I 
118TH CONGRESS 
1ST SESSION H. R. 6283 
To improve services provided by pharmacy benefit managers. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 8, 2023 
Mrs. MILLER-MEEKS (for herself, Ms. BARRAGA´N, Mrs. CHAVEZ-DEREMER, 
Ms. MANNING, Ms. MALLIOTAKIS, Mr. SCHNEIDER, Mr. KEAN of New 
Jersey, and Ms. SPANBERGER) introduced the following bill; which was 
referred to the Committee on Energy and Commerce, and in addition to 
the Committees on Ways and Means, Education and the Workforce, and 
Oversight and Accountability, for a period to be subsequently determined 
by the Speaker, in each case for consideration of such provisions as fall 
within the jurisdiction 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. 
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300gg–111 et seq.) is amended by adding at the end the 
following: 
‘‘SEC. 2799A–11. IMPROVING PHARMACY BENEFIT MANAGER 
SERVICES. 
‘‘(a) GENERAL.—For plan years beginning on or 
after January 1, 2026, except as provided in subsection 
(b), a pharmacy benefit manager shall derive no remu-
neration from any entity for services, benefit administra-
tion, or any other activities related to prescription drugs. 
‘‘(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 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) shall be a flat dollar amount; and 
‘‘(B) shall not be 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-
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lotter on DSK11XQN23PROD with BILLS
scribed to the participants, beneficiaries, or 
enrollees in the group health plan or cov-
erage involved; or 
‘‘(iii) any other amounts prohibited 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 
fair market value for a bona fide, itemized serv-
ice actually performed on behalf of an entity, 
that the entity would otherwise perform (or 
contract for) in the absence of the service ar-
rangement and that are 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, parent, or agent) or an arrangement 
with a third party— 
‘‘(i) acts as a price negotiator or 
group purchaser for prescription drugs on 
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lotter on DSK11XQN23PROD with BILLS
behalf of a group health plan or health in-
surance issuer offering group or individual 
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 or individual health insurance 
coverage, including the processing and pay-
ment of claims for prescription drugs, ar-
ranging alternative access to or funding for 
prescription drugs, the performance of 
drug utilization review, the processing of 
drug prior authorization requests, the ad-
judication of appeals or grievances related 
to the prescription drug benefit, con-
tracting with network pharmacies, control-
ling the cost of covered prescription drugs, 
or the provision of related services. 
‘‘(c) ACCOUNTABILITY AND CONDUCT.— 
‘‘(1) IN GENERAL.—A pharmacy benefit man-
ager shall not— 
‘‘(A) charge a group health plan or health 
insurance issuer offering group or individual 
health insurance coverage a different amount 
for a prescription drug’s ingredient cost or dis-
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lotter on DSK11XQN23PROD with BILLS
pensing fee as compared to the amount the 
pharmacy benefit manager reimburses a phar-
macy for the prescription drug’s ingredient cost 
or dispensing fee; 
‘‘(B) reimburse a network pharmacy or 
pharmacist in an amount less than the amount 
the pharmacy benefit manager would reimburse 
a network pharmacy that is owned, controlled 
by, or affiliated with the pharmacy benefit man-
ager for dispensing the same drug or for pro-
viding the same pharmacist services; or 
‘‘(C) directly or indirectly engage in steer-
ing (as defined in paragraph (2)) to a phar-
macy that is owned, controlled by, or affiliated 
with the pharmacy benefit manager. 
‘‘(2) STEERING.—In paragraph (1), the term 
‘steering’ with respect to a pharmacy benefit man- 
ager includes— 
‘‘(A) providing or implementing a benefit 
design that encourages a participant, bene-
ficiary, or enrollee to utilize a pharmacy that is 
owned, controlled by, or affiliated with the 
pharmacy benefit manager, if such design in-
creases costs for the plan or a participant, ben-
eficiary, or enrollee, including requiring a par-
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lotter on DSK11XQN23PROD with BILLS
ticipant, beneficiary, or enrollee to pay higher 
out-of-pocket costs for a prescription if the par-
ticipant, beneficiary, or enrollee chooses not to 
use a pharmacy owned, controlled by, or affili-
ated with the pharmacy benefit manager; 
‘‘(B) requiring a participant, beneficiary, 
or enrollee to use only a pharmacy that is 
owned, controlled by, or affiliated with the 
pharmacy benefit manager; 
‘‘(C) retaliating, making further attempts 
to influence a participant, beneficiary, or en-
rollee, or treating a participant, beneficiary, or 
enrollee or a participant, beneficiary, or enroll-
ee’s claim any differently if a participant, bene-
ficiary, or enrollee chooses to use a pharmacy 
that is not owned, controlled by, or affiliated 
with the pharmacy benefit manager; or 
‘‘(D) any other activities as defined by the 
Secretary, the Secretary of Labor, and the Sec-
retary of the Treasury. 
‘‘(d) ENFORCEMENT.— 
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with the Secretary of Labor and the Secretary 
of the Treasury, shall enforce this section. 
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‘‘(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 in violation of paragraph (a) or the agree-
ment entered into with such plan or issuer for bona 
fide service fees. 
‘‘(3) PENALTIES.—A pharmacy benefit man-
ager that violates subsection (a), (b), or (c) shall be 
subject 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-
sections (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. 
‘‘(e) REGULATIONS.—Notwithstanding any other 
provision of law, the Secretary shall initially implement 
this section through interim final regulations. 
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‘‘(f) RULES OF CONSTRUCTION.— 
‘‘(1) Nothing in this section shall be construed 
as prohibiting payments related to reimbursement 
for ingredient costs to entities that acquire prescrip-
tion drugs or pharmacy dispensing fees. 
‘‘(2) Nothing in this section shall be construed 
to prohibit rebates, discounts, or other price conces-
sions from being fully passed through to a group 
health plan or health insurance issuer offering 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: 
‘‘SEC. 726. IMPROVING PHARMACY BENEFIT MANAGER 
SERVICES. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after January 1, 2026, except as provided in subsection 
(b), a pharmacy benefit manager shall derive no remu-
neration from any entity for services, benefit administra-
tion, or any other activities related to prescription drugs. 
‘‘(b) EXCEPTION FOR BONA FIDE SERVICE FEES.— 
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‘‘(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 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) shall be a flat dollar amount; 
‘‘(B) shall not be 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 
enrollees in the group health plan or cov-
erage involved; or 
‘‘(iii) any other amounts prohibited 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 
fair market value for a bona fide, itemized serv-
ice actually performed on behalf of an entity, 
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that would otherwise perform (or contract for) 
in the absence of the service arrangement and 
that are not passed on in whole or in part to 
a client or customer, whether or not the entity 
takes title to the drug; 
‘‘(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— 
‘‘(i) acts as 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 the processing and payment of 
claims for prescription drugs, arranging al-
ternative access to or funding for prescrip-
tion drugs, the performance of drug utili-
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zation review, the processing of drug prior 
authorization requests, the adjudication of 
appeals or grievances related to the pre-
scription drug benefit, contracting with 
network pharmacies, controlling the cost of 
covered prescription drugs, or the provision 
of related services. 
‘‘(c) ACCOUNTABILITY AND CONDUCT.— 
‘‘(1) IN GENERAL.—A pharmacy benefit man-
ager shall not— 
‘‘(A) charge a group health plan or health 
insurance issuer offering group health insur-
ance coverage a different amount for a prescrip-
tion drug’s ingredient cost or dispensing fee as 
compared to the amount the pharmacy benefit 
manager reimburses a pharmacy for the pre-
scription drug’s ingredient cost or dispensing 
fee; 
‘‘(B) reimburse a network pharmacy or 
pharmacist in an amount less than the amount 
the pharmacy benefit manager would reimburse 
a network pharmacy that is owned, controlled 
by, or affiliated with the pharmacy benefit man-
ager for dispensing the same drug or for pro-
viding the same pharmacist services; or 
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‘‘(C) directly or indirectly engage in steer-
ing (as defined in paragraph (2)) to a phar-
macy that is owned, controlled by, or affiliated 
with the pharmacy benefit manager. 
‘‘(2) STEERING.—In paragraph (1), the term 
‘steering’ with respect to a pharmacy benefit man-
ager includes— 
‘‘(A) providing or implementing a benefit 
plan design that encourages a participant or 
beneficiary to utilize a pharmacy that is owned, 
controlled by, or affiliated with the pharmacy 
benefit manager, if such plan design increases 
costs for the plan or the participant or bene-
ficiary, including requiring a participant or ben-
eficiary to pay higher out-of-pocket costs for a 
prescription if the participant or beneficiary 
chooses not to use a pharmacy owned, con-
trolled by, or affiliated with the pharmacy ben-
efit manager; 
‘‘(B) requiring a participant or beneficiary 
to use only a pharmacy that is owned, con-
trolled by, or affiliated with the pharmacy ben-
efit manager; 
‘‘(C) retaliating, making further attempts 
to influence a participant or beneficiary, or 
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treating a participant or beneficiary or a partic-
ipant or beneficiary’s claim any differently if a 
participant or beneficiary chooses to use a phar-
macy that is not owned, controlled by, or affili-
ated with the pharmacy benefit manager; or 
‘‘(D) any other activities as defined by the 
Secretary, the Secretary of Health and Human 
Services, and the Secretary of the Treasury. 
‘‘(d) ENFORCEMENT.— 
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with the Secretary of Health and Human Serv-
ices 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 in violation of paragraph (a) or the agree-
ment entered into with such plan or issuer for bona 
fide service fees. 
‘‘(3) PENALTIES.—A pharmacy benefit man-
ager that violates subsection (a), (b), or (c) shall be 
subject to a civil monetary penalty in the amount of 
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$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-
sections (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. 
‘‘(e) REGULATIONS.—Notwithstanding any other 
provision of law, the Secretary shall initially implement 
this section through interim final regulations. 
‘‘(f) RULES OF CONSTRUCTION.— 
‘‘(1) Nothing in this section shall be construed 
as prohibiting payments related to reimbursement 
for ingredient costs to entities that acquire prescrip-
tion drugs or pharmacy dispensing fees. 
‘‘(2) Nothing in this section shall be construed 
to prohibit rebates, discounts, or other price conces-
sions from being fully passed through to a group 
health plan or health insurance issuer offering group 
or individual health insurance coverage to lower net 
costs for prescription drugs.’’. 
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(2) CLERICAL AMENDMENT.—The table of con-
tents in section 1 of the Employee Retirement In-
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.—Sub-chap-
ter B of chapter 100 of the Internal Revenue Code of 1986 
is amended by adding at the end the following: 
‘‘SEC. 9826. IMPROVING PHARMACY BENEFIT MANAGER 
SERVICES. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after January 1, 2026, except as provided in subsection 
(b), a pharmacy benefit manager shall derive no remu-
neration from any entity for services, benefit administra-
tion, or any other activities related to prescription drugs. 
‘‘(b) EXCEPTION FOR BONA FIDE SERVICES.— 
‘‘(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 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) shall be a flat dollar amount; and 
‘‘(B) shall not be directly or indirectly 
based on, or contingent upon— 
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‘‘(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 or cov-
erage involved; or 
‘‘(iii) any other amounts prohibited 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 
fair market value for a bona fide, itemized serv-
ice actually performed on behalf of an entity, 
that the entity would otherwise perform (or 
contract for) in the absence of the arrangement 
and that are not passed on in whole or in part 
to a client or customer, whether or not the enti-
ty 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 
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benefit manager, that, either directly or 
through an intermediary (including an affiliate, 
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 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 ad-
judication of appeals or grievances related 
to the prescription drug benefit, con-
tracting with network pharmacies, control-
ling the cost of covered prescription drugs, 
or the provision of related services. 
‘‘(c) ACCOUNTABILITY AND CONDUCT.— 
‘‘(1) IN GENERAL.—A pharmacy benefit man-
ager shall not— 
‘‘(A) charge a group health plan or health 
insurance issuer offering group health insur-
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lotter on DSK11XQN23PROD with BILLS
ance coverage a different amount for a prescrip-
tion drug’s ingredient cost or dispensing fee as 
compared to the amount the pharmacy benefit 
manager reimburses a pharmacy for the pre-
scription drug’s ingredient cost or dispensing 
fee; 
‘‘(B) reimburse a network pharmacy or 
pharmacist in an amount less than the amount 
the pharmacy benefit manager would reimburse 
a network pharmacy that is owned, controlled 
by, or affiliated with the pharmacy benefit man-
ager for dispensing the same drug or for pro-
viding the same pharmacist services; or 
‘‘(C) directly or indirectly engage in steer-
ing (as defined in paragraph (2)) to a phar-
macy that is owned, controlled by, or affiliated 
with the pharmacy benefit manager. 
‘‘(2) STEERING.—In paragraph (1), the term 
‘steering’ with respect to a pharmacy benefit man-
ager includes— 
‘‘(A) providing or implementing a benefit 
design that encourages a participant or bene-
ficiary to utilize a pharmacy that is owned, con-
trolled by, or affiliated with the pharmacy ben-
efit manager, if such benefit design increases 
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costs for the plan or the participant or bene-
ficiary, including requiring a participant or ben-
eficiary to pay higher out-of-pocket costs for a 
prescription if the participant or beneficiary 
chooses not to use a pharmacy owned, con-
trolled by, or affiliated with the pharmacy ben-
efit manager; 
‘‘(B) requiring an enrollee to use only a 
pharmacy that is owned, controlled by, or affili-
ated with the pharmacy benefit manager; 
‘‘(C) retaliating, making further attempts 
to influence a participant or beneficiary, or 
treating a participant or beneficiary or a partic-
ipant or beneficiary’s claim any differently if a 
participant or beneficiary chooses to use a phar-
macy that is not owned, controlled by, or affili-
ated with the pharmacy benefit manager; or 
‘‘(D) any other activities as defined by the 
Secretary, the Secretary of Labor, and the Sec-
retary of Health and Human Service. 
‘‘(d) ENFORCEMENT.— 
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with the Secretary of Labor and the Secretary 
of Health and Human Services, shall enforce this 
section. 
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‘‘(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 in violation of paragraph (a) or the agree-
ment entered into with such plan or issuer for bona 
fide service fees. 
‘‘(3) PENALTIES.—A pharmacy benefit man-
ager that violates subsection (a), (b), or (c) shall be 
subject 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-
sections (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. 
‘‘(e) REGULATIONS.—Notwithstanding any other 
provision of law, the Secretary shall initially implement 
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lotter on DSK11XQN23PROD with BILLS
the amendments made by this Act through interim final 
regulations. 
‘‘(f) RULES OF CONSTRUCTION.— 
‘‘(1) Nothing in this section shall be construed 
as prohibiting payments related to reimbursement 
for ingredient costs to entities that acquire prescrip-
tion drugs or pharmacy dispensing fees. 
‘‘(2) Nothing in this section shall be construed 
to prohibit rebates, discounts, or other price conces-
sions from being fully passed through to a group 
health plan or health insurance issuer offering group 
or individual health insurance coverage to lower net 
costs for prescription drugs.’’. 
(d) FEDERAL
EMPLOYEES
HEALTH
BENEFITS 
ACT.—Chapter 89 of subpart G of part III of title 5 of 
the United States Code is amended by adding at the end 
following: 
‘‘SEC. 8915. IMPROVING PHARMACY BENEFIT MANAGER 
SERVICES. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after January 1, 2026, except as provided in subsection 
(b), a pharmacy benefit manager shall derive no remu-
neration from any entity for services, benefit administra-
tion, or any other activities related to prescription drugs. 
‘‘(b) EXCEPTION FOR BONA FIDE SERVICES.— 
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‘‘(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 if such fee is 
set forth in an agreement between the pharmacy 
benefit manager and such entity, and 
‘‘(2) the amount of any bona fide service fee— 
‘‘(A) shall be a flat dollar amount; 
‘‘(B) shall not be 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 
enrollees in the group health plan or cov-
erage involved; or 
‘‘(iii) any other amounts prohibited by 
the Office of Personnel Management. 
‘‘(2) DEFINITIONS.—In this section— 
‘‘(A) the term ‘bona fide service fee’ means 
fair market value for a bona fide, itemized serv-
ice actually performed on behalf of an entity, 
that the entity would otherwise perform (or 
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contract for) in the absence of the arrangement 
and that are not passed on in whole or in part 
to a client or customer, whether or not the enti-
ty 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, 
or agent) or an arrangement with a third 
party— 
‘‘(i) acts as a price negotiator for pre-
scription drugs on behalf of a health bene-
fits plan or carrier; or 
‘‘(ii) manages or administers the pre-
scription drug benefits provided by a 
health benefits plan or carrier including 
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 
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benefit, contracting with network phar-
macies, controlling the cost of covered pre-
scription drugs, or the provision of related 
services. 
‘‘(c) ACCOUNTABILITY AND CONDUCT.— 
‘‘(1) IN GENERAL.—A pharmacy benefit man-
ager shall not— 
‘‘(A) charge a health benefits plan or car-
rier different amount for a prescription drug’s 
ingredient cost or dispensing fee as compared to 
the amount the pharmacy benefit manager re-
imburses a pharmacy for the prescription 
drug’s ingredient cost or dispensing fee; 
‘‘(B) reimburse a network pharmacy or 
pharmacist in an amount less than the amount 
the pharmacy benefit manager would reimburse 
a network pharmacy that is owned, controlled 
by, or affiliated with the pharmacy benefit man-
ager for dispensing the same drug or for pro-
viding the same pharmacist services; or 
‘‘(C) directly or indirectly engage in steer-
ing (as defined in paragraph (2)) to a phar-
macy that is owned, controlled by, or affiliated 
with the pharmacy benefit manager. 
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‘‘(2) STEERING.—In paragraph (1), the term 
‘steering’ with respect to a pharmacy benefit man-
ager includes— 
‘‘(A) providing or implementing a benefit 
design that encourages a participant or bene-
ficiary to utilize a pharmacy that is owned, con-
trolled by, or affiliated with the pharmacy ben-
efit manager, if such benefit design increases 
costs for the plan or the participant or bene-
ficiary, including requiring a participant or ben-
eficiary to pay higher out-of-pocket costs for a 
prescription if the participant or beneficiary 
chooses not to use a pharmacy owned, con-
trolled by, or affiliated with the pharmacy ben-
efit manager; 
‘‘(B) requiring an enrollee to use only a 
pharmacy that is owned, controlled by, or affili-
ated with the pharmacy benefit manager; 
‘‘(C) retaliating, making further attempts 
to influence a participant or beneficiary, or 
treating a participant or beneficiary or a partic-
ipant or beneficiary’s claim any differently if a 
participant or beneficiary chooses to use a phar-
macy that is not owned, controlled by, or affili-
ated with the pharmacy benefit manager; or 
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‘‘(D) any other activities as defined by the 
Office of Personnel Management. 
‘‘(d) ENFORCEMENT.— 
‘‘(1) IN
GENERAL.—The Office of Personnel 
Management shall enforce this section. 
‘‘(2) DISGORGEMENT.—The pharmacy benefit 
manager shall disgorge to a health benefits plan or 
carrier any payment, remuneration, or other amount 
received by the pharmacy benefit manager or an af-
filiate of such pharmacy benefit manager in violation 
of paragraph (a) or the agreement entered into with 
such plan or carrier for bona fide service fees. 
‘‘(3) PENALTIES.—A pharmacy benefit man-
ager that violates subsection (a), (b), or (c) shall be 
subject 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-
sections (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, except that for the purpose of this para-
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graph the ‘Office of Personnel Management’ is sub-
stituted wherever the term ‘Secretary’ is used in sec-
tion 1128A. 
‘‘(e) REGULATIONS.—Notwithstanding any other 
provision of law, the Director shall initially implement the 
amendments made by this Act through interim final regu-
lations. 
‘‘(f) RULES OF CONSTRUCTION.— 
‘‘(1) Nothing in this section shall be construed 
as prohibiting payments related to reimbursement 
for ingredient costs to entities that acquire prescrip-
tion drugs or pharmacy dispensing fees. 
‘‘(2) Nothing in this section shall be construed 
to prohibit rebates, discounts, or other price conces-
sions from being fully passed through to a health 
benefits plan or carrier to lower net costs for pre-
scription drugs.’’. 
Æ 
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