a covered outpatient drug for which benefits are available 
under such plan or coverage dispensed by an in-network 
pharmacy in an amount that exceeds the nationwide aver-
age of consumer purchase prices for such drug for the 1- 
year period ending on the first day of such plan year (as 
determined using information from the survey described 
in section 1927(f)(1)(A)(i) of the Social Security Act). 
‘‘(b) CLARIFICATION ON APPLICATION TO PHARMACY 
BENEFIT MANAGERS.—A group health plan, and a health 
insurance issuer offering group health insurance coverage, 
shall ensure that any pharmacy benefit manager providing 
services under the plan or coverage complies with sub-
section (a) in the same manner as such subsection applies 
with respect to such plan or issuer. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) COVERED OUTPATIENT DRUG.—The term 
‘covered outpatient drug’ has the meaning given 
such term in section 1927(k) of the Social Security 
Act. 
‘‘(2) IN-NETWORK PHARMACY.—The term ‘in- 
network pharmacy’ means, with respect to a group 
health plan or group health insurance coverage and 
a drug, a pharmacy with a contractual relationship 
in effect for dispensing such drug under such plan 
or coverage.’’. 
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(2) CLERICAL AMENDMENT.—The table of con-
tents in section 1 of such Act is amended by insert-
ing after the item relating to section 715 the fol-
lowing new item: 
‘‘Sec. 726. Limitation on cost sharing for drugs.’’. 
(c) IRC.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986 is amend-
ed by adding at the end the following new section: 
‘‘SEC. 9826. LIMITATION ON COST SHARING FOR DRUGS. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after the date of the enactment of this section, a group 
health plan may not impose cost sharing (including 
deductibles, coinsurance, and copayments) with respect to 
a covered outpatient drug for which benefits are available 
under such plan dispensed by an in-network pharmacy in 
an amount that exceeds the nationwide average of con-
sumer purchase prices for such drug for the 1-year period 
ending on the first day of such plan year (as determined 
using information from the survey described in section 
1927(f)(1)(A)(i) of the Social Security Act). 
‘‘(b) CLARIFICATION ON APPLICATION TO PHARMACY 
BENEFIT MANAGERS.—A group health plan shall ensure 
that any pharmacy benefit manager providing services 
under the plan complies with subsection (a) in the same 
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manner as such subsection applies with respect to such 
plan. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) COVERED OUTPATIENT DRUG.—The term 
‘covered outpatient drug’ has the meaning given 
such term in section 1927(k) of the Social Security 
Act. 
‘‘(2) IN-NETWORK PHARMACY.—The term ‘in- 
network pharmacy’ means, with respect to a group 
health plan and a drug, a pharmacy with a contrac-
tual relationship in effect for dispensing such drug 
under such plan.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for such subchapter is amended by adding at 
the end the following new item: 
‘‘Sec. 9826. Limitation on cost sharing for drugs.’’. 
Æ 
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