177 
plan pay a different co-payment amount for a drug dis-
pensed at a retail pharmacy, compared to the co-payment 
amount that would be charged to such participant or bene-
ficiary for the same amount of that drug at a mail order 
pharmacy. 
(i) COMPUTATION
OF CO-PAYMENT AMOUNTS.— 
Under the standards under subsection (a), a pharmacy 
benefit manager shall determine the co-payment amount 
charged a participant or beneficiary of a health benefits 
plan for a drug covered by the plan based on the amount 
that the plan or pharmacy benefit manager reimburses the 
pharmacy for such drug (including any applicable dis-
pensing fee). Such co-payment amount may not be deter-
mined based on the amount that the plan pays to the 
pharmacy benefit manager for such drug. 
(j) ENFORCEMENT.—In the regulations issued under 
subsection (a), the Secretary shall specify the sanctions 
which shall apply to health benefits plans and issuers of 
health insurance coverage under such plans that contract 
with pharmacy benefit managers that fail to comply with 
the standards under subsection (a). Such sanctions shall 
include the following: 
(1) 
RESTRICTION
ON
FEDERAL
CON-
TRACTING.—The health benefits plan issuer shall 
not be eligible to contract with a Federal program, 
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including Medicare under title XVIII of the Social 
Security Act and the Federal Employees Health 
Benefits Plan under chapter 89 of title 5, United 
States Code. 
(2) CIVIL
MONETARY
PENALTIES.—A health 
benefits plan or an issuer of such plan may be sub-
ject to a civil monetary penalty not to exceed 
$1,000.00 for each day that the pharmacy benefit 
manager is in an contract with the health benefits 
plan or issuer and such pharmacy benefit manager 
fails to comply with the standards under subsection 
(a). 
(k) PHARMACY BENEFIT MANAGER DEFINED.—The 
term ‘‘pharmacy benefit manager’’ means any entity that 
provides pharmacy benefit management services on behalf 
of a health benefits plan. 
(l) EFFECTIVE DATE.—This section shall take effect 
on January 1, 2011. 
SEC. 403. PRICE INFORMATION UNDER MEDICAID. 
(a) DISCLOSURE
OF INFORMATION
TO
THE SEC-
RETARY.—Section 1927(b)(3) of such Act (42 U.S.C. 
1396r–8(b)(3)) is amended— 
(1) in subparagraph (A)— 
(A) in the first sentence, by inserting after 
clause (iii) the following clause: 
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179 
‘‘(iv) not later than 30 days after the 
last day of each month of a rebate period 
under the agreement, on the manufactur-
er’s total number of units that are used to 
calculate the monthly average manufac-
turer price for each covered outpatient 
drug;’’; and 
(B) in the second sentence, by inserting 
‘‘(relating to the weighted average of the most 
recently reported monthly average manufacturer 
prices)’’ after ‘‘(D)(v)’’; and 
(2) in subparagraph (D)(v), by striking ‘‘aver-
age manufacturer prices’’ and inserting ‘‘the weight-
ed average of the most recently reported monthly av-
erage manufacturer prices and the average retail 
survey price determined for each multiple source 
drug in accordance with subsection (f)’’. 
(b) CLARIFICATION OF APPLICATION OF SURVEY OF 
RETAIL PRICES.—Section 1927(f)(1) of such Act (4222 
U.S.C. 1396r–8(b)(1)) is amended— 
(1) in subparagraph (A)(i), by inserting ‘‘with 
respect to a retail community pharmacy,’’ before 
‘‘the determination’’; and 
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(2) in subparagraph (C)(ii), by striking ‘‘retail 
pharmacies’’ and inserting ‘‘retail community phar-
macies’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the first day of the first 
calendar year quarter that begins at least 180 days after 
the date of enactment of this Act, without regard to 
whether or not final regulations to carry out such amend-
ments have been promulgated by such date. 
Æ 
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