I 
109TH CONGRESS 
1ST SESSION H. R. 1669
To ensure integrity in the operation of pharmacy benefit managers. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 14, 2005
Mr. WEINER (for himself and Mr. MORAN of Kansas) introduced the following 
bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To ensure integrity in the operation of 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 ‘‘Pharmacy Benefit 
Manager Transparency Act of 2005’’. 
SEC. 2. REQUIREMENTS RELATING TO PHARMACY BENEFIT 
MANAGERS. 
(a) PROHIBITION ON CROSS OWNERSHIP.—
(1) IN
GENERAL.—No pharmaceutical drug 
manufacturer may have a controlling interest in an 
entity that is a pharmacy benefit manager.
(2) PENALTY.—The Secretary of Health and 
Human Services may issue such civil penalties for a 
violation of paragraph (1) as the Secretary of 
Health and Human Services determines necessary. 
(b) DRUG INTERCHANGE.—
(1) PROHIBITIONS.—
(A) COST INCREASE.—A pharmacy benefit 
manager shall not make any drug interchange 
proposal for an individual who is served by such 
manager where the net cost of the drug to 
which the prescription would be changed ex-
ceeds that of the drug from which the prescrip-
tion would be changed. 
(B) 
DISCLOSURE
TO
INDIVIDUAL.—A 
pharmacy benefit manager shall not make any 
drug interchange for an individual who is 
served by such manager unless the pharmacy 
benefit manager discloses to the individual, in a 
clear and conspicuous manner, the savings to 
the individual associated with such interchange. 
(C) GENERICS.—A pharmacy benefit man-
ager shall not make any drug interchange pro-
posal for an individual who is served by such 
manager if the drug from which the prescrip-
tion would be changed has generic equivalents
and the drug to which the prescription would be 
changed has no generic equivalents, unless the 
drug to which the prescription would be 
changed has a lower net cost to the individual 
than does each of the generic equivalents of the 
drug from which the prescription would be 
changed. 
(2) PENALTY.—A pharmacy benefit manager 
that violates subparagraph (A), (B), or (C) of para-
graph (1) with respect to an individual and presents 
a claim for payment to the United States Govern-
ment as reimbursement for services to such indi-
vidual, shall be considered in violation of section 
3729 of title 31, United States Code. 
(c) DISCLOSURE OF COMPENSATION FROM DRUG 
MANUFACTURERS.—
(1) QUARTERLY AND ANNUAL DISCLOSURES.—
At the end of each fiscal year quarter, each phar-
macy benefit manager shall disclose—
(A) to the client plans of such manager 
and to the Antitrust Division of the Depart-
ment of Justice, all compensation and remu-
neration that the pharmacy benefit manager re-
ceived during such fiscal year quarter from a 
pharmaceutical drug manufacturer, including,
regardless of how categorized, market share in-
centives, commissions, mail service purchase 
discounts, and administrative or management 
fees; and 
(B) to the client plans of such manager, 
any fees received for sales of utilization data to 
a pharmaceutical drug manufacturer. 
(2) DISCLOSURE
AT
CONTRACTING
STAGE.—
Each pharmacy benefit manager shall disclose to 
each client plan and prospective client plan of such 
manager, in advance of executing an agreement with 
such plan, information relating to the pharmacy ben-
efit manager’s methodology of soliciting and receiv-
ing payments from pharmaceutical drug manufac-
turers. 
(d) DEFINITIONS.—For purposes of this section: 
(1) CLIENT
PLAN.—The term ‘‘client plan’’ 
means a pharmaceutical plan in which the entity 
that offers such plan to its beneficiaries contracts di-
rectly with a pharmacy benefit manager to provide 
or administer such plan. 
(2) DRUG
INTERCHANGE.—The term ‘‘drug 
interchange’’ means any change from one prescrip-
tion drug to another prescription drug that is in-
tended to address or treat the same illness or condi-
tion.
Æ