[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1669 Introduced in House (IH)]






109th CONGRESS
  1st Session
                                H. R. 1669

   To ensure integrity in the operation of pharmacy benefit managers.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 14, 2005

    Mr. Weiner (for himself and Mr. Moran of Kansas) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
   To ensure integrity in the operation of pharmacy benefit managers.

    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 ``Pharmacy Benefit Manager 
Transparency Act of 2005''.

SEC. 2. REQUIREMENTS RELATING TO PHARMACY BENEFIT MANAGERS.

    (a) Prohibition on Cross Ownership.--
            (1) In general.--No pharmaceutical drug manufacturer may 
        have a controlling interest in an entity that is a pharmacy 
        benefit manager.
            (2) Penalty.--The Secretary of Health and Human Services 
        may issue such civil penalties for a violation of paragraph (1) 
        as the Secretary of Health and Human Services determines 
        necessary.
    (b) Drug Interchange.--
            (1) Prohibitions.--
                    (A) Cost increase.--A pharmacy benefit manager 
                shall not make any drug interchange proposal for an 
                individual who is served by such manager where the net 
                cost of the drug to which the prescription would be 
                changed exceeds that of the drug from which the 
                prescription would be changed.
                    (B) Disclosure to individual.--A pharmacy benefit 
                manager shall not make any drug interchange for an 
                individual who is served by such manager unless the 
                pharmacy benefit manager discloses to the individual, 
                in a clear and conspicuous manner, the savings to the 
                individual associated with such interchange.
                    (C) Generics.--A pharmacy benefit manager shall not 
                make any drug interchange proposal for an individual 
                who is served by such manager if the drug from which 
                the prescription would be changed has generic 
                equivalents and the drug to which the prescription 
                would be changed has no generic equivalents, unless the 
                drug to which the prescription would be changed has a 
                lower net cost to the individual than does each of the 
                generic equivalents of the drug from which the 
                prescription would be changed.
            (2) Penalty.--A pharmacy benefit manager that violates 
        subparagraph (A), (B), or (C) of paragraph (1) with respect to 
        an individual and presents a claim for payment to the United 
        States Government as reimbursement for services to such 
        individual, shall be considered in violation of section 3729 of 
        title 31, United States Code.
    (c) Disclosure of Compensation From Drug Manufacturers.--
            (1) Quarterly and annual disclosures.--At the end of each 
        fiscal year quarter, each pharmacy benefit manager shall 
        disclose--
                    (A) to the client plans of such manager and to the 
                Antitrust Division of the Department of Justice, all 
                compensation and remuneration that the pharmacy benefit 
                manager received during such fiscal year quarter from a 
                pharmaceutical drug manufacturer, including, regardless 
                of how categorized, market share incentives, 
                commissions, mail service purchase discounts, and 
                administrative or management fees; and
                    (B) to the client plans of such manager, any fees 
                received for sales of utilization data to a 
                pharmaceutical drug manufacturer.
            (2) Disclosure at contracting stage.--Each pharmacy benefit 
        manager shall disclose to each client plan and prospective 
        client plan of such manager, in advance of executing an 
        agreement with such plan, information relating to the pharmacy 
        benefit manager's methodology of soliciting and receiving 
        payments from pharmaceutical drug manufacturers.
    (d) Definitions.--For purposes of this section:
            (1) Client plan.--The term ``client plan'' means a 
        pharmaceutical plan in which the entity that offers such plan 
        to its beneficiaries contracts directly with a pharmacy benefit 
        manager to provide or administer such plan.
            (2) Drug interchange.--The term ``drug interchange'' means 
        any change from one prescription drug to another prescription 
        drug that is intended to address or treat the same illness or 
        condition.
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