I 
119TH CONGRESS 
1ST SESSION H. R. 6501 
To amend the Internal Revenue Code of 1986 to extend and modify the 
enhanced premium tax credit, to amend the Patient Protection and 
Affordable Care Act to make certain adjustments to the operation of 
the Exchanges established under such Act, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 9, 2025 
Mr. FITZPATRICK (for himself, Mr. GOLDEN of Maine, Mr. BACON, Mr. 
SUOZZI, Mr. BRESNAHAN, Mr. DAVIS
of North Carolina, Ms. 
MALLIOTAKIS, Ms. PEREZ, Mr. LAWLER, Ms. SALAZAR, Mr. MACKENZIE, 
Mr. KEAN, Mr. VAN DREW, Mr. VALADAO, Mr. CISCOMANI, and Mr. 
LALOTA) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Ways and Means, and Education and Workforce, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of 
such provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend the Internal Revenue Code of 1986 to extend 
and modify the enhanced premium tax credit, to amend 
the Patient Protection and Affordable Care Act to make 
certain adjustments to the operation of the Exchanges 
established under such Act, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Bipartisan Health In-
surance Affordability Act’’. 
SEC. 2. EXTENSION AND MODIFICATION OF ENHANCED 
PREMIUM TAX CREDIT. 
(a) EXTENSION AND MODIFICATION OF RULES TO 
INCREASE
PREMIUM
ASSISTANCE
AMOUNTS.—Section 
36B(b)(3)(A)(iii) of the Internal Revenue Code of 1986 
is amended— 
(1) by redesignating subclauses (I) and (II) as 
items (aa) and (bb), respectively, and adjusting the 
margins accordingly, 
(2) by striking ‘‘TEMPORARY
PERCENTAGES 
FOR 2021 THROUGH 2025.—In the case of’’ and in-
serting ‘‘TEMPORARY RULES FOR CERTAIN YEARS.— 
‘‘(I) BEFORE 2026.—In the case 
of’’, and 
(3) by adding at the end the following: 
‘‘(II) AFTER
2025 FOR
TAX-
PAYERS WHOSE HOUSEHOLD INCOME 
DOES NOT EXCEED 150 PERCENT OF 
POVERTY LINE.—In the case of a tax-
able year beginning after December 
31, 2025, and before January 1, 
2028, if any taxpayer’s household in-
come does not exceed 150 percent of 
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the poverty line for such taxable year, 
the premium assistance amount deter-
mined under subsection (b)(2), with 
respect to any coverage month, is the 
excess of the lesser of the amount de-
scribed in paragraph (2)(A) or the 
amount 
described 
in 
paragraph 
(2)(B)(i), over $5. 
‘‘(III) AFTER 2025 FOR
TAX-
PAYERS WHOSE HOUSEHOLD INCOME 
DOES NOT EXCEED 200 PERCENT OF 
POVERTY LINE.—In the case of a tax-
able year beginning after December 
31, 2025, and before January 1, 
2028, if any taxpayer’s household in-
come exceeds 150 percent of the pov-
erty line but does not exceed 200 per-
cent of the poverty line for such tax-
able year, the premium assistance 
amount determined under subsection 
(b)(2), with respect to any coverage 
month, shall be such that the pre-
mium assistance amount for such a 
taxpayer shall decrease, on a sliding 
scale in a linear manner, from the 
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amount that would result if deter-
mined in accordance with subclause 
(II) to the amount that would result 
under 
subsection 
(b)(2) 
by 
sub-
stituting ‘2 percent’ for ‘the applicable 
percentage’ in subparagraph (B)(ii) 
thereof. 
‘‘(IV) AFTER
2025 FOR
TAX-
PAYERS WHOSE HOUSEHOLD INCOME 
EXCEEDS 200 percent OF
POVERTY 
LINE.—In the case of a taxable year 
beginning after December 31, 2025, 
and before January 1, 2028, if any 
taxpayer’s household income exceeds 
200 percent of the poverty line for 
such taxable year— 
‘‘(aa) clause (ii) shall not 
apply for purposes of adjusting 
premium percentages under this 
subparagraph, and 
‘‘(bb) the following table 
shall be applied in lieu of the 
table contained in clause (i): 
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‘‘In the case of household income (expressed as a 
percent of poverty line) within the following in-
come tier: 
The initial 
premium 
percentage 
is- 
The final 
premium 
percentage 
is- 
200% up to 250% 
2.0% 
4.0%
250% up to 300% 
4.0% 
6.0%
300% up to 400% 
6.0% 
8.5%
400% up to 600% 
8.5% 
8.5%
600% up to 700% 
8.5% 
9.25%’’. 
(b) EXTENSION AND MODIFICATION OF RULE TO 
ALLOW CREDIT TO TAXPAYERS WHOSE HOUSEHOLD IN-
COME EXCEEDS 400 PERCENT OF POVERTY LINE.—Sec-
tion 36B(c)(1)(E) of such Code is amended— 
(1) by striking ‘‘TEMPORARY RULE FOR 2021 
THROUGH 2025.—In the case of’’ and inserting 
‘‘TEMPORARY RULE FOR CERTAIN YEARS.— 
‘‘(i) BEFORE 2026.—In the case of’’, 
and 
(2) by adding at the end the following: 
‘‘(ii) AFTER 2025.—In the case of a 
taxable year beginning after December 31, 
2025, and before January 1, 2028, sub-
paragraph (A) shall be applied by sub-
stituting ‘but does not exceed 700 percent’ 
for ‘but does not exceed 400 percent’.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2025. 
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SEC. 3. GUARDRAILS TO PREVENT FRAUD IN EXCHANGES. 
(a) REDUCTION OF FRAUDULENT ENROLLMENT IN 
QUALIFIED HEALTH PLANS.— 
(1) PENALTIES FOR AGENTS AND BROKERS.— 
Section 1411(h)(1) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18081(h)(1)) is 
amended— 
(A) in subparagraph (A)— 
(i) by redesignating clause (ii) as 
clause (iv); 
(ii) in clause (i)— 
(I) in the matter preceding sub-
clause (I), by striking ‘‘If—’’ and all 
that follows through the ‘‘such per-
son’’ in the matter following subclause 
(II) and inserting the following: ‘‘If 
any person (other than an agent or 
broker) fails to provide correct infor-
mation under subsection (b) and such 
failure is attributable to negligence or 
disregard of any rules or regulations 
of the Secretary, such person’’; and 
(II) in the second sentence, by 
striking ‘‘For purposes’’ and inserting 
the following: 
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‘‘(iii) DEFINITIONS OF NEGLIGENCE, 
DISREGARD.—For purposes’’; 
(iii) by inserting after clause (i) the 
following: 
‘‘(ii) CIVIL PENALTIES FOR CERTAIN 
VIOLATIONS BY AGENTS OR BROKERS.—If 
any agent or broker fails to provide correct 
information under subsection (b) or section 
1311(c)(8) or other information, as speci-
fied by the Secretary, and such failure is 
attributable to negligence or disregard of 
any rules or regulations of the Secretary, 
such agent or broker shall be subject, in 
addition to any other penalties that may be 
prescribed by law, including subparagraph 
(C), to a civil penalty of not less than 
$10,000 and not more than $50,000 with 
respect to each individual who is the sub-
ject of an application for which such incor-
rect information is provided.’’; and 
(iv) in clause (iv) (as so redesignated), 
by inserting ‘‘or (ii)’’ after ‘‘clause (i)’’; 
(B) in subparagraph (B)— 
(i) by inserting ‘‘including subpara-
graph (C),’’ after ‘‘law,’’; 
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(ii) by striking ‘‘Any person’’ and in-
serting the following: 
‘‘(i) IN GENERAL.—Any person’’; and 
(iii) by adding at the end the fol-
lowing: 
‘‘(ii) CIVIL PENALTIES FOR KNOWING 
VIOLATIONS BY AGENTS OR BROKERS.— 
‘‘(I) IN GENERAL.—Any agent or 
broker who knowingly provides false 
or fraudulent information under sub-
section (b) or section 1311(c)(8), or 
other false or fraudulent information 
as part of an application for enroll-
ment in a qualified health plan offered 
through an Exchange, as specified by 
the Secretary, shall be subject, in ad-
dition to any other penalties that may 
be prescribed by law, including sub-
paragraph (C), to a civil penalty of 
not more than $200,000 with respect 
to each individual who is the subject 
of an application for which such false 
or fraudulent information is provided. 
‘‘(II) PROCEDURE.—The provi-
sions of section 1128A of the Social 
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Security Act (other than subsections 
(a) and (b) of such section) shall 
apply to a civil monetary penalty 
under subclause (I) in the same man-
ner as such provisions apply to a pen-
alty or proceeding under section 
1128A of the Social Security Act.’’; 
and 
(C) by adding at the end the following: 
‘‘(C) CRIMINAL PENALTIES.—Any agent or 
broker who knowingly and willfully provides 
false or fraudulent information under sub-
section (b) or section 1311(c)(8), or other false 
or fraudulent information as part of an applica-
tion for enrollment in a qualified health plan of-
fered through an Exchange, as specified by the 
Secretary, shall be fined under title 18, United 
States Code, imprisoned for not more than 10 
years, or both.’’. 
(2) CONSUMER PROTECTIONS.— 
(A) IN GENERAL.—Section 1311(c) of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18031(c)) is amended by adding at the 
end the following new paragraph: 
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‘‘(8) AGENT- OR
BROKER-ASSISTED
ENROLL-
MENT IN QUALIFIED HEALTH PLANS IN CERTAIN 
EXCHANGES.— 
‘‘(A) IN GENERAL.—For plan years begin-
ning on or after such date specified by the Sec-
retary, but not later than January 1, 2029, in 
the case of an Exchange that the Secretary op-
erates pursuant to section 1321(c)(1), the Sec-
retary shall establish a verification process for 
new enrollments of individuals in, and changes 
in coverage for individuals under, a qualified 
health plan offered through such Exchange, 
which are submitted by an agent or broker in 
accordance with section 1312(e) and for which 
the agent or broker is eligible to receive a com-
mission. 
‘‘(B) 
REQUIREMENTS.—The 
enrollment 
verification process under subparagraph (A) 
shall include— 
‘‘(i) a requirement that the agent or 
broker provide with the new enrollment or 
coverage change such documentation or 
evidence (such as a standardized consent 
form) or other sources as the Secretary de-
termines necessary to establish that the 
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agent or broker has the consent of the in-
dividual for the new enrollment or coverage 
change; 
‘‘(ii) a requirement that any commis-
sions due to a broker or agent for such 
new enrollment or coverage change are 
paid after the enrollee has resolved all in-
consistencies in accordance with para-
graphs (3) and (4) of section 1411(e); 
‘‘(iii) a requirement that the informa-
tion required under clause (i) and, as ap-
plicable, the date on which inconsistencies 
are resolved as described in clause (ii), is 
accessible to the applicable qualified health 
plan through a database or other resource, 
as determined by the Secretary, so that 
any commissions due to a broker or agent 
for such enrollment can be effectuated at 
the appropriate time; 
‘‘(iv) a requirement that individuals 
are notified of any changes to enrollment, 
coverage, the agent of record, or premium 
tax credits in a timely manner and that 
such notice provides plain language in-
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structions on how individuals can cancel 
unauthorized activity; 
‘‘(v) a requirement that individuals be 
able to access their account information on 
a website or other technology platform, as 
defined by the Secretary, when used to 
submit an enrollment or plan change, in 
lieu of the Exchange website described in 
subsection (d)(4)(C), including information 
on the agent of record, the qualified health 
plan, and when any changes are made to 
the agent of record or the qualified health 
plan, on a consumer-facing website or 
through a toll-free telephone hotline; and 
‘‘(vi) a requirement that the agent or 
broker report to the Secretary any third- 
party marketing organization or field mar-
keting organization (as such terms are de-
fined in section 1312(e)) involved in the 
chain of enrollment (as so defined) with re-
spect to such new enrollment or coverage 
change. 
‘‘(C) CONSUMER PROTECTION.—The Sec-
retary 
shall 
ensure 
that 
the 
enrollment 
verification process under subparagraph (A) 
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prioritizes continuity of coverage and care for 
individuals, including by not disenrolling indi-
viduals from a qualified health plan without the 
consent of the individual, regardless of whether 
the broker, agent, or qualified health plan is in 
violation of any requirement under this para-
graph.’’. 
(B) 
REQUIRED
REPORTING.—Section 
1311(c)(1) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18031(c)(1)) is 
amended— 
(i) in subparagraph (H), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (I), by striking 
the period at the end and inserting ‘‘; 
and’’; and 
(iii) by adding at the end the fol-
lowing: 
‘‘(J) report to the Secretary the termi-
nation (as defined in section 1312(e)(1)(C)) of 
an issuer.’’. 
(3) AUTHORITY
TO
REGULATE
FIELD
MAR-
KETING
ORGANIZATIONS
AND
THIRD-PARTY
MAR-
KETING
ORGANIZATIONS.—Section 1312(e) of the 
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Patient Protection and Affordable Care Act (42 
U.S.C. 18032(e)) is amended— 
(A) by redesignating paragraphs (1) and 
(2) as subclauses (I) and (II), respectively, and 
adjusting the margins accordingly; 
(B) in subclause (II) (as so redesignated), 
by striking the period at the end and inserting 
‘‘; and’’; 
(C) by striking the subsection designation 
and heading and all that follows through ‘‘bro-
kers—’’ and inserting the following: 
‘‘(e) REGULATION OF AGENTS, BROKERS, AND CER-
TAIN MARKETING ORGANIZATIONS.— 
‘‘(1) AGENTS, BROKERS, AND
CERTAIN
MAR-
KETING ORGANIZATIONS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish procedures under which a State may 
allow— 
‘‘(i) agents or brokers—’’; and 
(D) by adding at the end the following: 
‘‘(ii) field marketing organizations 
and third-party marketing organizations to 
participate in the chain of enrollment for 
an individual with respect to qualified 
health plans offered through an Exchange. 
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‘‘(B) CRITERIA.—For plan years beginning 
on or after such date specified by the Secretary, 
but not later than January 1, 2029, the Sec-
retary, by regulation, shall establish criteria for 
States to use in determining whether to allow 
agents and brokers to enroll individuals and 
employers in qualified health plans as described 
in subclause (I) of subparagraph (A)(i) and to 
assist individuals as described in subclause (II) 
of such subparagraph and field marketing orga-
nizations and third-party marketing organiza-
tions to participate in the chain of enrollment 
as described in subparagraph (A)(ii). Such cri-
teria shall, at a minimum, require that— 
‘‘(i) an agent or broker act in accord-
ance with a standard of conduct that in-
cludes a duty of such agent or broker to 
act in the best interests of the enrollee; 
‘‘(ii) a field marketing organization or 
third-party marketing organization agree 
to report the termination of an agent or 
broker to the applicable State and the Sec-
retary, including the reason for termi-
nation; and 
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‘‘(iii) an agent, broker, field mar-
keting organization, or third-party mar-
keting organization— 
‘‘(I) meet such marketing re-
quirements as are required by the 
Secretary; 
‘‘(II) meet marketing require-
ments in accordance with other appli-
cable Federal or State law; 
‘‘(III) does not employ practices 
that are confusing or misleading, as 
determined by the Secretary; 
‘‘(IV) submit all marketing mate-
rials to the Secretary for, as deter-
mined appropriate by the Secretary, 
review and approval; 
‘‘(V) is a licensed agent or broker 
or meets other licensure requirements, 
as required by the State; 
‘‘(VI) register with the Secretary; 
and 
‘‘(VII) does not compensate any 
individual or organization for referrals 
or any other service relating to the 
sale of, marketing for, or enrollment 
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in qualified health plans unless such 
individual or organization meets the 
criteria described in subclauses (I) 
through (VI). 
‘‘(C) DEFINITIONS.—In this paragraph: 
‘‘(i) CHAIN
OF
ENROLLMENT.—The 
term ‘chain of enrollment’, with respect to 
enrollment of an individual in a qualified 
health plan offered through an Exchange, 
means any steps taken from marketing to 
such individual, to such individual making 
an enrollment decision with respect to such 
a plan. 
‘‘(ii) FIELD
MARKETING
ORGANIZA-
TION.—The term ‘field marketing organi-
zation’ means an organization or individual 
that directly employs or contracts with 
agents and brokers, or contracts with car-
riers, to provide functions relating to en-
rollment of individuals in qualified health 
plans offered through an Exchange as part 
of the chain of enrollment. 
‘‘(iii) MARKETING.—The term ‘mar-
keting’ means the use of marketing mate-
rials to provide information to current and 
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prospective enrollees in a qualified health 
plan offered through an Exchange. 
‘‘(iv) MARKETING
MATERIALS.—The 
term ‘marketing materials’ means mate-
rials relating to a qualified health plan of-
fered through an Exchange or benefits of-
fered through an Exchange that— 
‘‘(I) are intended— 
‘‘(aa) to draw an individual’s 
attention to such plan or the pre-
mium tax credits or cost-sharing 
reductions for such plan or plans 
offered through an Exchange; 
‘‘(bb) to influence an indi-
vidual’s decision-making process 
when selecting a qualified health 
plan in which to enroll; or 
‘‘(cc) to influence an enroll-
ee’s decision to stay enrolled in 
such plan; and 
‘‘(II) include or address content 
regarding the benefits, benefit struc-
ture, premiums, or cost sharing of 
such plan. 
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‘‘(v) TERMINATION.—The term ‘ter-
mination’, with respect to a contract or 
business arrangement between an agent or 
broker and a field marketing organization, 
third-party marketing organization, or 
health insurance issuer, means— 
‘‘(I) the ending of such contract 
or business arrangement, either uni-
laterally by one of the parties or on 
mutual agreement; or 
‘‘(II) the expiration of such con-
tract or business arrangement that is 
not replaced by a substantially similar 
agreement. 
‘‘(vi) THIRD-PARTY MARKETING ORGA-
NIZATION.—The term ‘third-party mar-
keting organization’ means an organization 
or individual that is compensated to per-
form lead generation, marketing, or sales 
relating to enrollment of individuals in 
qualified health plans offered through an 
Exchange as part of the chain of enroll-
ment.’’. 
(4) TRANSPARENCY.—Section 1312(e) of the 
Patient Protection and Affordable Care Act (42 
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U.S.C. 18032(e)), as amended by paragraph (3), is 
further amended by adding at the end the following 
new paragraphs: 
‘‘(2) AUDITS.— 
‘‘(A) IN GENERAL.—For plan years begin-
ning on or after such date specified by the Sec-
retary, but not later than January 1, 2029, the 
Secretary, in coordination with the States and 
in consultation with the National Association of 
Insurance Commissioners, shall implement a 
process for the oversight and enforcement of 
agent and broker compliance with this section 
and other applicable Federal and State law (in-
cluding regulations) that shall include— 
‘‘(i) periodic audits of agents and bro-
kers based on— 
‘‘(I) complaints filed with the 
Secretary by individuals enrolled by 
such an agent or broker in a qualified 
health plan offered through an Ex-
change; 
‘‘(II) an incident or enrollment 
pattern that suggests fraud; and 
‘‘(III) other factors determined 
by the Secretary; and 
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‘‘(ii) a process under which the Sec-
retary shall share audit results and refer 
potential cases of fraud to the relevant 
State department of insurance. 
‘‘(B) EFFECT.—Nothing in this paragraph 
limits or restricts any referrals made under sec-
tion 1311(i)(3) or any enforcement actions 
under section 1411(h). 
‘‘(3) LIST.—The Secretary shall develop a proc-
ess to regularly provide to qualified health plans, 
Exchanges, and States a list of suspended and ter-
minated agents and brokers.’’. 
(b) REMOVAL OF DECEASED INDIVIDUALS FROM EX-
CHANGE PLANS.—Section 1311(c) of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 18031(c)), as 
amended by subsection (a), is further amended by adding 
at the end the following new paragraph: 
‘‘(9) REMOVAL
OF
DECEASED
INDIVIDUALS 
FROM EXCHANGE PLANS.— 
‘‘(A) IN
GENERAL.—Not later than 90 
days after the date of the enactment of this 
paragraph, and on a quarterly basis thereafter, 
the Secretary shall conduct a check of the 
Death Master File (as such term is defined in 
section 203(d) of the Bipartisan Budget Act of 
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2013) for purposes of identifying individuals 
enrolled in a qualified health plan through an 
Exchange who are deceased. 
‘‘(B) PROCESS.—The Secretary shall— 
‘‘(i) establish a process to verify that 
an individual identified pursuant to a 
check described in subparagraph (A) is de-
ceased; and 
‘‘(ii) require an Exchange to termi-
nate such individual’s enrollment under a 
qualified health plan.’’. 
(c) STANDARD
OF
PROOF
FOR
TERMINATING 
AGENTS AND BROKERS.—Section 1312(e) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18032(e)), 
as amended by subsection (a), is further amended by add-
ing at the end the following new paragraph: 
‘‘(4) STANDARD FOR TERMINATION FOR CER-
TAIN
EXCHANGES.—In the case of an agent or 
broker with an agreement in effect with an Ex-
change operated by the Secretary pursuant to sec-
tion 1321(c) to perform activities described in para-
graph (1)(A)(i) with respect to such Exchange, the 
Secretary may terminate such agreement for cause 
if the Secretary finds, based on a preponderance of 
the evidence, that such agent or broker has violated 
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such agreement, otherwise applicable law, or any 
other requirement applicable to such agent or 
broker.’’. 
(d) REQUIREMENT FOR EXCHANGE TO NOTIFY INDI-
VIDUALS OF VALUE OF PREMIUM TAX CREDITS.—Section 
1412(c)(2) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18082(c)(2)) is amended by adding at the 
end the following new subparagraph: 
‘‘(C) EXCHANGE RESPONSIBILITIES.—Be-
ginning January 1, 2027, if an Exchange is no-
tified under paragraph (1) of an advance deter-
mination under section 1411 with respect to the 
eligibility of an individual for a premium tax 
credit under section 36B of the Internal Rev-
enue Code of 1986, the Exchange shall, prior to 
enrolling such individual in a qualified health 
plan, clearly notify such individual of the 
amount of such tax credit.’’. 
SEC. 4. EXTENDING ANNUAL OPEN ENROLLMENT PERIOD 
FOR EXCHANGES FOR PLAN YEAR 2026. 
The Secretary of Health and Human Services shall 
revise section 155.410(e) of title 45, Code of Federal Reg-
ulations (or any successor regulation) to provide that the 
annual open enrollment period determined for plan year 
2026 pursuant to section 1311(c)(6) of the Patient Pro-
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tection and Affordable Care Act (42 U.S.C. 18031(c)(6)) 
shall begin on November 1, 2025, and end on March 1, 
2026. 
SEC. 5. MODERNIZING AND ENSURING PBM ACCOUNT-
ABILITY. 
(a) IN GENERAL.— 
(1) 
PRESCRIPTION
DRUG
PLANS.—Section 
1860D–12 of the Social Security Act (42 U.S.C. 
1395w–112) is amended by adding at the end the 
following new subsection: 
‘‘(h) REQUIREMENTS RELATING TO PHARMACY BEN-
EFIT MANAGERS.—For plan years beginning on or after 
January 1, 2029: 
‘‘(1) AGREEMENTS WITH PHARMACY BENEFIT 
MANAGERS.—Each contract entered into with a 
PDP sponsor under this part with respect to a pre-
scription drug plan offered by such sponsor shall 
provide that any pharmacy benefit manager acting 
on behalf of such sponsor has a written agreement 
with the PDP sponsor under which the pharmacy 
benefit manager, and any affiliates of such phar-
macy benefit manager, as applicable, agree to meet 
the following requirements: 
‘‘(A) NO INCOME OTHER THAN BONA FIDE 
SERVICE FEES.— 
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‘‘(i) IN
GENERAL.—The pharmacy 
benefit manager and any affiliate of such 
pharmacy benefit manager shall not derive 
any remuneration with respect to any serv-
ices provided on behalf of any entity or in-
dividual, in connection with the utilization 
of covered part D drugs, from any such en-
tity or individual other than bona fide serv-
ice fees, subject to clauses (ii) and (iii). 
‘‘(ii) INCENTIVE PAYMENTS.—For the 
purposes of this subsection, an incentive 
payment (as determined by the Secretary) 
paid by a PDP sponsor to a pharmacy 
benefit manager that is performing serv-
ices on behalf of such sponsor shall be 
deemed a ‘bona fide service fee’ (even if 
such payment does not otherwise meet the 
definition of such term under paragraph 
(7)(B)) if such payment is a flat dollar 
amount, is consistent with fair market 
value (as specified by the Secretary), is re-
lated to services actually performed by the 
pharmacy benefit manager or affiliate of 
such pharmacy benefit manager, on behalf 
of the PDP sponsor making such payment, 
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