‘‘(i) means the managing or administration 
of a plan or program that pays for, reimburses, 
and covers the cost of prescription drugs and 
medical devices; and 
‘‘(ii) includes the processing and payment 
of claims for prescription drugs and the adju-
dication of appeals or grievances related to the 
prescription drug benefit. 
‘‘(F) The term ‘prescription drug’ means a pre-
scription drug covered by a health benefits plan that 
is dispensed to a beneficiary for self-administra-
tion.’’. 
(b) NONCOMPLIANCE PENALTIES.— 
(1) IN GENERAL.—Chapter 89 of title 5, United 
States Code, is amended by inserting after section 
8902a the following new section: 
‘‘§ 8902b. Pharmacy benefit manager-related sanc-
tions 
‘‘(a) MONETARY PENALTIES.— 
‘‘(1) IN GENERAL.—Except as otherwise pro-
vided by this subsection and subsection (c), if the 
Office of Personnel Management determines that a 
pharmacy benefits manager violated a requirement 
or prohibition applicable to such pharmacy benefits 
manager with respect to a health benefits plan pur-
VerDate Sep 11 2014 
21:14 Dec 26, 2025
Jkt 069200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H6610.IH
H6610
ssavage on LAPJG3WLY3PROD with BILLS
suant to section 8904(c)(1) of this title, the Office 
shall, in addition to any other penalties that may be 
prescribed by law and after consultation with the At-
torney General, impose a civil monetary penalty of 
$10,000 for each such violation— 
‘‘(A) on such pharmacy benefits manager; 
and 
‘‘(B) if, during the 10-year period ending 
on the imposition of such civil monetary pen-
alty, not fewer than five civil monetary pen-
alties have been imposed on such pharmacy 
benefits manager under this paragraph with re-
spect to health benefit plans provided by the 
carrier providing such health benefits plan, on 
such carrier. 
‘‘(2) MAXIMUM PENALTY AMOUNT.— 
‘‘(A) PHARMACY
BENEFIT
MANAGERS.— 
For each carrier providing a health benefits 
plan with respect to which a pharmacy benefits 
manager is determined to have committed a vio-
lation described in paragraph (1), the total 
amount of civil monetary penalties imposed on 
such pharmacy benefits manager under such 
paragraph for violations with respect to the 
VerDate Sep 11 2014 
21:14 Dec 26, 2025
Jkt 069200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H6610.IH
H6610
ssavage on LAPJG3WLY3PROD with BILLS
health benefit plans of such carrier many not 
exceed $100,000 during any 10-year period. 
‘‘(B) CARRIERS.—The total amount of civil 
monetary penalties imposed on a carrier under 
paragraph (1) may not exceed $50,000 during 
any 10-year period. 
‘‘(3) REMEDIATION PLAN.— 
‘‘(A) IN
GENERAL.—Not later than 60 
days after the date on which the Office of Per-
sonnel Management imposes a civil monetary 
penalty on a carrier under paragraph (1) with 
respect to a pharmacy benefits manager that is 
the fifth such civil monetary penalty imposed on 
such carrier with respect to such pharmacy ben-
efits manager in a 10-year period, such carrier 
shall develop and submit to the Office of Per-
sonnel Management a plan to ensure that each 
pharmacy benefit manager administering pre-
scription drug benefits on behalf of a health 
benefits plan provided by such carrier complies 
with the requirements and prohibitions applica-
ble to such pharmacy benefit manager pursuant 
to section 8904(c)(1). 
‘‘(B) OVERSIGHT.—Not later than 60 days 
after the date on which a carrier submits plan 
VerDate Sep 11 2014 
21:14 Dec 26, 2025
Jkt 069200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H6610.IH
H6610
ssavage on LAPJG3WLY3PROD with BILLS
under subparagraph (A), and with such fre-
quency thereafter as determined appropriate by 
the Office of Personnel Management, the Office 
of Personnel Management shall inspect such 
carrier to assess the compliance of such carrier 
with such plan. 
‘‘(4) SEQUENTIAL IMPOSITION.—For the pur-
poses of this subsection, any civil monetary penalties 
concurrently imposed under paragraph (1) shall be 
deemed to be imposed sequentially. 
‘‘(5) CIVIL ACTION.— 
‘‘(A) IN GENERAL.—A civil action to re-
cover a civil monetary penalty imposed under 
this subsection shall be brought by the Attorney 
General in the name of the United States, and 
may be brought in the United States district 
court for the district where the claim involved 
was presented or where the pharmacy benefits 
manager or carrier subject to such civil mone-
tary penalty resides. 
‘‘(B) TREATMENT
OF
AMOUNTS
RECOV-
ERED.—Amounts recovered under this sub-
section shall be paid to the Office of Personnel 
Management for deposit into the Employees 
Health Benefits Fund. 
VerDate Sep 11 2014 
21:14 Dec 26, 2025
Jkt 069200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H6610.IH
H6610
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(6) DEDUCTION FROM AMOUNTS OWED.—The 
amount of a civil monetary penalty imposed under 
this subsection may be deducted from any sum then 
or later owing by the United States to the party 
against whom the penalty or assessment has been 
levied. 
‘‘(7) STATUTE OF LIMITATIONS.—The Office of 
Personnel Management may not initiate any action 
to impose a civil monetary penalty on a pharmacy 
benefits manager or carrier under this subsection 
later than 6 years after the date of the violation of 
the requirement or prohibition by the pharmacy ben-
efits manager for which such civil monetary penalty 
would be imposed. 
‘‘(b) DEBARMENT.— 
‘‘(1) IN
GENERAL.—The Office of Personnel 
Management shall bar a pharmacy benefits manager 
from administering prescription drug benefits on be-
half of a health benefits plan, either directly of 
through an affiliate of such pharmacy benefits man-
ager, under the program under this chapter if, in 
any 10-year period, the Office of Personnel Manage-
ment imposes 10 or more civil monetary penalties on 
such pharmacy benefits manager under subsection 
(a). 
VerDate Sep 11 2014 
21:14 Dec 26, 2025
Jkt 069200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H6610.IH
H6610
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(2) EFFECTIVE DATE.—Except as provided by 
subsection (c), debarment of a pharmacy benefits 
manager under paragraph (1) shall be effective on 
the date that is 90 days after the date on which the 
Office of Personnel Management imposes the first 
civil monetary penalty pursuant to which such phar-
macy benefits manager is subject to such debarment. 
‘‘(3) PAYMENT PROHIBITED.— 
‘‘(A) IN GENERAL.—Notwithstanding sec-
tion 8902(j) or any other provision of this chap-
ter, if, under this section a pharmacy benefits 
manager is debarred under paragraph (1), no 
payment may be made by a carrier pursuant to 
any contract under this chapter (either to such 
pharmacy benefits manager or by reimburse-
ment) for any service or supply furnished by 
such pharmacy benefits manager during the pe-
riod of the debarment. 
‘‘(B) SUBCONTRACT
CONTRACTS.—Each 
contract under this chapter shall contain such 
provisions as may be necessary to carry out 
subparagraph (A) and the other provisions of 
this section. 
‘‘(4) TERMINATION.—The debarment of a phar-
macy benefits manager under paragraph (1) shall be 
VerDate Sep 11 2014 
21:14 Dec 26, 2025
Jkt 069200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H6610.IH
H6610
ssavage on LAPJG3WLY3PROD with BILLS
immediately terminated if all civil monetary pen-
alties pursuant to which such pharmacy benefits 
manager is subject to such debarment are over-
turned or wholly set aside on appeal. 
‘‘(5) RULE OF CONSTRUCTION.—For the pur-
poses of this subsection, a civil monetary penalty is 
a civil monetary penalty pursuant to which a phar-
macy benefits manager is subject to debarment 
under paragraph (1) if such civil monetary penalty 
is not less than the tenth civil monetary penalty im-
posed on such pharmacy benefits manager under 
subsection (a) during a 10-year period that— 
‘‘(A) has not been appealed and for which 
the period of appeal has elapsed; or 
‘‘(B) has been appealed, all appeals have 
been exhausted, and has not be overturned or 
wholly set aside. 
‘‘(c) HEARING.— 
‘‘(1) IN
GENERAL.—The Office of Personnel 
Management shall not make a determination adverse 
to a pharmacy benefits manager or carrier under 
subsection (a) or a determination adverse to a phar-
macy benefits manager (b) until such pharmacy ben-
efits manager or carrier, as applicable, has been 
given reasonable notice and an opportunity for the 
VerDate Sep 11 2014 
21:14 Dec 26, 2025
Jkt 069200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H6610.IH
H6610
ssavage on LAPJG3WLY3PROD with BILLS
determination to be made after a hearing as pro-
vided in accordance with this subsection. 
‘‘(2) HEARING REQUIRED.—Any pharmacy ben-
efits manager or carrier that is the subject of an ad-
verse determination by the Office of Personnel Man-
agement under this section shall be entitled to rea-
sonable notice and an opportunity to request a hear-
ing on the record, and to judicial review as provided 
in this subsection after the Office of Personnel Man-
agement makes a final decision regarding such ad-
verse determination. 
‘‘(3) HEARING CRITERIA.—The Office of Per-
sonnel Management shall grant a request for a hear-
ing under paragraph (2) upon a showing that due 
process rights have not previously been afforded with 
respect to any finding of fact which is relied upon 
as a cause for an adverse determination under this 
section. Such hearing shall be conducted without re-
gard to subchapter II of chapter 5 and chapter 7 of 
this title by a hearing officer who shall be designated 
by the Director of the Office of Personnel Manage-
ment and who shall not otherwise have been involved 
in the adverse determination being appealed. 
‘‘(4) REQUEST FOR HEARING.—A request for a 
hearing under paragraph (2) shall be filed within 
VerDate Sep 11 2014 
21:14 Dec 26, 2025
Jkt 069200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H6610.IH
H6610
ssavage on LAPJG3WLY3PROD with BILLS
such period and in accordance with such procedures 
as the Office of Personnel Management shall pre-
scribe by regulation. 
‘‘(5) APPEAL.— 
‘‘(A) IN GENERAL.—Any pharmacy bene-
fits manager or carrier adversely affected by a 
final decision of the Office of Personnel Man-
agement regarding an adverse determination 
that is made after a hearing under paragraph 
(2) with respect to such adverse determination 
and to which such pharmacy benefits manager 
or carrier was a party may seek review of such 
final decision in the United States District 
Court for the District of Columbia or for the 
district in which the pharmacy benefits man-
ager or carrier resides or has his or her prin-
cipal place of business by filing a notice of ap-
peal in such court within 60 days after the date 
the decision is issued, and by simultaneously 
sending copies of such notice by certified mail 
to the Director of the Office and to the Attor-
ney General. 
‘‘(B) ANSWER.—In answer to an appeal 
filed under subparagraph (A), the Director of 
the Office of Personnel Management shall 
VerDate Sep 11 2014 
21:14 Dec 26, 2025
Jkt 069200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H6610.IH
H6610
ssavage on LAPJG3WLY3PROD with BILLS
promptly file in the relevant court a certified 
copy of the transcript of the record of the hear-
ing conducted under paragraph (2) and other 
evidence upon which the findings and final deci-
sion complained of are based. 
‘‘(C) COURT AUTHORITY.—With respect to 
an appeal filed under subparagraph (A), the 
court shall have power to enter, upon the plead-
ings and evidence of record, a judgment affirm-
ing, modifying, or setting aside, in whole or in 
part, the final decision of the Office of Per-
sonnel Management that is the subject of such 
appeal, with or without remanding the case for 
a rehearing. The court shall not set aside or re-
mand such final decision unless there is not 
substantial evidence on the record, taken as 
whole, to support the such final decision or un-
less the actions of the Office of Personnel Man-
agement with respect to such final decision con-
stitutes an abuse of discretion. 
‘‘(6) DEFENSE
FORFEITURE.—Matters that 
were raised or that could have been raised in a hear-
ing under paragraph (2) or an appeal under para-
graph (5) may not be raised as a defense to a civil 
VerDate Sep 11 2014 
21:14 Dec 26, 2025
Jkt 069200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H6610.IH
H6610
ssavage on LAPJG3WLY3PROD with BILLS
action by the United States to collect a civil mone-
tary penalty imposed under subsection (a). 
‘‘(d) AFFILIATE; PHARMACY BENEFITS MANAGER; 
PRESCRIPTION DRUG DEFINED.—In this section, the 
terms ‘affiliate’, ‘pharmacy benefits manager’ and ‘pre-
scription drug’ have the meanings given such terms, re-
spectively, in section 8904(c) of this title.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for chapter 89 of title 5, United States Code, 
is amended by inserting after the item relating to 
section 8902a the following new item: 
‘‘8902b. Pharmacy benefit manager-related sanctions.’’. 
(c) CONFORMING AMENDMENT.—Section 8903a(b) 
of title 5, United States Code, is amended— 
(1) in paragraph (3), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (4), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(5) complies with the requirements under sec-
tion 8904(c).’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this Act shall take effect on the date that is one year after 
the date of the enactment of this Act. 
Æ 
VerDate Sep 11 2014 
21:14 Dec 26, 2025
Jkt 069200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6301
E:\BILLS\H6610.IH
H6610
ssavage on LAPJG3WLY3PROD with BILLS