) HEALTH PLAN.—The term ‘‘health plan’’ 

13 means any public or private health insurance plan. 

14 (2) PERSON.—The term ‘‘person’’ has the 

15 meaning given the term in section 8 of the Sherman 

16 Act (15 U.S.C. 7). 

17 (3) PHARMACY.— 

18 (A) IN GENERAL.—The term ‘‘pharmacy’’ 

19 means any person, business, or entity licensed, 

20 registered, or otherwise permitted by a State or 

21 a territory of the United States to dispense, de22 liver, or distribute a controlled substance, pre23 scription drug, or other medication— 

24 (i) to the general public; or 


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1 (ii) to a bed patient for immediate ad2 ministration. 

3 (B) INCLUSIONS.—The term ‘‘pharmacy’’ 

4 includes— 

5 (i) a mail-order pharmacy; 

6 (ii) a specialty pharmacy; 

7 (iii) a retail pharmacy; 

8 (iv) a nursing home pharmacy; 

9 (v) a long-term care pharmacy; 

10 (vi) a hospital pharmacy; 

11 (vii) an infusion or other outpatient 

12 treatment pharmacy; 

13 (viii) any organization the National 

14 Provider Identifier (NPI) registration of 

15 which has 1 or more taxonomy codes under 

16 the pharmacy section of the National Uni17 form Claim Committee (or a subsequent 

18 organization); and 

19 (ix) any other type of pharmacy. 

20 (4) PHARMACY BENEFIT MANAGER.—The term 

21 ‘‘pharmacy benefit manager’’ means any person, 

22 business, or other entity, such as a third-party ad23 ministrator, regardless of whether such person, busi24 ness, or entity identifies itself as a pharmacy benefit 

25 manager, that, either directly or indirectly through 


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1 an intermediary (including an affiliate, subsidiary, 

2 or agent) or an arrangement with a third party— 

3 (A) acts as a negotiator of prices, rebates, 

4 fees, or discounts for prescription drugs on be5 half of a health plan or health plan sponsor; 

6 (B) contracts with pharmacies to create 

7 pharmacy networks and designs and manages 

8 such networks; or 

9 (C) manages or administers the prescrip10 tion drug benefits provided by a health plan, in11 cluding the processing and payment of claims 

12 for prescription drugs, arranging alternative ac13 cess to or funding for prescription drugs, the 

14 performance of utilization management services, 

15 including drug utilization review, the processing 

16 of drug prior authorization requests, the adju17 dication of appeals or grievances related to the 

18 prescription drug benefit, contracting with net19 work pharmacies, controlling the cost of covered 

20 prescription drugs, or the provision of related 

21 services. 

Æ 


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