I 

118TH CONGRESS 

1ST SESSION H. R. 6283 

To improve services provided by pharmacy benefit managers. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 8, 2023 

Mrs. MILLER-MEEKS (for herself, Ms. BARRAGA ́N, Mrs. CHAVEZ-DEREMER, 

Ms. MANNING, Ms. MALLIOTAKIS, Mr. SCHNEIDER, Mr. KEAN of New 

Jersey, and Ms. SPANBERGER) introduced the following bill; which was 

referred to the Committee on Energy and Commerce, and in addition to 

the Committees on Ways and Means, Education and the Workforce, and 

Oversight and Accountability, for a period to be subsequently determined 

by the Speaker, in each case for consideration of such provisions as fall 

within the jurisdiction of the committee concerned 

A BILL 

To improve services provided by pharmacy benefit managers. 

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 ‘‘Delinking Revenue 

5 from Unfair Gouging Act’’ or the ‘‘DRUG Act’’. 

6 SEC. 2. IMPROVING PHARMACY BENEFIT MANAGER SERV7 ICES. 

8 (a) PUBLIC HEALTH SERVICE ACT.—Part D of title 

9 XXVII of the Public Health Service Act (42 U.S.C. 


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1 300gg–111 et seq.) is amended by adding at the end the 

2 following: 

3 ‘‘SEC. 2799A–11. IMPROVING PHARMACY BENEFIT MANAGER 

4 SERVICES. 

5 ‘‘(a) GENERAL.—For plan years beginning on or 

6 after January 1, 2026, except as provided in subsection 

7 (b), a pharmacy benefit manager shall derive no remu8 neration from any entity for services, benefit administra9 tion, or any other activities related to prescription drugs. 

10 ‘‘(b) EXCEPTION FOR BONA FIDE SERVICE FEES.— 

11 ‘‘(1) IN GENERAL.—A pharmacy benefit man12 ager may charge an entity a bona fide service fee for 

13 the provision of services to such entity if such fee is 

14 set forth in an agreement between the pharmacy 

15 benefit manager and such entity, and the amount of 

16 any bona fide service fee— 

17 ‘‘(A) shall be a flat dollar amount; and 

18 ‘‘(B) shall not be directly or indirectly 

19 based on, or contingent upon— 

20 ‘‘(i) a drug price (such as wholesale 

21 acquisition cost) or drug benchmark price 

22 (such as average wholesale price); 

23 ‘‘(ii) the amount of discounts, rebates, 

24 fees, or other direct or indirect remunera25 tion with respect to prescription drugs preVerDate Sep 11 2014 21:12 Nov 28, 2023 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6283.IH H6283

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1 scribed to the participants, beneficiaries, or 

2 enrollees in the group health plan or cov3 erage involved; or 

4 ‘‘(iii) any other amounts prohibited by 

5 the Secretary, the Secretary of Labor, and 

6 the Secretary of the Treasury. 

7 ‘‘(2) DEFINITIONS.—In this section— 

8 ‘‘(A) the term ‘bona fide service fee’ means 

9 fair market value for a bona fide, itemized serv10 ice actually performed on behalf of an entity, 

11 that the entity would otherwise perform (or 

12 contract for) in the absence of the service ar13 rangement and that are not passed on in whole 

14 or in part to a client or customer, whether or 

15 not the entity takes title to the drug; and 

16 ‘‘(B) the term ‘pharmacy benefit manager’ 

17 means any person, business, or other entity 

18 such as a third-party administrator, regardless 

19 of whether it identifies itself as a pharmacy 

20 benefit manager, that, either directly or 

21 through an intermediary (including an affiliate, 

22 subsidiary, parent, or agent) or an arrangement 

23 with a third party— 

24 ‘‘(i) acts as a price negotiator or 

25 group purchaser for prescription drugs on 


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1 behalf of a group health plan or health in2 surance issuer offering group or individual 

3 health insurance coverage; or 

4 ‘‘(ii) manages or administers the pre5 scription drug benefits provided by a group 

6 health plan or health insurance issuer of7 fering group or individual health insurance 

8 coverage, including the processing and pay9 ment of claims for prescription drugs, ar10 ranging alternative access to or funding for 

11 prescription drugs, the performance of 

12 drug utilization review, the processing of 

13 drug prior authorization requests, the ad14 judication of appeals or grievances related 

15 to the prescription drug benefit, con16 tracting with network pharmacies, control17 ling the cost of covered prescription drugs, 

18 or the provision of related services. 

19 ‘‘(c) ACCOUNTABILITY AND CONDUCT.— 

20 ‘‘(1) IN GENERAL.—A pharmacy benefit man21 ager shall not— 

22 ‘‘(A) charge a group health plan or health 

23 insurance issuer offering group or individual 

24 health insurance coverage a different amount 

25 for a prescription drug’s ingredient cost or disVerDate Sep 11 2014 21:12 Nov 28, 2023 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6283.IH H6283

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1 pensing fee as compared to the amount the 

2 pharmacy benefit manager reimburses a phar3 macy for the prescription drug’s ingredient cost 

4 or dispensing fee; 

5 ‘‘(B) reimburse a network pharmacy or 

6 pharmacist in an amount less than the amount 

7 the pharmacy benefit manager would reimburse 

8 a network pharmacy that is owned, controlled 

9 by, or affiliated with the pharmacy benefit man10 ager for dispensing the same drug or for pro11 viding the same pharmacist services; or 

12 ‘‘(C) directly or indirectly engage in steer13 ing (as defined in paragraph (2)) to a phar14 macy that is owned, controlled by, or affiliated 

15 with the pharmacy benefit manager. 

16 ‘‘(2) STEERING.—In paragraph (1), the term 

17 ‘steering’ with respect to a pharmacy benefit man18 ager includes— 

19 ‘‘(A) providing or implementing a benefit 

20 design that encourages a participant, bene21 ficiary, or enrollee to utilize a pharmacy that is 

22 owned, controlled by, or affiliated with the 

23 pharmacy benefit manager, if such design in24 creases costs for the plan or a participant, ben25 eficiary, or enrollee, including requiring a parVerDate Sep 11 2014 21:12 Nov 28, 2023 Jkt 049200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6283.IH H6283

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1 ticipant, beneficiary, or enrollee to pay higher 

2 out-of-pocket costs for a prescription if the par3 ticipant, beneficiary, or enrollee chooses not to 

4 use a pharmacy owned, controlled by, or affili5 ated with the pharmacy benefit manager; 

6 ‘‘(B) requiring a participant, beneficiary, 

7 or enrollee to use only a pharmacy that is 

8 owned, controlled by, or affiliated with the 

9 pharmacy benefit manager; 

10 ‘‘(C) retaliating, making further attempts 

11 to influence a participant, beneficiary, or en12 rollee, or treating a participant, beneficiary, or 

13 enrollee or a participant, beneficiary, or enroll14 ee’s claim any differently if a participant, bene15 ficiary, or enrollee chooses to use a pharmacy 

16 that is not owned, controlled by, or affiliated 

17 with the pharmacy benefit manager; or 

18 ‘‘(D) any other activities as defined by the 

19 Secretary, the Secretary of Labor, and the Sec20 retary of the Treasury. 

21 ‘‘(d) ENFORCEMENT.— 

22 ‘‘(1) IN GENERAL.—The Secretary, in consulta23 tion with the Secretary of Labor and the Secretary 

24 of the Treasury, shall enforce this section. 


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1 ‘‘(2) DISGORGEMENT.—The pharmacy benefit 

2 manager shall disgorge to a group health plan or 

3 health insurance issuer offering group or individual 

4 health insurance coverage any payment, remunera5 tion, or other amount received by the pharmacy ben6 efit manager or an affiliate of such pharmacy benefit 

7 manager in violation of paragraph (a) or the agree8 ment entered into with such plan or issuer for bona 

9 fide service fees. 

10 ‘‘(3) PENALTIES.—A pharmacy benefit man11 ager that violates subsection (a), (b), or (c) shall be 

12 subject to a civil monetary penalty in the amount of 

13 $10,000 for each day during which such violation 

14 continues. 

15 ‘‘(4) PROCEDURE.—The provisions of section 

16 1128A of the Social Security Act, other than sub17 sections (a) and (b) and the first sentence of sub18 section (c)(1) of such section shall apply to civil 

19 monetary penalties under this subsection in the 

20 same manner as such provisions apply to a penalty 

21 or proceeding under section 1128A of the Social Se22 curity Act. 

23 ‘‘(e) REGULATIONS.—Notwithstanding any other 

24 provision of law, the Secretary shall initially implement 

25 this section through interim final regulations. 


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1 ‘‘(f) RULES OF CONSTRUCTION.— 

2 ‘‘(1) Nothing in this section shall be construed 

3 as prohibiting payments related to reimbursement 

4 for ingredient costs to entities that acquire prescrip5 tion drugs or pharmacy dispensing fees. 

6 ‘‘(2) Nothing in this section shall be construed 

7 to prohibit rebates, discounts, or other price conces8 sions from being fully passed through to a group 

9 health plan or health insurance issuer offering group 

10 or individual health insurance coverage to lower net 

11 costs for prescription drugs.’’. 

12 (b) ERISA.— 

13 (1) IN GENERAL.—Subpart B of part 7 of sub14 title B of title I of the Employee Retirement Income 

15 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 

16 amended by inserting after section 725 the fol17 lowing: 

18 ‘‘SEC. 726. IMPROVING PHARMACY BENEFIT MANAGER 

19 SERVICES. 

20 ‘‘(a) IN GENERAL.—For plan years beginning on or 

21 after January 1, 2026, except as provided in subsection 

22 (b), a pharmacy benefit manager shall derive no remu23 neration from any entity for services, benefit administra24 tion, or any other activities related to prescription drugs. 

25 ‘‘(b) EXCEPTION FOR BONA FIDE SERVICE FEES.— 


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1 ‘‘(1) IN GENERAL.—A pharmacy benefit man2 ager may charge an entity a bona fide service fee for 

3 the provision of services to such entity if such fee is 

4 set forth in an agreement between the pharmacy 

5 benefit manager and such entity and the amount of 

6 any bona fide service fee— 

7 ‘‘(A) shall be a flat dollar amount; 

8 ‘‘(B) shall not be directly or indirectly 

9 based on, or contingent upon— 

10 ‘‘(i) a drug price (such as wholesale 

11 acquisition cost) or drug benchmark price 

12 (such as average wholesale price); 

13 ‘‘(ii) the amount of discounts, rebates, 

14 fees, or other direct or indirect remunera15 tion with respect to prescription drugs pre16 scribed to the participants, beneficiaries, or 

17 enrollees in the group health plan or cov18 erage involved; or 

19 ‘‘(iii) any other amounts prohibited by 

20 the Secretary, the Secretary of Labor, and 

21 the Secretary of the Treasury. 

22 ‘‘(2) DEFINITIONS.—In this section— 

23 ‘‘(A) the term ‘bona fide service fee’ means 

24 fair market value for a bona fide, itemized serv25 ice actually performed on behalf of an entity, 


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1 that would otherwise perform (or contract for) 

2 in the absence of the service arrangement and 

3 that are not passed on in whole or in part to 

4 a client or customer, whether or not the entity 

5 takes title to the drug; 

6 ‘‘(B) the term ‘pharmacy benefit manager’ 

7 means any person, business, or other entity 

8 such as a third-party administrator, regardless 

9 of whether it identifies itself as a pharmacy 

10 benefit manager, that, either directly or 

11 through an intermediary (including an affiliate, 

12 subsidiary, or agent) or an arrangement with a 

13 third party— 

14 ‘‘(i) acts as a price negotiator for pre15 scription drugs on behalf of a group health 

16 plan or health insurance issuer offering 

17 group health insurance coverage; or 

18 ‘‘(ii) manages or administers the pre19 scription drug benefits provided by a group 

20 health plan or health insurance issuer of21 fering group health insurance coverage, in22 cluding the processing and payment of 

23 claims for prescription drugs, arranging al24 ternative access to or funding for prescrip25 tion drugs, the performance of drug utiliVerDate Sep 11 2014 21:12 Nov 28, 2023 Jkt 049200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H6283.IH H6283

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1 zation review, the processing of drug prior 

2 authorization requests, the adjudication of 

3 appeals or grievances related to the pre4 scription drug benefit, contracting with 

5 network pharmacies, controlling the cost of 

6 covered prescription drugs, or the provision 

7 of related services. 

8 ‘‘(c) ACCOUNTABILITY AND CONDUCT.— 

9 ‘‘(1) IN GENERAL.—A pharmacy benefit man10 ager shall not— 

11 ‘‘(A) charge a group health plan or health 

12 insurance issuer offering group health insur13 ance coverage a different amount for a prescrip14 tion drug’s ingredient cost or dispensing fee as 

15 compared to the amount the pharmacy benefit 

16 manager reimburses a pharmacy for the pre17 scription drug’s ingredient cost or dispensing 

18 fee; 

19 ‘‘(B) reimburse a network pharmacy or 

20 pharmacist in an amount less than the amount 

21 the pharmacy benefit manager would reimburse 

22 a network pharmacy that is owned, controlled 

23 by, or affiliated with the pharmacy benefit man24 ager for dispensing the same drug or for pro25 viding the same pharmacist services; or 


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1 ‘‘(C) directly or indirectly engage in steer2 ing (as defined in paragraph (2)) to a phar3 macy that is owned, controlled by, or affiliated 

4 with the pharmacy benefit manager. 

5 ‘‘(2) STEERING.—In paragraph (1), the term 

6 ‘steering’ with respect to a pharmacy benefit man7 ager includes— 

8 ‘‘(A) providing or implementing a benefit 

9 plan design that encourages a participant or 

10 beneficiary to utilize a pharmacy that is owned, 

11 controlled by, or affiliated with the pharmacy 

12 benefit manager, if such plan design increases 

13 costs for the plan or the participant or bene14 ficiary, including requiring a participant or ben15 eficiary to pay higher out-of-pocket costs for a 

16 prescription if the participant or beneficiary 

17 chooses not to use a pharmacy owned, con18 trolled by, or affiliated with the pharmacy ben19 efit manager; 

20 ‘‘(B) requiring a participant or beneficiary 

21 to use only a pharmacy that is owned, con22 trolled by, or affiliated with the pharmacy ben23 efit manager; 

24 ‘‘(C) retaliating, making further attempts 

25 to influence a participant or beneficiary, or 


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1 treating a participant or beneficiary or a partic2 ipant or beneficiary’s claim any differently if a 

3 participant or beneficiary chooses to use a phar4 macy that is not owned, controlled by, or affili5 ated with the pharmacy benefit manager; or 

6 ‘‘(D) any other activities as defined by the 

7 Secretary, the Secretary of Health and Human 

8 Services, and the Secretary of the Treasury. 

9 ‘‘(d) ENFORCEMENT.— 

10 ‘‘(1) IN GENERAL.—The Secretary, in consulta11 tion with the Secretary of Health and Human Serv12 ices and the Secretary of the Treasury, shall enforce 

13 this section. 

14 ‘‘(2) DISGORGEMENT.—The pharmacy benefit 

15 manager shall disgorge to a group health plan or 

16 health insurance issuer offering group or individual 

17 health insurance coverage any payment, remunera18 tion, or other amount received by the pharmacy ben19 efit manager or an affiliate of such pharmacy benefit 

20 manager in violation of paragraph (a) or the agree21 ment entered into with such plan or issuer for bona 

22 fide service fees. 

23 ‘‘(3) PENALTIES.—A pharmacy benefit man24 ager that violates subsection (a), (b), or (c) shall be 

25 subject to a civil monetary penalty in the amount of 


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1 $10,000 for each day during which such violation 

2 continues. 

3 ‘‘(4) PROCEDURE.—The provisions of section 

4 1128A of the Social Security Act, other than sub5 sections (a) and (b) and the first sentence of sub6 section (c)(1) of such section shall apply to civil 

7 monetary penalties under this subsection in the 

8 same manner as such provisions apply to a penalty 

9 or proceeding under section 1128A of the Social Se10 curity Act. 

11 ‘‘(e) REGULATIONS.—Notwithstanding any other 

12 provision of law, the Secretary shall initially implement 

13 this section through interim final regulations. 

14 ‘‘(f) RULES OF CONSTRUCTION.— 

15 ‘‘(1) Nothing in this section shall be construed 

16 as prohibiting payments related to reimbursement 

17 for ingredient costs to entities that acquire prescrip18 tion drugs or pharmacy dispensing fees. 

19 ‘‘(2) Nothing in this section shall be construed 

20 to prohibit rebates, discounts, or other price conces21 sions from being fully passed through to a group 

22 health plan or health insurance issuer offering group 

23 or individual health insurance coverage to lower net 

24 costs for prescription drugs.’’. 


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1 (2) CLERICAL AMENDMENT.—The table of con2 tents in section 1 of the Employee Retirement In3 come Security Act of 1974 (29 U.S.C. 1001 et seq.) 

4 is amended by inserting after the item relating to 

5 section 725 the following new item: 

‘‘Sec. 726. Improving pharmacy benefit manager services.’’. 

6 (c) INTERNAL REVENUE CODE OF 1986.—Sub-chap7 ter B of chapter 100 of the Internal Revenue Code of 1986 

8 is amended by adding at the end the following: 

9 ‘‘SEC. 9826. IMPROVING PHARMACY BENEFIT MANAGER 

10 SERVICES. 

11 ‘‘(a) IN GENERAL.—For plan years beginning on or 

12 after January 1, 2026, except as provided in subsection 

13 (b), a pharmacy benefit manager shall derive no remu14 neration from any entity for services, benefit administra15 tion, or any other activities related to prescription drugs. 

16 ‘‘(b) EXCEPTION FOR BONA FIDE SERVICES.— 

17 ‘‘(1) IN GENERAL.—A pharmacy benefit man18 ager may charge an entity a bona fide service fee for 

19 the provision of services to such entity if such fee is 

20 set forth in an agreement between the pharmacy 

21 benefit manager and such entity, and the amount of 

22 any bona fide service fee— 

23 ‘‘(A) shall be a flat dollar amount; and 

24 ‘‘(B) shall not be directly or indirectly 

25 based on, or contingent upon— 


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1 ‘‘(i) a drug price (such as wholesale 

2 acquisition cost) or drug benchmark price 

3 (such as average wholesale price); 

4 ‘‘(ii) the amount of discounts, rebates, 

5 fees, or other direct or indirect remunera6 tion with respect to prescription drugs pre7 scribed to the participants, beneficiaries, or 

8 enrollees in the group health plan or cov9 erage involved; or 

10 ‘‘(iii) any other amounts prohibited by 

11 the Secretary, the Secretary of Labor, and 

12 the Secretary of the Treasury. 

13 ‘‘(2) DEFINITIONS.—In this section— 

14 ‘‘(A) the term ‘bona fide service fee’ means 

15 fair market value for a bona fide, itemized serv16 ice actually performed on behalf of an entity, 

17 that the entity would otherwise perform (or 

18 contract for) in the absence of the arrangement 

19 and that are not passed on in whole or in part 

20 to a client or customer, whether or not the enti21 ty takes title to the drug; and 

22 ‘‘(B) the term ‘pharmacy benefit manager’ 

23 means any person, business, or other entity 

24 such as a third-party administrator, regardless 

25 of whether it identifies itself as a pharmacy 


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1 benefit manager, that, either directly or 

2 through an intermediary (including an affiliate, 

3 or agent) or an arrangement with a third 

4 party— 

5 ‘‘(i) acts as a price negotiator for pre6 scription drugs on behalf of a group health 

7 plan; or 

8 ‘‘(ii) manages or administers the pre9 scription drug benefits provided by a group 

10 health plan, including the processing and 

11 payment of claims for prescription drugs, 

12 arranging alternative access to or funding 

13 for prescription drugs, the performance of 

14 drug utilization review, the processing of 

15 drug prior authorization requests, the ad16 judication of appeals or grievances related 

17 to the prescription drug benefit, con18 tracting with network pharmacies, control19 ling the cost of covered prescription drugs, 

20 or the provision of related services. 

21 ‘‘(c) ACCOUNTABILITY AND CONDUCT.— 

22 ‘‘(1) IN GENERAL.—A pharmacy benefit man23 ager shall not— 

24 ‘‘(A) charge a group health plan or health 

25 insurance issuer offering group health insurVerDate Sep 11 2014 21:12 Nov 28, 2023 Jkt 049200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H6283.IH H6283

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1 ance coverage a different amount for a prescrip2 tion drug’s ingredient cost or dispensing fee as 

3 compared to the amount the pharmacy benefit 

4 manager reimburses a pharmacy for the pre5 scription drug’s ingredient cost or dispensing 

6 fee; 

7 ‘‘(B) reimburse a network pharmacy or 

8 pharmacist in an amount less than the amount 

9 the pharmacy benefit manager would reimburse 

10 a network pharmacy that is owned, controlled 

11 by, or affiliated with the pharmacy benefit man12 ager for dispensing the same drug or for pro13 viding the same pharmacist services; or 

14 ‘‘(C) directly or indirectly engage in steer15 ing (as defined in paragraph (2)) to a phar16 macy that is owned, controlled by, or affiliated 

17 with the pharmacy benefit manager. 

18 ‘‘(2) STEERING.—In paragraph (1), the term 

19 ‘steering’ with respect to a pharmacy benefit man20 ager includes— 

21 ‘‘(A) providing or implementing a benefit 

22 design that encourages a participant or bene23 ficiary to utilize a pharmacy that is owned, con24 trolled by, or affiliated with the pharmacy ben25 efit manager, if such benefit design increases 


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1 costs for the plan or the participant or bene2 ficiary, including requiring a participant or ben3 eficiary to pay higher out-of-pocket costs for a 

4 prescription if the participant or beneficiary 

5 chooses not to use a pharmacy owned, con6 trolled by, or affiliated with the pharmacy ben7 efit manager; 

8 ‘‘(B) requiring an enrollee to use only a 

9 pharmacy that is owned, controlled by, or affili10 ated with the pharmacy benefit manager; 

11 ‘‘(C) retaliating, making further attempts 

12 to influence a participant or beneficiary, or 

13 treating a participant or beneficiary or a partic14 ipant or beneficiary’s claim any differently if a 

15 participant or beneficiary chooses to use a phar16 macy that is not owned, controlled by, or affili17 ated with the pharmacy benefit manager; or 

18 ‘‘(D) any other activities as defined by the 

19 Secretary, the Secretary of Labor, and the Sec20 retary of Health and Human Service. 

21 ‘‘(d) ENFORCEMENT.— 

22 ‘‘(1) IN GENERAL.—The Secretary, in consulta23 tion with the Secretary of Labor and the Secretary 

24 of Health and Human Services, shall enforce this 

25 section. 


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1 ‘‘(2) DISGORGEMENT.—The pharmacy benefit 

2 manager shall disgorge to a group health plan or 

3 health insurance issuer offering group or individual 

4 health insurance coverage any payment, remunera5 tion, or other amount received by the pharmacy ben6 efit manager or an affiliate of such pharmacy benefit 

7 manager in violation of paragraph (a) or the agree8 ment entered into with such plan or issuer for bona 

9 fide service fees. 

10 ‘‘(3) PENALTIES.—A pharmacy benefit man11 ager that violates subsection (a), (b), or (c) shall be 

12 subject to a civil monetary penalty in the amount of 

13 $10,000 for each day during which such violation 

14 continues. 

15 ‘‘(4) PROCEDURE.—The provisions of section 

16 1128A of the Social Security Act, other than sub17 sections (a) and (b) and the first sentence of sub18 section (c)(1) of such section shall apply to civil 

19 monetary penalties under this subsection in the 

20 same manner as such provisions apply to a penalty 

21 or proceeding under section 1128A of the Social Se22 curity Act. 

23 ‘‘(e) REGULATIONS.—Notwithstanding any other 

24 provision of law, the Secretary shall initially implement 


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1 the amendments made by this Act through interim final 

2 regulations. 

3 ‘‘(f) RULES OF CONSTRUCTION.— 

4 ‘‘(1) Nothing in this section shall be construed 

5 as prohibiting payments related to reimbursement 

6 for ingredient costs to entities that acquire prescrip7 tion drugs or pharmacy dispensing fees. 

8 ‘‘(2) Nothing in this section shall be construed 

9 to prohibit rebates, discounts, or other price conces10 sions from being fully passed through to a group 

11 health plan or health insurance issuer offering group 

12 or individual health insurance coverage to lower net 

13 costs for prescription drugs.’’. 

14 (d) FEDERAL EMPLOYEES HEALTH BENEFITS

15 ACT.—Chapter 89 of subpart G of part III of title 5 of 

16 the United States Code is amended by adding at the end 

17 following: 

18 ‘‘SEC. 8915. IMPROVING PHARMACY BENEFIT MANAGER 

19 SERVICES. 

20 ‘‘(a) IN GENERAL.—For plan years beginning on or 

21 after January 1, 2026, except as provided in subsection 

22 (b), a pharmacy benefit manager shall derive no remu23 neration from any entity for services, benefit administra24 tion, or any other activities related to prescription drugs. 

25 ‘‘(b) EXCEPTION FOR BONA FIDE SERVICES.— 


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1 ‘‘(1) IN GENERAL.—A pharmacy benefit man2 ager may charge an entity a bona fide service fee for 

3 the provision of services to such entity if such fee is 

4 set forth in an agreement between the pharmacy 

5 benefit manager and such entity, and 

6 ‘‘(2) the amount of any bona fide service fee— 

7 ‘‘(A) shall be a flat dollar amount; 

8 ‘‘(B) shall not be directly or indirectly 

9 based on, or contingent upon— 

10 ‘‘(i) a drug price (such as wholesale 

11 acquisition cost) or drug benchmark price 

12 (such as average wholesale price); 

13 ‘‘(ii) the amount of discounts, rebates, 

14 fees, or other direct or indirect remunera15 tion with respect to prescription drugs pre16 scribed to the participants, beneficiaries, or 

17 enrollees in the group health plan or cov18 erage involved; or 

19 ‘‘(iii) any other amounts prohibited by 

20 the Office of Personnel Management. 

21 ‘‘(2) DEFINITIONS.—In this section— 

22 ‘‘(A) the term ‘bona fide service fee’ means 

23 fair market value for a bona fide, itemized serv24 ice actually performed on behalf of an entity, 

25 that the entity would otherwise perform (or 


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1 contract for) in the absence of the arrangement 

2 and that are not passed on in whole or in part 

3 to a client or customer, whether or not the enti4 ty takes title to the drug; and 

5 ‘‘(B) the term ‘pharmacy benefit manager’ 

6 means any person, business, or other entity 

7 such as a third-party administrator, regardless 

8 of whether it identifies itself as a pharmacy 

9 benefit manager, that, either directly or 

10 through an intermediary (including an affiliate, 

11 or agent) or an arrangement with a third 

12 party— 

13 ‘‘(i) acts as a price negotiator for pre14 scription drugs on behalf of a health bene15 fits plan or carrier; or 

16 ‘‘(ii) manages or administers the pre17 scription drug benefits provided by a 

18 health benefits plan or carrier including 

19 the processing and payment of claims for 

20 prescription drugs, arranging alternative 

21 access to or funding for prescription drugs, 

22 the performance of drug utilization review, 

23 the processing of drug prior authorization 

24 requests, the adjudication of appeals or 

25 grievances related to the prescription drug 


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1 benefit, contracting with network phar2 macies, controlling the cost of covered pre3 scription drugs, or the provision of related 

4 services. 

5 ‘‘(c) ACCOUNTABILITY AND CONDUCT.— 

6 ‘‘(1) IN GENERAL.—A pharmacy benefit man7 ager shall not— 

8 ‘‘(A) charge a health benefits plan or car9 rier different amount for a prescription drug’s 

10 ingredient cost or dispensing fee as compared to 

11 the amount the pharmacy benefit manager re12 imburses a pharmacy for the prescription 

13 drug’s ingredient cost or dispensing fee; 

14 ‘‘(B) reimburse a network pharmacy or 

15 pharmacist in an amount less than the amount 

16 the pharmacy benefit manager would reimburse 

17 a network pharmacy that is owned, controlled 

18 by, or affiliated with the pharmacy benefit man19 ager for dispensing the same drug or for pro20 viding the same pharmacist services; or 

21 ‘‘(C) directly or indirectly engage in steer22 ing (as defined in paragraph (2)) to a phar23 macy that is owned, controlled by, or affiliated 

24 with the pharmacy benefit manager. 


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•HR 6283 IH

1 ‘‘(2) STEERING.—In paragraph (1), the term 

2 ‘steering’ with respect to a pharmacy benefit man3 ager includes— 

4 ‘‘(A) providing or implementing a benefit 

5 design that encourages a participant or bene6 ficiary to utilize a pharmacy that is owned, con7 trolled by, or affiliated with the pharmacy ben8 efit manager, if such benefit design increases 

9 costs for the plan or the participant or bene10 ficiary, including requiring a participant or ben11 eficiary to pay higher out-of-pocket costs for a 

12 prescription if the participant or beneficiary 

13 chooses not to use a pharmacy owned, con14 trolled by, or affiliated with the pharmacy ben15 efit manager; 

16 ‘‘(B) requiring an enrollee to use only a 

17 pharmacy that is owned, controlled by, or affili18 ated with the pharmacy benefit manager; 

19 ‘‘(C) retaliating, making further attempts 

20 to influence a participant or beneficiary, or 

21 treating a participant or beneficiary or a partic22 ipant or beneficiary’s claim any differently if a 

23 participant or beneficiary chooses to use a phar24 macy that is not owned, controlled by, or affili25 ated with the pharmacy benefit manager; or 


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•HR 6283 IH

1 ‘‘(D) any other activities as defined by the 

2 Office of Personnel Management. 

3 ‘‘(d) ENFORCEMENT.— 

4 ‘‘(1) IN GENERAL.—The Office of Personnel 

5 Management shall enforce this section. 

6 ‘‘(2) DISGORGEMENT.—The pharmacy benefit 

7 manager shall disgorge to a health benefits plan or 

8 carrier any payment, remuneration, or other amount 

9 received by the pharmacy benefit manager or an af10 filiate of such pharmacy benefit manager in violation 

11 of paragraph (a) or the agreement entered into with 

12 such plan or carrier for bona fide service fees. 

13 ‘‘(3) PENALTIES.—A pharmacy benefit man14 ager that violates subsection (a), (b), or (c) shall be 

15 subject to a civil monetary penalty in the amount of 

16 $10,000 for each day during which such violation 

17 continues. 

18 ‘‘(4) PROCEDURE.—The provisions of section 

19 1128A of the Social Security Act, other than sub20 sections (a) and (b) and the first sentence of sub21 section (c)(1) of such section shall apply to civil 

22 monetary penalties under this subsection in the 

23 same manner as such provisions apply to a penalty 

24 or proceeding under section 1128A of the Social Se25 curity Act, except that for the purpose of this paraVerDate Sep 11 2014 21:12 Nov 28, 2023 Jkt 049200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H6283.IH H6283

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•HR 6283 IH

1 graph the ‘Office of Personnel Management’ is sub2 stituted wherever the term ‘Secretary’ is used in sec3 tion 1128A. 

4 ‘‘(e) REGULATIONS.—Notwithstanding any other 

5 provision of law, the Director shall initially implement the 

6 amendments made by this Act through interim final regu7 lations. 

8 ‘‘(f) RULES OF CONSTRUCTION.— 

9 ‘‘(1) Nothing in this section shall be construed 

10 as prohibiting payments related to reimbursement 

11 for ingredient costs to entities that acquire prescrip12 tion drugs or pharmacy dispensing fees. 

13 ‘‘(2) Nothing in this section shall be construed 

14 to prohibit rebates, discounts, or other price conces15 sions from being fully passed through to a health 

16 benefits plan or carrier to lower net costs for pre17 scription drugs.’’. 

Æ 


lotter on DSK11XQN23PROD with BILLS