I 
113TH CONGRESS 
2D SESSION 
H. R. 4437 
To amend title XVIII of the Social Security Act to provide for pharmacy 
benefits manager standards under the Medicare prescription drug pro-
gram to further transparency of payment methodologies to pharmacies, 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 9, 2014 
Mr. COLLINS of Georgia (for himself and Mr. LOEBSACK) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for pharmacy benefits manager standards under the 
Medicare prescription drug program to further trans-
parency of payment methodologies to pharmacies, and 
for other purposes. 
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 ‘‘Generic Drug Pricing 
Fairness Act’’. 
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SEC. 
2. 
PHARMACY 
BENEFITS 
MANAGER 
STANDARDS 
UNDER THE MEDICARE PROGRAM. 
(a) IN GENERAL.—Section 1860D–12(b) of the So-
cial Security Act (42 U.S.C. 1395w–112(b)) is amended 
by adding at the end the following new paragraphs: 
‘‘(7) PHARMACY
BENEFITS
MANAGER
TRANS-
PARENCY
REQUIREMENTS.—Each contract entered 
into with a PDP sponsor under this part with re-
spect to a prescription drug plan offered by such 
sponsor shall provide that the PDP may not enter 
into a contract with any pharmacy benefits manager 
(referred to in this paragraph as a ‘PBM’) to man-
age the prescription drug coverage provided under 
such plan, or to control the costs of the prescription 
drug coverage under such plan, unless the PBM ad-
heres to the following criteria when handling person-
ally identifiable utilization and claims data or other 
sensitive patient data: 
‘‘(A) The PBM may not transmit any per-
sonally identifiable utilization or claims data, 
with respect to a plan enrollee, to a pharmacy 
owned by a PBM if the plan enrollee has not 
voluntarily elected in writing or via secure elec-
tronic means to fill that particular prescription 
at the PBM-owned pharmacy. 
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under this part with respect to the plan shall 
provide that the sponsor shall— 
‘‘(i) update such standard not less fre-
quently than once every 7 days, beginning 
with an initial update on January 1 of 
each year, to accurately reflect the market 
price of acquiring the drug; 
‘‘(ii) disclose to applicable pharmacies 
the sources used for making any such up-
date; 
‘‘(iii) if the source for such a standard 
for reimbursement is not publicly available, 
disclose to the applicable pharmacies all in-
dividual drug prices to be so updated in 
advance of the use of such prices for the 
reimbursement of claims; and 
‘‘(iv) establish a process to appeal, in-
vestigate, and resolve disputes regarding 
individual drug prices that are less than 
the pharmacy acquisition price for such 
drug. 
‘‘(B) 
PRESCRIPTION
DRUG
PRICING 
STANDARD
DEFINED.—For purposes of sub-
paragraph (A), a standard for reimbursement 
of a pharmacy is any methodology or formula 
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for varying the pricing of a drug or drugs dur-
ing the term of the pharmacy reimbursement 
contract that is based on the cost of the drug 
involved, including drug pricing references and 
amounts that are based upon average wholesale 
price, wholesale average cost, average manufac-
turer price, average sales price, maximum al-
lowable cost (MAC), or other costs, whether 
publicly available or not.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to plan years beginning on or after 
January 1, 2015. 
Æ 
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