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.