[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4409 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 4409
To prohibit the common ownership pharmacy benefit managers and
pharmacies that provide services under contracts with Federal health
plans for Federal employees.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 15, 2025
Mr. Krishnamoorthi (for himself and Mrs. Harshbarger) introduced the
following bill; which was referred to the Committee on Oversight and
Government Reform
_______________________________________________________________________
A BILL
To prohibit the common ownership pharmacy benefit managers and
pharmacies that provide services under contracts with Federal health
plans for Federal employees.
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 ``Fair Pharmacies for Federal
Employees Act of 2025''.
SEC. 2. PROHIBITIONS RELATING TO ANTICOMPETITIVE PHARMACY OWNERSHIP AND
CONTRACTS.
(a) Prohibition on Pharmacy or Pharmacy Benefit Manager Ownership
by Entities Providing Insurance Under Federal Employee Health Plans.--
It shall be unlawful for the Office of Personnel Management to contract
with a Federal employee health benefit qualified carrier who--
(1) directly or indirectly owns, operates, controls, or
directs the operation of the whole or any part of a pharmacy;
or
(2) directly or indirectly owns, operates, or controls the
whole or any part of a pharmacy benefit manager, or is directly
or indirectly owned, operated, or has its operation directed by
the whole or in any part by a pharmacy benefit manager.
(b) Prohibition on Pharmacy Ownership by Entities Providing
Pharmacy Benefit Management Services Under Federal Employee Health
Plans.--It shall be unlawful of the Office of Personnel Management or a
Federal employee health benefit qualified carrier to contract or
subcontract with a pharmacy benefit manager who directly or indirectly
owns, operates, controls, or directs the operation of the whole or any
part of a pharmacy.
(c) 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.
(d) Definitions.--In this section:
(1) Health plan.--The term ``health plan'' means a group
insurance policy or contract, medical or hospital service
agreement, membership or subscription contract, or similar
group arrangement provided by a carrier for the purpose of
providing, paying for, or reimbursing expenses for health
services.
(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.
(5) Qualified carrier.--The term ``qualified carrier''
means a voluntary association, corporation, partnership, or
other nongovernmental organization which is lawfully engaged in
providing, paying for, or reimbursing the cost of, health
services under group insurance policies or contracts, medical
or hospital service agreements, membership or subscription
contracts, or similar group arrangements, in consideration of
premiums or other periodic charges payable to the carrier,
including a health benefits plan duly sponsored or underwritten
by an employee organization and an association of organizations
or other entities described in this paragraph sponsoring a
health benefits plan.
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