Definitions

In this Act: (1) Commission The term Commission means the Federal Trade Commission. (2) Covered individual The term covered individual means a current or former employee, contractor, subcontractor, service provider, or agent of a pharmacy benefit manager, health plan, pharmaceutical manufacturer, pharmacy, or any affiliate, subsidiary, or agent thereof. (3) Health plan The term health plan means any group or individual health insurance plan or coverage, including any health insurance plan or coverage sponsored or funded by the Federal Government or the government of any State, Territory, or subdivision thereof. (4) Pharmacy benefit manager The term pharmacy benefit manager means any entity that provides pharmacy benefit management services on behalf of a health plan, a payer, or health insurance issuer. (5) Pharmacy benefit management services The term pharmacy benefit management services means, pursuant to a written agreement with a payer or health plan offering group or individual health insurance coverage, directly or through an intermediary, the service of— (A) negotiating terms and conditions, including rebates and price concessions, with respect to a prescription drug on behalf of the health plan, coverage, or payer; or (B) managing the prescription drug benefits provided by the health plan, coverage, or payer, which may include formulary management 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 prescription drug benefit, contracting with network pharmacies, or the provision of related services. (6) Prescription drug The term prescription drug means— (A) a drug, as that term is defined in section 201(g) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(g)), that is— (i) approved by the Food and Drug Administration under section 505 of such Act (21 U.S.C. 355); and (ii) subject to the requirements of section 503(b)(1) of such Act (21 U.S.C. 353(b)(1)); (B) a biological product as that term is defined in section 351 of the Public Health Service Act (42 U.S.C. 262(i)(1)); or (C) a product that is biosimilar to, or interchangeable with, a biologic product under section 351 of the Public Health Service Act (42 U.S.C. 262(i)).