I 

116TH CONGRESS 

1ST SESSION H. R. 3223 

To require the Comptroller General of the United States to study the role 

pharmacy benefit managers play in the pharmaceutical supply chain 

and to provide Congress with appropriate policy recommendations, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 12, 2019 

Mr. MARSHALL (for himself, Mr. WELCH, Mr. CARTER of Georgia, and Mr. 

GONZALEZ of Texas) introduced the following bill; which was referred to 

the Committee on Energy and Commerce 

A BILL 

To require the Comptroller General of the United States 

to study the role pharmacy benefit managers play in 

the pharmaceutical supply chain and to provide Congress 

with appropriate policy recommendations, 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 ‘‘Pharmacy Benefit 

5 Manager Accountability Study Act of 2019’’. 


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1 SEC. 2. STUDY BY COMPTROLLER GENERAL OF UNITED 

2 STATES. 

3 (a) IN GENERAL.—The Comptroller General of the 

4 United States shall, in consultation with appropriate 

5 stakeholders, conduct a study on the role of pharmacy 

6 benefit managers with respect to federally facilitated Ex7 changes operated pursuant to section 1321(c) of the Pa8 tient Protection and Affordable Care Act (42 U.S.C. 

9 18041(c)). 

10 (b) PERMISSIBLE EXAMINATION.—In conducting the 

11 study required under subsection (a), the Comptroller Gen12 eral may examine various qualitative and quantitative as13 pects of the role of pharmacy benefit managers with re14 spect to federally facilitated Exchanges described in such 

15 subsection, such as the following: 

16 (1) The role that pharmacy benefit managers 

17 play in the pharmaceutical supply chain of such Ex18 changes. 

19 (2) The state of competition among pharmacy 

20 benefit managers on such Exchanges, including the 

21 market share for the Nation’s largest pharmacy ben22 efit managers. 

23 (3) The use of rebates and fees by pharmacy 

24 benefit managers with respect to such Exchanges, 

25 including— 


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1 (A) the extent to which rebates are passed 

2 on to qualified health plans offered on such Ex3 changes and whether such rebates are passed 

4 on to individuals enrolled in such plans; 

5 (B) the extent to which rebates are kept by 

6 such pharmacy benefit managers; and 

7 (C) the role of any fees charged by such 

8 pharmacy benefit managers. 

9 (4) Whether pharmacy benefit managers struc10 ture their formularies with respect to such Ex11 changes in favor of high-rebate prescription drugs 

12 over lower-cost, lower-rebate alternatives. 

13 (5) The average prior authorization approval 

14 time for pharmacy benefit managers with respect to 

15 such Exchanges. 

16 (6) Factors affecting the use of step therapy by 

17 pharmacy benefit managers with respect to such Ex18 changes. 

19 (7) The extent to which the price that phar20 macy benefit managers charge private payors on 

21 such Exchanges for a drug is more than such phar22 macy benefit managers pay the pharmacy for the 

23 drug. 

24 (c) REPORT.—Not later than the date that is three 

25 years after the date of enactment of this Act, the CompVerDate Sep 11 2014 23:47 Jun 14, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3223.IH H3223

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1 troller General shall submit to the Secretary of Health and 

2 Human Services, the Committee on Health, Education, 

3 Labor, and Pensions of the Senate, and the Committee 

4 on Energy and Commerce of the House of Representatives 

5 a report containing the results of the study conducted 

6 under subsection (a), including policy recommendations. 

Æ 


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