Affiliate, bona fide service fee and pharmacy benefit manager are defined
What the document says“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 calls itself a `pharmacy benefit manager'.''.”
The new subsection defines affiliate to cover any entity related in any ownership structure to a manager or sponsor, or acting as its contractor, principal or agent in the listed functions. A bona fide service fee must be a flat dollar amount reflecting fair market value for an itemized service actually performed, not passed on to a client, and not based on drug price, on the amount of rebates or other remuneration, on coverage or formulary placement decisions or referral volume, or on anything else the Secretary bars. A pharmacy benefit manager is any person or entity that negotiates prices or purchases as a group for a sponsor or plan, or manages the drug benefit, whatever it calls itself.
What the document actually says“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 calls itself a `pharmacy benefit manager'.''.”
The term covers anyone who does one or more of the things named above. It does not matter what the firm calls itself.
A rule aimed at a job title is easy to slip. A firm just picks a new name. This one is aimed at what the firm actually does.
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