S.Amdt. 2912

SA 2912. 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 PASS THROUGH ANY
REBATES, PRICE CONCESSIONS, ALTERNATIVE
DISCOUNTS, OR OTHER REMUNERATION.

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 disclose to the
Secretary (in a form and manner specified by the Secretary)--
``(I) for each category or class of drugs for which a claim
was filed, a breakdown of the total gross spending on drugs
in such category or class before rebates, price concessions,
alternative discounts, or other remuneration from drug
manufacturers, and the net spending after such rebates, price
concessions, alternative discounts, or other remuneration
from drug manufacturers; and
``(II) any administrative or other fees received from drug
manufacturers.
``(ii)(I) The pharmacy benefit manager shall not accept any
remuneration for services provided by the pharmacy benefit
manager other than bona fide service fees.
``(II) For purposes of this clause, a `bona fide service
fee'--
``(aa) shall be related to services actually provided by
the pharmacy benefit manager;
``(bb) shall reflect the fair market value of such
services; and
``(cc) may include an incentive payment if such payment is
a flat dollar amount, rather than based or contingent upon
the manufacturer list price or other related drug price
benchmarks and factors.
``(III) Rebates, price concessions, alternative discounts,
or other remuneration from drug manufacturers, even if such
price concessions are calculated as a percentage of a drug's
price, shall not be considered a violation of the
requirements of subclause (I) if they are fully passed
through to the pharmacy benefits program and exclusively used
to lower costs for prescription drugs under such program.
``(iii) The pharmacy benefit manager shall not engage in
any form of spread pricing, whereby any amount charged or
claimed by the pharmacy benefit manager exceeds the amount
paid to a pharmacy on behalf of the pharmacy benefits
program. The amount of payment to a pharmacy benefit manager
for covered outpatient drugs under the pharmacy benefits
program may not exceed the ingredient costs for the drug and
a professional dispensing fee.
``(B) In this paragraph, the term `pharmacy benefit
manager' means any person or entity that, either directly or
through an intermediary, acts as a 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'.''.
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