S.Amdt. 2897

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'.''.
______