[Congressional Record Volume 170, Number 115 (Thursday, July 11, 2024)]
[Senate]
[Pages S5126-S5127]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 2897. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill S. 4638, to authorize appropriations for fiscal year 
2025 for military activities of the Department of Defense, for military 
construction, and for defense activities of the Department of Energy, 
to prescribe military personnel strengths for such fiscal year, and for 
other purposes; which was ordered to lie on the table; as follows:

       At the end of subtitle A of title VII, insert the 
     following:

     SEC. 710. REQUIRING ANY PHARMACY BENEFIT MANAGER THAT 
                   CONTRACTS WITH TRICARE TO MEET MINIMUM NETWORK 
                   ADEQUACY, REASONABLE PHARMACY REIMBURSEMENT, 
                   AND TRANSPARENCY REQUIREMENTS.

       Section 1074g(a) of title 10, United States Code, is 
     amended by adding at the end the following new paragraph:
       ``(11)(A) Beginning on January 1, 2025, the Secretary may 
     not contract with a pharmacy benefit manager under the 
     pharmacy benefits program unless the pharmacy benefit manager 
     meets the following requirements:
       ``(i) The pharmacy benefit manager shall contract with, as 
     a TRICARE network retail pharmacy provider, at least--
       ``(I) 80 percent of essential retail pharmacies (as defined 
     in subparagraph (B)) that are independent community 
     pharmacies (as defined in such subparagraph); and
       ``(II) 50 percent of essential retail pharmacies not 
     described in subclause (I).
       ``(ii) The pharmacy benefit manager shall reimburse 
     pharmacies for the ingredient costs of prescription drugs and 
     dispensing fees at rates that are not less than the rates 
     that would apply under the State Medicaid rebate agreement in 
     effect under section 1927 of the Social Security Act (42 
     U.S.C. 1396r-8); and
       ``(iii) The pharmacy benefit manager shall not reimburse 
     any pharmacy that is an affiliate of the pharmacy benefit 
     manager at a higher rate than the rate at which the pharmacy 
     benefit manager reimburses pharmacies that are not affiliates 
     of the pharmacy benefit manager.
       ``(iv) Not later than 1 year after the date of enactment of 
     this paragraph, and annually thereafter, the pharmacy benefit 
     manager (or an affiliate, subsidiary, or agent of the 
     pharmacy benefit manager) shall submit to the Secretary 
     information regarding any differences in reimbursement rates 
     or practices, direct and indirect remuneration fees or other 
     price concessions, and clawbacks between--
       ``(I) pharmacies that are affiliates of the pharmacy 
     benefit manager; and
       ``(II) pharmacies that are not affiliates of the pharmacy 
     benefit manager.
       ``(v) The pharmacy benefit manager shall disclose to the 
     Secretary (in a form and manner specified by the Secretary) 
     the amount of any administrative fee they receive for each 
     prescription the pharmacy benefit manager processes under the 
     pharmacy benefits program.
       ``(B) In this paragraph:
       ``(i) The term `affiliate' means any entity that is owned 
     by, controlled by, or related under a common ownership 
     structure with, a pharmacy benefit manager, or that acts as a 
     contractor or agent to such pharmacy benefit manager, if such 
     contractor or agent performs any of the functions described 
     in clause (iv).
       ``(ii) The term `essential retail pharmacy' means a 
     pharmacy that--
       ``(I) is not an affiliate of a pharmacy benefit manager;
       ``(II) is located in a medically underserved area (as 
     designated pursuant to section 330(b)(3)(A) of the Public 
     Health Service Act); and
       ``(III) is designated as an essential retail pharmacy by 
     the Secretary [is this designation by the Secretary of 
     Defense or the Secretary of Health and Human Services?].
       ``(iii) The term `independent community pharmacy' means a 
     retail pharmacy that has fewer than 4 locations and is not 
     affiliated with any person or entity other than its owners.
       ``(iv) The term `pharmacy benefit manager' means any person 
     or entity that, either directly or through an intermediary, 
     acts as a

[[Page S5127]]

     price negotiator or group purchaser on behalf of the pharmacy 
     benefits program, or manages the prescription drug benefits 
     provided under such program, including the processing and 
     payment of claims for prescription drugs, the performance of 
     drug utilization review, the processing of drug prior 
     authorization requests, the adjudication of appeals or 
     grievances related to the pharmacy benefits program, 
     contracting with network pharmacies, controlling the cost of 
     prescription drugs, or the provision of related services. 
     Such term includes any person or entity that carries out one 
     or more of the activities described in the preceding 
     sentence, irrespective of whether such person or entity 
     identifies itself as a `pharmacy benefit manager'.''.
                                 ______