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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 5503 Introduced in Senate (IS)]

<DOC>

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Patients Before Monopolies Act'' or 
the ``PBM Act''.

SEC. 2. PROHIBITIONS RELATING TO ANTICOMPETITIVE PHARMACY OWNERSHIP AND 
              CONTRACTS.

    (a) Prohibition on Pharmacy Ownership by Entities Providing 
Insurance or Pharmacy Benefit Management Services.--
            (1) In general.--It shall be unlawful for any person to 
        both--
                    (A) directly or indirectly own, operate, control, 
                or direct the operation of the whole or any part of a 
                pharmacy; and
                    (B) directly or indirectly own, operate, or control 
                the whole or any part of--
                            (i) an insurance company; or
                            (ii) a pharmacy benefit manager.
            (2) Divestment.--Not later than 3 years after the date of 
        enactment of this Act, any person in violation of paragraph (1) 
        shall divest the pharmacy of such person.
    (b) Civil Actions.--
            (1) In general.--When the Inspector General of the 
        Department of Health and Human Services, the Assistant Attorney 
        General in charge of the Antitrust Division of the Department 
        of Justice, the Federal Trade Commission, or an attorney 
        general of a State has reason to believe that a person is in 
        violation of subsection (a), such Inspector General, Assistant 
        Attorney General, Federal Trade Commission or attorney general 
        of a State may bring a civil action in an applicable district 
        court of the United States for the relief described in 
        paragraph (2).
            (2) Injunctive and equitable relief.--In any action 
        described in paragraph (1), the applicable court, on a finding 
        that a person is in violation of subsection (a), shall issue an 
        order requiring such person--
                    (A) to cease and desist from such violation, and, 
                if applicable, divest the pharmacy services of such 
                person; and
                    (B) to disgorge any revenue received from the 
                pharmacy from the sale of prescription drugs during the 
                period of such violation.
            (3) Other relief.--In addition to any relief obtained under 
        paragraph (2), the court may grant any other equitable relief 
        necessary to redress and prevent recurrence of the violation.
            (4) Deposit.--Any revenue received from the sale of 
        prescription drugs disgorged pursuant to an action under this 
        subsection shall be deposited in a fund created by the Federal 
        Trade Commission and distributed by the Federal Trade 
        Commission to be put to use in the interest of serving the 
        health care needs of the harmed community, including consumers 
        overcharged at vertically integrated pharmacies.
    (c) FTC Review.--
            (1) Reporting required.--Any divestment of a pharmacy or 
        pharmacy benefit manager required under subsection (a) shall be 
        reported to the Federal Trade Commission and the Assistant 
        Attorney General in charge of the Antitrust Division of the 
        Department of Justice under section 7A of the Clayton Act (15 
        U.S.C. 18a) without respect to the thresholds under subsection 
        (a)(2) of that section.
            (2) Tolling of divestment period during review.--The 
        divestment period under subsection (a) shall be tolled during 
        the pendency of any waiting period required under section 7A of 
        the Clayton Act (15 U.S.C. 18a).
            (3) Review of effect of divestiture.--With respect to each 
        divestiture undertaken pursuant to subsection (a), in addition 
        to any applicable review under section 7A of the Clayton Act 
        (15 U.S.C. 18a), the Federal Trade Commission and the Assistant 
        Attorney General in charge of the Antitrust Division of the 
        Department of Justice shall review the effect on competition, 
        financial viability, and the public interest--
                    (A) of the divestiture; and
                    (B) of the subsequent acquisition of the divested 
                pharmacy by the acquiring person.
    (d) Rulemaking Authority.--The Federal Trade Commission shall 
promulgate rules to carry out this section. Such rules shall not 
diminish any obligation under this section.
    (e) Rule of Construction.--Nothing in this section shall be 
construed to limit the authority of the Federal Trade Commission, the 
Inspector General of the Department of Justice, the Department of 
Health and Human Services, or the attorney general of a State under any 
other provision of law.
    (f) Definitions.--In this section:
            (1) Health plan.--The term ``health plan'' means any public 
        or private health insurance plan.
            (2) Person.--The term ``person'' has the meaning given the 
        term in section 8 of the Sherman Act (15 U.S.C. 7).
            (3) Pharmacy.--
                    (A) In general.--The term ``pharmacy'' means any 
                person, business, or entity licensed, registered, or 
                otherwise permitted by a State or a territory of the 
                United States to dispense, deliver, or distribute a 
                controlled substance, prescription drug, or other 
                medication--
                            (i) to the general public; or
                            (ii) to a bed patient for immediate 
                        administration.
                    (B) Inclusions.--The term ``pharmacy'' includes--
                            (i) a mail-order pharmacy;
                            (ii) a specialty pharmacy;
                            (iii) a retail pharmacy;
                            (iv) a nursing home pharmacy;
                            (v) a long-term care pharmacy;
                            (vi) a hospital pharmacy;
                            (vii) an infusion or other outpatient 
                        treatment pharmacy;
                            (viii) any organization the National 
                        Provider Identifier (NPI) registration of which 
                        has 1 or more taxonomy codes under the pharmacy 
                        section of the National Uniform Claim Committee 
                        (or a subsequent organization); and
                            (ix) any other type of pharmacy.
            (4) Pharmacy benefit manager.--The term ``pharmacy benefit 
        manager'' means any person, business, or other entity, such as 
        a third-party administrator, regardless of whether such person, 
        business, or entity identifies itself as a pharmacy benefit 
        manager, that, either directly or indirectly through an 
        intermediary (including an affiliate, subsidiary, or agent) or 
        an arrangement with a third party--
                    (A) acts as a negotiator of prices, rebates, fees, 
                or discounts for prescription drugs on behalf of a 
                health plan or health plan sponsor;
                    (B) contracts with pharmacies to create pharmacy 
                networks and designs and manages such networks; or
                    (C) manages or administers the prescription drug 
                benefits provided by a health plan, including the 
                processing and payment of claims for prescription 
                drugs, arranging alternative access to or funding for 
                prescription drugs, the performance of utilization 
                management services, including drug utilization review, 
                the processing of drug prior authorization requests, 
                the adjudication of appeals or grievances related to 
                the prescription drug benefit, contracting with network 
                pharmacies, controlling the cost of covered 
                prescription drugs, or the provision of related 
                services.
                                 <all>
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