I 
118TH CONGRESS 
1ST SESSION H. R. 2880 
To amend title XVIII of the Social Security Act to establish certain require-
ments for pharmacy benefit managers under part D of the Medicare 
program. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 26, 2023 
Mr. CARTER
of Georgia (for himself, Ms. BLUNT
ROCHESTER, Ms. 
MALLIOTAKIS, and Mr. AUCHINCLOSS) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently 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 title XVIII of the Social Security Act to establish 
certain requirements for pharmacy benefit managers 
under part D of the Medicare program. 
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 ‘‘Protecting Patients 
Against PBM Abuses Act’’. 
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SEC. 2. ESTABLISHING CERTAIN REQUIREMENTS FOR 
PHARMACY 
BENEFIT 
MANAGERS 
UNDER 
PART D OF THE MEDICARE PROGRAM. 
(a) PRESCRIPTION DRUG PLANS.—Section 1860D– 
12(b) of the Social Security Act (42 U.S.C. 1395w– 
112(b)) is amended by adding at the end the following 
new paragraph: 
‘‘(9) RESPONSIBILITY OF PHARMACY BENEFIT 
MANAGERS.— 
‘‘(A) IN GENERAL.—Each contract entered 
into with a PDP sponsor under this part with 
respect to a prescription drug plan offered by 
such sponsor shall provide that any pharmacy 
benefit manager acting on behalf of such spon-
sor complies with the following provisions: 
‘‘(i) The pharmacy benefit manager 
derives no income with respect to any serv-
ices provided in connection with covered 
part D drugs furnished under such plan 
from any entity other than flat dollar 
amount service fees. 
‘‘(ii) The pharmacy benefit manager 
receives such service fees only pursuant to 
a written agreement between the manager 
and such sponsor that sets forth the 
amount of any such fees. Any such fee 
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may not be directly or indirectly based on, 
or contingent upon— 
‘‘(I) the price of any covered part 
D drug; 
‘‘(II) discounts, rebates, fees, or 
other remuneration with respect to 
such drugs; or 
‘‘(III) any other circumstance 
specified by the Secretary. 
‘‘(iii) With respect to a covered part 
D drug dispensed by a pharmacy, the 
pharmacy benefit manager may not charge 
such sponsor a different amount for such 
drug’s ingredient cost or dispensing fee 
than the amount the pharmacy benefit 
manager reimburses such pharmacy for 
such drug’s ingredient cost or dispensing 
fee. 
‘‘(iv) With respect to a covered part D 
drug dispensed by a network pharmacy, 
the pharmacy benefit manager may not re-
imburse such pharmacy an amount less 
than the amount the pharmacy benefit 
manager would reimburse an affiliated 
pharmacy for such drug. 
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‘‘(v) With respect to each covered part 
D drug included on the formulary of such 
plan for which there is a drug that is not 
included on such formulary with a thera-
peutic equivalence rating of AB (as estab-
lished pursuant to section 505(j)(7) of the 
Federal Food, Drug, and Cosmetic Act) in 
the same therapeutic class or category of 
such covered part D drug, the pharmacy 
benefit manager shall submit to such plan 
a report specifying the difference between 
the national average drug acquisition cost 
(as published by the Secretary) for such 
drug not included in such formulary and 
the negotiated prices for such drug that is 
included in such formulary. 
‘‘(B) CERTIFICATION.—Each PDP sponsor 
(and each pharmacy benefit manager providing 
services under a prescription drug plan fur-
nished by such sponsor) shall furnish to the 
Secretary (in a time and manner specified by 
the Secretary) an annual certification of compli-
ance with this paragraph, as well as such infor-
mation as the Secretary determines necessary 
to carry out this paragraph. 
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‘‘(C) DISGORGEMENT OF PROHIBITED PAY-
MENTS.—A pharmacy benefit manager shall 
disgorge to the Secretary any payment, remu-
neration, or other amount received in violation 
of this paragraph or the contract entered into 
with a PDP sponsor under this part with re-
spect to a prescription drug plan. A PDP spon-
sor shall suspend payments to a pharmacy ben-
efit manager for failure to disgorge such 
amounts pursuant to the preceding sentence or 
for other violations of this paragraph. 
‘‘(D) CLARIFICATION.—The requirements 
of this paragraph shall apply regardless of 
whether a PDP sponsor is acting as its own 
pharmacy benefit manager and regardless of 
whether a pharmacy benefit manager is under 
common ownership or control of the PDP spon-
sor with respect to which the manager is fur-
nishing services. 
‘‘(E) DEFINITIONS.—For purposes of this 
paragraph: 
‘‘(i) AFFILIATED
PHARMACY.—The 
term ‘affiliated pharmacy’ means, with re-
spect to a pharmacy benefit manager, a 
pharmacy 
that 
directly 
or 
indirectly 
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through one or more intermediaries is 
owned by, controlled by, or is under com-
mon ownership or control of such manager, 
or a pharmacy in which such manager has 
a financial interest. 
‘‘(ii) 
PHARMACY
BENEFIT
MAN-
AGER.—The term ‘pharmacy benefit man-
ager’ means any entity (and any affiliate, 
subsidiary, or agent of such entity) that, 
pursuant to an agreement with a PDP 
sponsor either directly or through an inter-
mediary acts as a price negotiator or group 
purchaser on behalf of such sponsor, or 
manages the prescription drug benefits 
provided by such sponsor, including by 
processing and paying claims for covered 
part D drugs, performing drug utilization 
review, processing drug prior authorization 
requests, adjudicating appeals or griev-
ances related to covered part D drugs, con-
tracting with network pharmacies, control-
ling the cost of such drugs, or providing 
any related services. 
‘‘(F) NONDISCLOSURE OF CERTAIN INFOR-
MATION.—Nothing in this paragraph shall be 
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construed to require public disclosure of any in-
formation that is a trade secret or confidential 
information (as described in section 552(b)(4) 
of title 5, United States Code).’’. 
(b) MA–PD PLANS.—Section 1857(f)(3) of the So-
cial Security Act (42 U.S.C. 1395w–27(f)(3)) is amended 
by adding at the end the following new subparagraph: 
‘‘(F) RESPONSIBILITY OF PHARMACY BEN-
EFIT MANAGERS.—Section 1860D–12(b)(9).’’. 
SEC. 3. CONFLICT OF INTEREST. 
Section 1860D–4(b)(3)(A)(ii)(I) of the Social Secu-
rity Act (42 U.S.C. 1395w–104(b)(3)(A)(ii)(I)) is amend-
ed by striking ‘‘with respect to the sponsor and plan’’ and 
replacing it with ‘‘with respect to the sponsor, plan, and 
any pharmacy benefit manager furnishing services to such 
sponsor or plan’’. 
SEC. 4. PBM TRANSPARENCY. 
Section 1150A of the Social Security Act (42 U.S.C. 
1320b–23) is amended— 
(1) in subsection (b), by adding at the end the 
following new paragraph: 
‘‘(4) In the case of the provision of information 
by a PBM that manages prescription drug coverage 
under a contract with a sponsor described in sub-
section (a)(1) for a plan so described— 
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‘‘(A) the aggregate dollar amount of all re-
bates that the PBM received with respect to 
drugs furnished under such plan from drug 
manufacturers; 
‘‘(B) the aggregate dollar amount of all 
administrative fees that the PBM received with 
respect to drugs furnished under such plan 
from drug manufacturers; 
‘‘(C) the aggregate dollar amount of all re-
bates described in subparagraph (A) that the 
PBM did not pass through to such sponsor; 
‘‘(D) the percentage of the aggregate dol-
lar amount of all rebates described in subpara-
graph (A) that the PBM did not pass through 
to such sponsor; and 
‘‘(E) with respect to all plans described in 
subsection (a)(1) for which the PBM manages 
prescription drug coverage, the highest percent-
age calculated under subparagraph (D) and the 
lowest such percentage.’’; 
(2) by redesignating subsections (c) and (d) as 
subsections (d) and (e), respectively; and 
(3) by inserting after subsection (b), the fol-
lowing new subsection: 
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‘‘(c) PUBLICATION OF PART D INFORMATION.—The 
Secretary shall publish, not less frequently than annually, 
the information reported under subsection (b) by or on 
behalf of sponsors described in subsection (a)(1) on a pub-
licly available website, provided that such information 
shall be made available in a form that does not disclose 
the identity of a specific plan, the prices charged for spe-
cific drugs or classes of drugs, or the amount of any re-
bates provided for specific drugs or classes of drugs.’’. 
SEC. 5. EFFECTIVE DATE. 
The amendments made by this Act shall take effect 
January 1, 2024. 
SEC. 6. REGULATIONS. 
Notwithstanding any other provision of law, the Sec-
retary shall initially implement the amendments made by 
this Act through interim final regulations. 
Æ 
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