I 
119TH CONGRESS 
1ST SESSION H. R. 2214 
To improve services provided by pharmacy benefit managers. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 18, 2025 
Mrs. MILLER-MEEKS (for herself, Ms. BARRAGA´N, Ms. MALLIOTAKIS, Mr. 
SCHNEIDER, Mr. ALLEN, and Mr. NORCROSS) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committees on Ways and Means, and Education and 
Workforce, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To improve services provided by pharmacy benefit managers. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Delinking Revenue 
from Unfair Gouging Act’’ or the ‘‘DRUG Act’’. 
SEC. 2. IMPROVING PHARMACY BENEFIT MANAGER SERV-
ICES. 
(a) PUBLIC HEALTH SERVICE ACT.—Part D of title 
XXVII of the Public Health Service Act (42 U.S.C. 
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
300gg–111 et seq.) is amended by adding at the end the 
following: 
‘‘SEC. 2799A–11. IMPROVING PHARMACY BENEFIT MANAGER 
SERVICES. 
‘‘(a) IN GENERAL.—Beginning on January 1, 2027, 
except as provided in subsection (b), a pharmacy benefit 
manager shall derive no remuneration from any entity for 
services, benefit administration, or any other activities re-
lated to prescription drug benefits under a group health 
plan or group or individual health insurance coverage. 
‘‘(b) EXCEPTION FOR BONA FIDE SERVICE FEES.— 
‘‘(1) IN GENERAL.—A pharmacy benefit man-
ager may charge an entity a bona fide service fee for 
the provision of services to such entity only if such 
fee is set forth in an agreement between the phar-
macy benefit manager and such entity and the 
amount of any bona fide service fee— 
‘‘(A) is a flat dollar amount; and 
‘‘(B) is not directly or indirectly based on, 
or contingent upon— 
‘‘(i) a drug price (such as wholesale 
acquisition cost) or drug benchmark price 
(such as average wholesale price); 
‘‘(ii) the amount of discounts, rebates, 
fees, or other direct or indirect remunera-
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
tion with respect to prescription drugs pre-
scribed to the participants, beneficiaries, or 
enrollees in the group health plan or health 
insurance coverage involved; or 
‘‘(iii) any other amounts specified by 
the Secretary, the Secretary of Labor, and 
the Secretary of the Treasury; 
‘‘(2) DEFINITIONS.—In this section— 
‘‘(A) the term ‘bona fide service fee’ means 
a fee that is equal to the fair market value of 
a bona fide, itemized service that is actually 
performed on behalf of an entity, that the enti-
ty would otherwise perform (or contract for) in 
the absence of the service arrangement, and 
that is not passed on in whole or in part to a 
client or customer, whether or not the entity 
takes title to the drug; and 
‘‘(B) the term ‘pharmacy benefit manager’ 
means any person, business, or other entity, 
such as a third-party administrator, regardless 
of whether it identifies itself as a pharmacy 
benefit manager, that, either directly or 
through an intermediary (including an affiliate, 
subsidiary, or agent) or an arrangement with a 
third-party— 
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(i) acts a price negotiator for pre-
scription drugs on behalf of a group health 
plan or health insurance issuer offering 
group or individual health insurance cov-
erage; or 
‘‘(ii) manages or administers the pre-
scription drug benefits provided by a group 
health plan or health insurance issuer of-
fering group or individual health insurance 
coverage, including creating formularies, 
the processing and payment of claims for 
prescription drugs, arranging alternative 
access to or funding for prescription drugs, 
the performance of drug utilization review, 
the processing of drug prior authorization 
requests, the adjudication of appeals or 
grievances related to the prescription drug 
benefit, contracting with network phar-
macies (including retail and mail phar-
macies), controlling the cost of covered 
prescription drugs, or the provision of re-
lated services. 
‘‘(c) ENFORCEMENT.— 
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with the Secretary of Labor and the Secretary 
of the Treasury, shall enforce this section. 
‘‘(2) DISGORGEMENT.—The pharmacy benefit 
manager shall disgorge to a group health plan or 
health insurance issuer offering group or individual 
health insurance coverage any payment, remunera-
tion, or other amount received by the pharmacy ben-
efit manager or an affiliate of such pharmacy benefit 
manager from such plan or issuer in violation of 
subsection (a) or, pursuant to subsection (b), the 
agreement entered into with such plan or issuer for 
bona fide service fees. 
‘‘(3) PENALTIES.—A pharmacy benefit man-
ager that violates subsection (a) or (b) shall be sub-
ject to a civil monetary penalty in the amount of 
$10,000 for each day during which such violation 
continues. 
‘‘(4) 
PROCEDURE.—Notwithstanding 
section 
2723, the provisions of section 1128A of the Social 
Security Act, other than subsection (a) and (b) and 
the first sentence of subsection (c)(1) of such sec-
tion, shall apply to civil monetary penalties under 
this subsection in the same manner as such provi-
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
sions apply to a penalty or proceeding under section 
1128A of the Social Security Act. 
‘‘(d) REGULATIONS.—Notwithstanding any other 
provision of law, the Secretary, in consultation with the 
Secretary of Labor and the Secretary of the Treasury, 
shall implement this section through interim final regula-
tions. 
‘‘(e) RULES OF CONSTRUCTION.—Nothing in this 
section shall be construed— 
‘‘(1) as prohibiting payments related to reim-
bursement for ingredient costs to entities that ac-
quire prescription drugs or pharmacy dispensing 
fees; and 
‘‘(2) to prohibit rebates, discounts, or other 
price concessions from being fully passed through to 
a group health plan or health insurance issuer offer-
ing group or individual health insurance coverage to 
lower net costs for prescription drugs.’’. 
(b) ERISA.— 
(1) IN GENERAL.—Subpart B of part 7 of sub-
title B of title I of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1185 et seq.) is 
amended by inserting after section 725 the fol-
lowing: 
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘SEC. 726. IMPROVING PHARMACY BENEFIT MANAGER 
SERVICES. 
‘‘(a) GENERAL.—Beginning on January 1, 2027, ex-
cept as provided in subsection (b), a pharmacy benefit 
manager shall derive no remuneration from any entity for 
services, benefit administration, or any other activities re-
lated to prescription drug benefits under a group health 
plan or group health insurance coverage. 
‘‘(b) EXCEPTION FOR BONA FIDE SERVICE FEES.— 
‘‘(1) IN GENERAL.—A pharmacy benefit man-
ager may charge an entity a bona fide service fee for 
the provision of services to an entity only if such fee 
is set forth in an agreement between the pharmacy 
benefit manager and such entity and the amount of 
any bona fide service fee— 
‘‘(A) is a flat dollar amount; and 
‘‘(B) is not directly or indirectly based on, 
or contingent upon— 
‘‘(i) a drug price (such as wholesale 
acquisition cost) or drug benchmark price 
(such as average wholesale price); 
‘‘(ii) the amount of discounts, rebates, 
fees, or other direct or indirect remunera-
tion with respect to prescription drugs pre-
scribed to the participants, beneficiaries, or 
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
enrollees in the group health plan or health 
insurance coverage involved; or 
‘‘(iii) any other amounts specified by 
the Secretary, the Secretary of Health and 
Human Services, and the Secretary of the 
Treasury. 
‘‘(2) DEFINITIONS.—In this section— 
‘‘(A) the term ‘bona fide service fee’ means 
a fee that is equal to the fair market value of 
a bona fide, itemized service that is actually 
performed on behalf of an entity, that the enti-
ty would otherwise perform (or contract for) in 
the absence of the service arrangement, and 
that is not passed on in whole or in part to a 
client or customer, whether or not the entity 
takes title to the drug; and 
‘‘(B) the term ‘pharmacy benefit manager’ 
means any person, business, or other entity, 
such as a third-party administrator, regardless 
of whether it identifies itself as a pharmacy 
benefit manager, that, either directly or 
through an intermediary (including an affiliate, 
subsidiary, or agent) or an arrangement with a 
third-party— 
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(i) acts a price negotiator for pre-
scription drugs on behalf of a group health 
plan or health insurance issuer offering 
group health insurance coverage; or 
‘‘(ii) manages or administers the pre-
scription drug benefits provided by a group 
health plan or health insurance issuer of-
fering group health insurance coverage, in-
cluding creating formularies, the proc-
essing and payment of claims for prescrip-
tion drugs, arranging alternative access to 
or funding for prescription drugs, the per-
formance of drug utilization review, the 
processing of drug prior authorization re-
quests, the adjudication of appeals or 
grievances related to the prescription drug 
benefit, contracting with network phar-
macies (including retail and mail phar-
macies), controlling the cost of covered 
prescription drugs, or the provision of re-
lated services. 
‘‘(c) ENFORCEMENT.—The Secretary shall enforce 
this section as provided for in section 502(c)(13). 
‘‘(d) REGULATIONS.—Notwithstanding any other 
provision of law, the Secretary, in consultation with the 
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
Secretary of Health and Human Services and the Sec-
retary of the Treasury, shall implement this section 
through interim final regulations. 
‘‘(e) RULES OF CONSTRUCTION.—Nothing in this 
section shall be construed— 
‘‘(1) as prohibiting payments related to reim-
bursement for ingredient costs to entities that ac-
quire prescription drugs or pharmacy dispensing 
fees; and 
‘‘(2) to prohibit rebates, discounts, or other 
price concessions from being fully passed through to 
a group health plan or health insurance issuer offer-
ing group health insurance coverage to lower net 
costs for prescription drugs.’’. 
(2) ENFORCEMENT.—Section 502 of the Em-
ployee Retirement Income Security Act of 1974 (29 
U.S.C. 1132) is amended— 
(A) in subsection (a)(6), by striking ‘‘or 
(9)’’ and inserting ‘‘(9), or (13)’’; and 
(B) in subsection (c), by adding at the end 
the following: 
‘‘(13) SECRETARIAL ENFORCEMENT AUTHORITY RE-
LATING TO PHARMACY BENEFIT MANAGER SERVICES.— 
‘‘(A) DISGORGEMENT.—With respect to a viola-
tion of section 726 by a pharmacy benefit manager, 
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
such pharmacy benefit manager shall disgorge to a 
group health plan or health insurance issuer offering 
group health insurance coverage any payment, remu-
neration, or other amount received by the pharmacy 
benefit manager or an affiliate of such pharmacy 
benefit manager from such plan or issuer in viola-
tion of subsection (a) of such section or, pursuant to 
subsection (b) of such section, the agreement en-
tered into with such plan or issuer for bona fide 
service fees. 
‘‘(B) PENALTIES.—A pharmacy benefit man-
ager that violates subsection (a) or (b) of section 
726 shall be subject to a civil monetary penalty in 
the amount of $10,000 for each day during which 
such violation continues. 
‘‘(C) PROCEDURE.—Except as provided in this 
paragraph, the provisions of this section shall apply 
to civil monetary penalties under this paragraph in 
the same manner as such provisions apply to other 
civil penalties under this section. 
‘‘(D) RULE
OF
CONSTRUCTION.—Nothing in 
this paragraph shall effect the authority of the Sec-
retary under subsection (a)(5).’’. 
(3) CLERICAL AMENDMENT.—The table of con-
tents in section 1 of the Employee Retirement In-
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
come Security Act of 1974 (29 U.S.C. 1001 et seq.) 
is amended by inserting after the item relating to 
section 725 the following new item: 
Sec. 726. Improving pharmacy benefit manager services. 
(c) INTERNAL REVENUE CODE OF 1986.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986 is amend-
ed by adding at the end the following: 
‘‘SEC. 9826. IMPROVING PHARMACY BENEFIT MANAGER 
SERVICES. 
‘‘(a) IN GENERAL.—Beginning on January 1, 2027, 
except as provided in subsection (b), a pharmacy benefit 
manager shall derive no remuneration from any entity for 
services, benefit administration, or any other activities re-
lated to prescription drug benefits under a group health 
plan. 
‘‘(b) EXCEPTION FOR BONA FIDE SERVICE FEES.— 
‘‘(1) IN GENERAL.—A pharmacy benefit man-
ager may charge an entity a bona fide service fee for 
the provision of services to such entity only if such 
fee is set forth in an agreement between the phar-
macy benefit manager and such entity and the 
amount of any bona fide service fee— 
‘‘(A) is a flat dollar amount; and 
‘‘(B) is not directly or indirectly based on, 
or contingent upon— 
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(i) a drug price (such as wholesale 
acquisition cost) or drug benchmark price 
(such as average wholesale price); 
‘‘(ii) the amount of discounts, rebates, 
fees, or other direct or indirect remunera-
tion with respect to prescription drugs pre-
scribed to the participants, beneficiaries, or 
enrollees in the group health plan involved; 
or 
‘‘(iii) any other amounts specified by 
the Secretary, the Secretary of Health and 
Human Services, and the Secretary of the 
Labor. 
‘‘(2) DEFINITIONS.—In this section— 
‘‘(A) the term ‘bona fide service fee’ means 
a fee that is equal to the fair market value of 
a bona fide, itemized service that is actually 
performed on behalf of an entity, that the enti-
ty would otherwise perform (or contract for) in 
the absence of the service arrangement, and 
that is not passed on in whole or in part to a 
client or customer, whether or not the entity 
takes title to the drug; and 
‘‘(B) the term ‘pharmacy benefit manager’ 
means any person, business, or other entity 
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
such as a third-party administrator, regardless 
of whether it identifies itself as a pharmacy 
benefit manager, that, either directly or 
through an intermediary (including an affiliate, 
subsidiary, or agent) or an arrangement with a 
third-party— 
‘‘(i) acts as a price negotiator for pre-
scription drugs on behalf of a group health 
plan; or 
‘‘(ii) manages or administers the pre-
scription drug benefits provided by a group 
health plan, including creating formularies, 
the processing and payment of claims for 
prescription drugs, arranging alternative 
access to or funding for prescription drugs, 
the performance of drug utilization review, 
the processing of drug prior authorization 
requests, the adjudication of appeals or 
grievances related to the prescription drug 
benefit, contracting with network phar-
macies, controlling the cost of covered pre-
scription drugs, or the provision of related 
services. 
‘‘(c) ENFORCEMENT.— 
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with the Secretary of Health and Human Serv-
ices and the Secretary of Labor, shall enforce this 
section. 
‘‘(2) DISGORGEMENT.—The pharmacy benefit 
manager shall disgorge to a group health plan any 
payment, remuneration, or other amount received by 
the pharmacy benefit manager or an affiliate of such 
pharmacy benefit manager from such plan or issuer 
in violation of subsection (a) or, pursuant to sub-
section (b), the agreement entered into with such 
plan for bona fide service fees. 
‘‘(3) PENALTIES.—A pharmacy benefit man-
ager that violates subsection (a) or (b) shall be sub-
ject to a civil monetary penalty in the amount of 
$10,000 for each day during which such violation 
continues. 
‘‘(4) PROCEDURE.—The provisions of section 
1128A of the Social Security Act, other than sub-
section (a) and (b) and the first sentence of sub-
section (c)(1) of such section, shall apply to civil 
monetary penalties under this subsection in the 
same manner as such provisions apply to a penalty 
or proceeding under section 1128A of the Social Se-
curity Act. 
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(d) REGULATIONS.—Notwithstanding any other 
provision of law, the Secretary, in consultation with the 
Secretary of Health and Human Services and the Sec-
retary of Labor, shall implement this section through in-
terim final regulations.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for subchapter B of chapter 100 of the Inter-
nal Revenue Code of 1986 is amended by adding at 
the end the following new item: 
‘‘Sec. 9826. Improving pharmacy benefit manager services.’’. 
Æ 
VerDate Sep 11 2014 
22:01 Mar 28, 2025
Jkt 059200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6301
E:\BILLS\H2214.IH
H2214
kjohnson on DSK7ZCZBW3PROD with $$_JOB