H.R. 8779

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8779 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 8779

To prohibit pharmacy benefit managers and pharmacies from being under 
common ownership, and for other purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

May 13, 2026

Mrs. Harshbarger (for herself, Mr. Auchincloss, Mr. Carter of Georgia, 
Mr. Landsman, Mr. Nehls, and Mr. Nadler) introduced the following bill; 
which was referred to the Committee on the Judiciary

_______________________________________________________________________

A BILL

To prohibit pharmacy benefit managers and pharmacies from being under 
common ownership, and for other purposes.

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 ``Patients Before Monopolies Act'' or 
the ``PBM Act''.

SEC. 2. FINDINGS.

The Congress finds the following:
(1) Pharmacy benefit managers are corporate entities that 
play a dominant role in pharmaceutical supply chains, 
determining which drugs health plans will cover for enrollees, 
what prices patients and health plans will pay for those drugs, 
and how much health plans will reimburse pharmacies for 
dispensing them.
(2) The market for pharmacy benefit manager services has 
become highly concentrated. As of 2025, the 6 largest pharmacy 
benefit managers are each integrated into large health care 
conglomerates that include downstream businesses such as 
retail, mail order, and specialty pharmacies. These 
conglomerates also processed more than 90 percent of the 
prescriptions in the United States in 2023.
(3) The 3 largest pharmacy benefit managers are also 
vertically integrated into health care platforms that include 
both upstream business lines, like health insurance, and 
downstream suppliers, like pharmacies and providers.
(4) The Federal Trade Commission has found that vertically 
integrated pharmacy benefit managers have both the ability and 
incentive to steer business to their own affiliated pharmacies, 
which reduces competition and increases prescription drug costs 
for patients.
(5) Pharmacy benefit managers increasingly leverage their 
market power to pressure smaller, unaffiliated, independent 
pharmacies to enter into unfavorable contracts with the largest 
pharmacy benefit managers. This dynamic has likely contributed 
to the closure of more than 7,000 pharmacies between 2019 and 
2024.
(6) Self-preferencing of affiliated pharmacies may also 
allow large, vertically integrated health conglomerates to 
evade statutory limits on profits known as the Medical Loss 
Ratio. Gaming of the profit constraint using transfer pricing 
techniques may allow affiliated health insurance businesses to 
hide profits in the unregulated pharmacy business segment, 
costing enrollees and taxpayers money.
(7) Pursuant to its powers under article I, section 8, of 
the United States Constitution, Congress has the ability to 
create any law necessary and appropriate to regulate interstate 
commerce. As pharmacy benefit managers are part of large, 
national health conglomerates that operate across state lines, 
and engage in intrastate activities that also substantially 
relate to interstate commerce, Congress intends to regulate 
pharmacy benefit managers in the public interest.
(8) In order to eliminate the conflicts of interest 
described in paragraphs (1) through (7) and restore competition 
to the marketplace, the Federal Government should--
(A) protect patients, independent pharmacies, and 
taxpayers by structurally separating vertically 
integrated health conglomerates;
(B) require parent companies that own a pharmacy 
benefit manager or insurer to divest their pharmacy 
businesses;
(C) enable Federal agencies, state attorneys 
general, and private citizens to bring civil actions to 
enforce the structural separation of these companies; 
and
(D) grant the Federal Trade Commission and 
Department of Justice additional authority to review 
and block future transactions that would re-create 
these conflicts of interest.

SEC. 3. PROHIBITIONS RELATING TO ANTICOMPETITIVE PHARMACY OWNERSHIP AND 
CONTRACTS.

(a) Prohibition on Pharmacy Ownership by Entities Providing 
Insurance or Pharmacy Benefit Management Services.--
(1) In general.--It shall be unlawful for any person to 
both--
(A) directly or indirectly own, operate, control, 
or direct the operation of the whole or any part of a 
pharmacy; and
(B) directly or indirectly own, operate, or control 
the whole or any part of--
(i) an insurance company; or
(ii) a pharmacy benefit manager.
(2) Divestment.--Not later than 1 year after the date of 
enactment of this Act, any person in violation of paragraph (1) 
shall divest the pharmacy of such person.
(b) Antitrust Enforcement.--
(1) In general.--Both the Federal Trade Commission and the 
Assistant Attorney General in charge of the Antitrust Division 
shall have jurisdiction, jointly or separately, to enforce this 
section.
(2) Penalties for failure to divest.--
(A) Guidance.--Not later than 30 days after the 
date of enactment of this Act, the Chair of the Federal 
Trade Commission and the Assistant Attorney General in 
charge of the Antitrust Division shall issue guidance 
specifying milestones for divestment within the 
deadline under subsection (a)(2).
(B) Penalties.--
(i) In general.--For any person that does 
not comply with the milestones specified under 
subparagraph (A), the Chair of the Federal 
Trade Commission or the Assistant Attorney 
General in charge of the Antitrust Division 
shall cause 10 percent of the profits of the 
person to be transferred into escrow on a 
monthly basis, to be--
(I) returned to the person if 
divestment occurs by the deadline under 
subsection (a)(2); or
(II) deposited into the fund 
described in subsection (c)(7) if 
divestment does not occur by the 
deadline under subsection (a)(2).
(C) Trustee.--If divestiture does not occur by the 
deadline under subsection (a)(2), a divestiture trustee 
shall oversee the divestiture required under that 
paragraph. The divestiture trustee shall have the 
authority to sell the pharmacy.
(c) Civil Actions.--
(1) In general.--When the Inspector General of the 
Department of Health and Human Services, the Assistant Attorney 
General in charge of the Antitrust Division of the Department 
of Justice, the Federal Trade Commission, or an attorney 
general of a State has reason to believe that a person is in 
violation of subsection (a), such Inspector General, Assistant 
Attorney General, Federal Trade Commission or attorney general 
of a State may bring a civil action in an appropriate district 
court of the United States.
(2) Private right of action.--
(A) In general.--An individual alleging damages as 
a result of a violation of this Act may bring a civil 
action in any court of competent jurisdiction, State or 
Federal.
(B) Relief.--In a civil action brought under 
subparagraph (A) in which the plaintiff prevails, the 
court may award--
(i) treble damages;
(ii) reasonable attorney's fees and 
litigation costs; and
(iii) any other relief, including equitable 
or declaratory relief, that the court 
determines appropriate.
(3) Actions by state attorneys general.--If the attorney 
general of a State has reason to believe that an interest of 
the residents of the State has been or is being threatened or 
adversely affected by a practice that violates subsection (a), 
the attorney general of the State may, as parens patriae, bring 
a civil action on behalf of the residents of the State in an 
appropriate district court of the United States to obtain 
appropriate relief, including monetary damages.
(4) Injunctive and equitable relief.--In any action 
described in paragraph (1), (2), or (3), the applicable court, 
on a finding that a person is in violation of subsection (a), 
shall issue an order requiring such person--
(A) to cease and desist from such violation, and, 
if applicable, divest the pharmacy services of such 
person; and
(B) to disgorge any revenue received from the 
pharmacy from the sale of prescription drugs during the 
period of such violation.
(5) Other relief.--In addition to any relief obtained under 
paragraph (1), (2), or (3), the court may grant any other 
equitable relief necessary to redress and prevent recurrence of 
the violation.
(6) Right to jury trial.--Either party, upon request, shall 
have the right to a jury trial.
(7) Deposit.--Any revenue received from the sale of 
prescription drugs disgorged pursuant to an action under 
paragraph (1) shall be deposited in a fund created by the 
Federal Trade Commission and distributed by the Federal Trade 
Commission to be put to use in the interest of serving the 
health care needs of the harmed community, including consumers 
overcharged at vertically integrated pharmacies.
(d) FTC and DOJ Review.--
(1) Reporting required.--Any divestment of a pharmacy or 
pharmacy benefit manager required under subsection (a) shall be 
reported to the Federal Trade Commission and the Assistant 
Attorney General in charge of the Antitrust Division of the 
Department of Justice under section 7A of the Clayton Act (15 
U.S.C. 18a) without respect to the thresholds under subsection 
(a)(2) of that section.
(2) Tolling of divestment period during review.--The 
divestment period under subsection (a) shall be tolled during 
the pendency of any waiting period required under section 7A of 
the Clayton Act (15 U.S.C. 18a).
(3) Review of effect of divestiture.--With respect to each 
divestiture undertaken pursuant to subsection (a), in addition 
to any applicable review under section 7A of the Clayton Act 
(15 U.S.C. 18a), the Federal Trade Commission and the Assistant 
Attorney General in charge of the Antitrust Division of the 
Department of Justice shall review the effect on competition, 
financial viability, and the public interest--
(A) of the divestiture; and
(B) of the subsequent acquisition of the divested 
pharmacy by the acquiring person.
(4) Blocking of actions.--The Federal Trade Commission and 
the Assistant Attorney General in charge of the Antitrust 
Division of the Department of Justice, jointly or separately, 
may bring a civil action in any court of competent jurisdiction 
to block any action that would harm competition to the 
detriment of the public interest with respect to the conflicts 
of interest described in subsection (a).
(e) Rulemaking Authority.--The Federal Trade Commission shall 
promulgate rules to carry out this section. Such rules shall not 
diminish any obligation under this section.
(f) Reports Required.--The Chair of the Federal Trade Commission 
and the Assistant Attorney General in charge of the Antitrust Division 
of the Department of Justice shall submit to the appropriate 
congressional committees quarterly reports on compliance with this Act, 
including the status of any divestitures required under this Act.
(g) 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.
(h) Severability.--If any provision of this Act or the application 
thereof to any person or circumstance is held invalid, the remainder of 
this Act, or the application of that provision to persons or 
circumstances other than those as to which it is held invalid, shall 
not be affected thereby.
(i) Definitions.--In this section:
(1) Health plan.--The term ``health plan'' means any public 
or private health insurance plan.
(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.
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