119-hr4409

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4409 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 4409

 To prohibit the common ownership pharmacy benefit managers and 
 pharmacies that provide services under contracts with Federal health 
 plans for Federal employees.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 July 15, 2025

 Mr. Krishnamoorthi (for himself and Mrs. Harshbarger) introduced the 
 following bill; which was referred to the Committee on Oversight and 
 Government Reform

_______________________________________________________________________

 A BILL

 To prohibit the common ownership pharmacy benefit managers and 
 pharmacies that provide services under contracts with Federal health 
 plans for Federal employees.

 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 ``Fair Pharmacies for Federal 
Employees Act of 2025''.

SEC. 2. 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.
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