PBM Act of 2024

This bill prohibits common ownership between pharmacies and insurance companies or pharmacy benefit managers (PBMs), requiring divestment within three years, and allows enforcement through civil actions by federal and state authorities. It also mandates reporting of divestments to the FTC and DOJ, with a review of competitive effects, and grants the FTC rulemaking authority.

Sec. 2, Prohibitions relating to anticompetitive pharmacy ownership: It is unlawful for any person to both own or operate a pharmacy and also own or operate an insurance company or a PBM. Persons in violation must divest the pharmacy within three years of enactment.

Sec. 2, Civil actions: The Inspector General of HHS, the Assistant Attorney General for Antitrust, the FTC, or a state attorney general may bring a civil action in federal court if they believe a violation has occurred. The court must order the person to cease and desist, divest if applicable, and disgorge any revenue from prescription drug sales during the violation. The court may also grant other equitable relief. Disgorged funds are deposited into an FTC-created fund for the health care needs of the harmed community.

Sec. 2, FTC review: Any required divestment must be reported to the FTC and the Assistant Attorney General under the Clayton Act, regardless of size thresholds. The three-year divestment period is paused during any waiting period under the Clayton Act. The FTC and DOJ must review the effect on competition, financial viability, and public interest of the divestiture and any subsequent acquisition of the divested pharmacy.

Sec. 2, Rulemaking authority: The FTC must issue rules to carry out this section, which cannot reduce any obligation under it.

Sec. 2, Rule of construction: This section does not limit the authority of the FTC, the Inspector General of DOJ, HHS, or a state attorney general under any other law.

Sec. 2, Definitions: Defines 'health plan' as any public or private health insurance plan; 'person' as under the Sherman Act; 'pharmacy' broadly to include various types like retail, mail-order, specialty, hospital, and long-term care pharmacies; and 'pharmacy benefit manager' as any entity that negotiates drug prices, contracts with pharmacies, or manages prescription drug benefits for a health plan.