[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10362 Introduced in House (IH)]
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118th CONGRESS
2d Session
H. R. 10362
To prohibit pharmacy benefit managers and pharmacies from being under
common ownership, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 11, 2024
Mrs. Harshbarger (for herself and Mr. Auchincloss) introduced the
following bill; which was referred to the Committee on the Judiciary
_______________________________________________________________________
A BILL
To prohibit pharmacy benefit managers and pharmacies from being under
common ownership, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Patients Before Monopolies Act of
2024'' or the ``PBM Act of 2024''.
SEC. 2. PROHIBITIONS RELATING TO ANTICOMPETITIVE PHARMACY OWNERSHIP.
(a) Prohibition on Pharmacy Ownership by Entities Providing
Insurance or Pharmacy Benefit Management Services.--
(1) In general.--It shall be unlawful for any person to
both--
(A) directly or indirectly own, operate, control,
or direct the operation of the whole or any part of a
pharmacy; and
(B) directly or indirectly own, operate, or control
the whole or any part of--
(i) an insurance company; or
(ii) a pharmacy benefit manager.
(2) Divestment.--Not later than 3 years after the date of
enactment of this Act, any person in violation of subsection
(a) shall divest the pharmacy of such person.
(b) Civil Actions.--
(1) In general.--When the Inspector General of the
Department of Health and Human Services, the Assistant Attorney
General in charge of the Antitrust Division of the Department
of Justice, the Federal Trade Commission, or an attorney
general of a State has reason to believe that a person is in
violation of subsection (a), such Inspector General, Assistant
Attorney General, Federal Trade Commission or attorney general
of a State may bring a civil action in an applicable district
court of the United States for the relief described in
paragraph (2).
(2) Injunctive and equitable relief.--In any action
described in paragraph (1), the applicable court, on a finding
that a person is in violation of subsection (a), shall issue an
order requiring such person--
(A) to cease and desist from such violation, and,
if applicable, divest the pharmacy services of such
person; and
(B) to disgorge any revenue received from the
pharmacy from the sale of prescription drugs during the
period of such violation.
(3) Other relief.--In addition to any relief obtained under
paragraph (2), the court may grant any other equitable relief
necessary to redress and prevent recurrence of the violation.
(4) Deposit.--Any revenue received from the sale of
prescription drugs disgorged pursuant to an action under this
subsection shall be deposited in a fund created by the Federal
Trade Commission and distributed by the Federal Trade
Commission to be put to use in the interest of serving the
health care needs of the harmed community, including consumers
overcharged at vertically integrated pharmacies.
(c) FTC Review.--
(1) Reporting required.--Any divestment of a pharmacy or
pharmacy benefit manager required under subsection (a) shall be
reported to the Federal Trade Commission and the Assistant
Attorney General in charge of the Antitrust Division of the
Department of Justice under section 7A of the Clayton Act (15
U.S.C. 18a) without respect to the thresholds under subsection
(a)(2) of that section.
(2) Tolling of divestment period during review.--The
divestment period under subsection (a) shall be tolled during
the pendency of any waiting period required under section 7A of
the Clayton Act (15 U.S.C. 18a).
(3) Review of effect of divestiture.--With respect to each
divestiture undertaken pursuant to subsection (a), in addition
to any applicable review under section 7A of the Clayton Act
(15 U.S.C. 18a), the Federal Trade Commission and the Assistant
Attorney General in charge of the Antitrust Division of the
Department of Justice shall review the effect on competition,
financial viability, and the public interest--
(A) of the divestiture; and
(B) of the subsequent acquisition of the divested
pharmacy by the acquiring person.
(d) Rulemaking Authority.--The Federal Trade Commission shall
promulgate rules to carry out this section. Such rules shall not
diminish any obligation under this section.
(e) Rule of Construction.--Nothing in this section shall be
construed to limit the authority of the Federal Trade Commission, the
Inspector General of the Department of Justice, the Department of
Health and Human Services, or the attorney general of a State under any
other provision of law.
(f) Definitions.--In this section:
(1) Health plan.--The term ``health plan'' means any public
or private health insurance plan.
(2) Person.--The term ``person'' has the meaning given the
term in section 8 of the Sherman Act (15 U.S.C. 7).
(3) Pharmacy.--
(A) In general.--The term ``pharmacy'' means any
person, business, or entity licensed, registered, or
otherwise permitted by a State or a territory of the
United States to dispense, deliver, or distribute a
controlled substance, prescription drug, or other
medication--
(i) to the general public; or
(ii) to a bed patient for immediate
administration.
(B) Inclusions.--The term ``pharmacy'' includes--
(i) a mail-order pharmacy;
(ii) a specialty pharmacy;
(iii) a retail pharmacy;
(iv) a nursing home pharmacy;
(v) a long-term care pharmacy;
(vi) a hospital pharmacy;
(vii) an infusion or other outpatient
treatment pharmacy;
(viii) any organization the National
Provider Identifier (NPI) registration of which
has 1 or more taxonomy codes under the pharmacy
section of the National Uniform Claim Committee
(or a subsequent organization); and
(ix) any other type of pharmacy.
(4) Pharmacy benefit manager.--The term ``pharmacy benefit
manager'' means any person, business, or other entity, such as
a third-party administrator, regardless of whether such person,
business, or entity identifies itself as a pharmacy benefit
manager, that, either directly or indirectly through an
intermediary (including an affiliate, subsidiary, or agent) or
an arrangement with a third party--
(A) acts as a negotiator of prices, rebates, fees,
or discounts for prescription drugs on behalf of a
health plan or health plan sponsor;
(B) contracts with pharmacies to create pharmacy
networks and designs and manages such networks; or
(C) manages or administers the prescription drug
benefits provided by a health plan, including the
processing and payment of claims for prescription
drugs, arranging alternative access to or funding for
prescription drugs, the performance of utilization
management services, including drug utilization review,
the processing of drug prior authorization requests,
the adjudication of appeals or grievances related to
the prescription drug benefit, contracting with network
pharmacies, controlling the cost of covered
prescription drugs, or the provision of related
services.
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