,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #bifj  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,augu/ #a1 #bjac ,mr4 
,pallone introduc$ ! foll[+ bill2 :i* 0 
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce1 & 9 addition to ! ,committees 
on ,ways & ,means & ! ,judici>y1 = a    
p]iod to be subsequ5tly det]m9$ by !    
,speak]1 9 ea* case = consid]ation ( su*
 provisions z fall )9 ! jurisdiction ( !
 committee conc]n$  ,a ,,bill  ,to am5d 
title ,,xviii ( ! ,social ,security ,act
 to require sponsors ( ,m$ic>e          
prescription drug plans to implem5t     
proc$ures to prev5t fraud & abuse1 & =  
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,m$ic>e ,prescription  
,drug ,integrity ,act ( #bjac4  #b4     
,prev5tion ( fraud & abuse 9 ,m$ic>e    
prescription drug plans  7a7 ,proc$ures 
= ,,pdp sponsors ,to id5tify fraud &    
abuse ,section #ahfj;,d-#d7;c7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ajd7;c77 is am5d$--  7#a7 9     
p>agraph 7#a77;,d7--  7,a7 by ins]t+ 1  

design$ to aft] program2 &  7,b7 by     
ins]t+ 1 t includes ! proc$ures describ$
 9 p>agraph 7#d7 aft] wa/e2 &  7#b7 by  
add+ at ! end ! foll[+3  7#d7 ,proc$ures
 to prev5t fraud & abuse  7,a7 ,,pdp    
sponsor proc$ures ,a ,,pdp sponsor %all 
h 9 place proc$ures design$ to--  7i7   
id5tify an individual t has obta9$      
cov]age = a cov]$ "p ,d drug at a       
frequ5cy or am\nt n m$ically necess>y1 z
 det]m9$ 9 accordance ) utilization     
guidel9es e/abli%$ by ! ,secret>y2  7ii7
 subject to proc$ures develop$ by !     
,secret>y1 limit cov]age = "s or all    
classes ( cov]$ "p ,d drugs = an        
individual id5tifi$ "u clause 7i7 to    
drugs prescrib$ by "o or m designat$    
prescrib]s or disp5s$ by "o or m        
designat$ disp5s]s1 or bo?1 = a         
reasonable p]iod ( "t foll[+ ! date !   
individual is notifi$ ( su*             
id5tification2  7iii7 provide to !      
,secret>y ! "n1 & o!r in=mation t !     
,secret>y may require1 ( individuals    
id5tifi$ pursuant to clause 7i72  7iv7 z

 direct$ by ! ,secret>y1 limit cov]age =
 "s or all classes ( cov]$ "p ,d drugs =
 an individual id5tifi$ pursuant to     
clause 7i7 by a ,,pdp sponsor ) :om su* 
individual 0 previ\sly enroll$2 &  7v7  
d5y paym5t ( a claim = a controll$      
sub/ance 9 s*$ule ,,ii or ,,iii z       
e/abli%$ "u ,controll$ ,sub/ances ,act  
unless ! ,,pdp sponsor has v]ifi$ at    
po9t-(-sale t ! prescrib] & disp5s] are 
au?oriz$ by ! ,adm9i/rator ( ! ,drug    
,en=cem5t ,adm9i/ration to prescribe or 
disp5se su* controll$ sub/ances4  7,b7  
,au?orization = ! ,secret>y to %>e      
in=mation ,! ,secret>y may %>e in=mation
 ) respect to an individual provid$ "u  
subp>agraph 7,a77iii7 ) a ,,pdp sponsor 
enroll+ su* individual4  4  7b7 ,dual   
eligibles ,section                      
#ahfj;,d-#a7;b77#c77;,d7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#aciew-#aja7;b77#c77;,d77 is am5d$ by   
ins]t+ 1 subject to su* limits z !      
,secret>y may e/abli% = individuals     
id5tifi$ pursuant to section            

#ahfj;,d-#d7;c77#d77;,a77i7 aft] !      
,secret>y4  7c7 ,exclusion & d5ial (    
paym5t = inappropriate prescrib+ &      
disp5s+  7#a7 ,exclusion = inappropriate
 prescrib+ or disp5s+ ,section #aabh7;b7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acbj;a-#g7;b77 is am5d$ by   
add+ at ! end ! foll[+3  7#ag7          
,inappropriate prescrib+ or disp5s+ ,any
 individual or entity t ! ,secret>y     
det]m9es has prescrib$ or disp5s$ "u    
title ,,xviii--  7,a7 a cov]$ "p ,d drug
 to an individual "u a prescription drug
 plan or a ,,ma-,,pd plan1 z su* t]ms   
are def9$ = purposes ( "p ,d ( su*      
title1 t c\ld n h be5 prescrib$ or      
disp5s$ to ! individual on ! date ( su* 
prescrib+ or disp5s+2 or  7,b7 any drug 
"u su* title at a frequ5cy or am\nt t-- 
7i7 repres5ts a practice or patt]n (    
abusive prescrib+ or disp5s+2 or  7ii7  
pres5ts a risk to enrollee heal? or     
safety4  4  7#b7 ,d5ial ( paym5t =      
inappropriate prescrib+ or disp5s+      
,section #ahfj;,d-#b7;e77#c7 ( ! ,social

 ,security ,act 7#db ,u4,s4,c4          
#aciew-#ajb7;e77#c77 is am5d$--  7,a7 9 
subp>agraph 7,a71 by /rik+ 2 or & ins]t+
 a semicolon2  7,b7 9 subp>agraph 7,b71 
by /rik+ ! p]iod at ! end & ins]t+ 2 or2
  7,c7 by ins]t+ aft] subp>agraph 7,b7 !
 foll[+3  7,c7 :i* is prescrib$ or      
disp5s$ by an individual or entity t !  
,secret>y det]m9es1 subject to su*      
review1 r$et]m9ation1 & appeal z !      
,secret>y provides1 has prescrib$ or    
disp5s$ to an individual "u a           
prescription drug plan or a ,,ma-,,pd   
plan a cov]$ "p ,d drug--  7i7 t c\ld n 
h be5 prescrib$ or disp5s$ to !         
individual on ! date ( su* prescrib+ or 
disp5s+2 or  7ii7 at a frequ5cy or am\nt
 t pres5ts a risk to ! heal? or safety (
 an enrollee or t repres5ts a practice  
or patt]n ( abusive prescrib+ or        
disp5s+4  2 &  7,d7 by add+ at ! end !  
foll[+3 ,! exclusion ( a prescrib] or   
disp5s] "u subp>agraph 7,c7 %all be =   
su* p]iod ( "t z ! ,secret>y %all       
specify4  7d7 ,regi/ration (            

au?orization = individuals ,to prescribe
 & disp5se controll$ sub/ances ,section 
#cjc ( ! ,controll$ ,sub/ances ,act 7#ba
 ,u4,s4,c4 #hbc7 is am5d$ by add+ at !  
end ! foll[+3  7i7 ,unique heal?        
id5tifi]s = memb]s ( gr\p practices     
7#a7 ,9 g5]al ,! ,attorney ,g5]al %all--
  7,a7 compile & ma9ta9 a li/ ( ! unique
 heal? id5tifi]s ( prescrib]s & disp5s]s
 t are memb]s ( a gr\p practice regi/]$ 
"u ?is section & h au?ority to prescribe
 or disp5se controll$ sub/ances 9       
s*$ules ,,ii & ,,iii2 &  7,b7 make ! li/
 compil$ "u subp>agraph 7,a7 available  
to all ,,pdp sponsors4  7#b7 ,def9itions
 ,9 ?is section3  7,a7 ,gr\p practice ,!
 t]m gr\p practice has ! mean+ giv5 su* 
t]m 9 section #ahgg7;h77#d7 ( ! ,social 
,security ,act4  7,b7 ,unique heal?     
id5tifi] ,! t]m unique heal? id5tifi]   
has ! mean+ giv5 su* t]m 9 section      
#aagc7;b7 ( ! ,social ,security ,act4   
7,c7 ,,pdp sponsor ,! t]m ,,pdp sponsor 
has ! mean+ giv5 su* t]m 9 section      
#ahfj;,d-#da7;a77#ac7 ( ! ,social       

,security ,act4  4  7e7 ,use ( recov]y  
audit contractor recov]ies ,to prev5t   
fraud & wa/e ,section #ahic7;h77#a77;,c7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acie;ddd7h77#a77;,c77 is     
am5d$--  7#a7 by /rik+ ! ,secret>y %all 
reta9 & ins]t+  ! ,secret>y-- 7i7 %all  
reta9  2  7#b7 9 clause 7i71 z add$ by  
p>agraph 7#a7--  7,a7 by ins]t+ 1 9     
addition to any o!r funds t may be      
available1 aft] available2 &  7,b7 by   
/rik+ ! p]iod at ! end & ins]t+ 2 &2 &  
7#c7 by add+ at ! end ! foll[+3  7ii7   
may reta9 an additional portion ( !     
am\nts recov]$ 7n to exce$ #be p]c5t (  
su* am\nts recov]$7 :i* %all be         
available1 9 addition to any o!r funds t
 may be available1 to su* program       
managem5t acc\nt until exp5d$ = purposes
 ( c>ry+ out ! am5dm5ts made by !       
,m$ic>e ,prescription ,drug ,integrity  
,act ( #bjac4  4  7f7 ,implem5tation ,! 
,secret>y ( ,heal? & ,human ,s]vices may
 implem5t ! am5dm5ts made by subsections
 7a71 7b71 & 7c77#b7 by regulations1    

guidance1 or o!rwise4  7g7 ,effective   
date  7#a7 ,9 g5]al ,except z provid$ 9 
p>agraph 7#b71 ! am5dm5ts made by ?is   
section %all take effect on ! date ( !  
enactm5t ( ?is ,act4  7#b7 ,delay$      
effective date = c]ta9 provisions ,!    
am5dm5ts made by subsection 7a7 %all    
apply ) respect to plan ye>s beg9n+ aft]
 ! date t is #h mon?s aft] ! date ( !   
enactm5t ( ?is ,act1 except t           
subp>agraph 7,a77v7 ( section           
#ahfj;,d-#d7;c77#d7 ( ! ,social         
,security ,act1 z add$ by subsection    
7a77#b71 %all apply ) respect to plan   
ye>s beg9n+ aft] ! date t is #f mon?s   
aft] ! date on :i* ! ,secret>y ( ,heal? 
& ,human ,s]vices det]m9es ,,pdp        
sponsors1 z def9$ 9 section             
#ahfj;,d-#da7;a77#ac7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#aciew-#aea7;a77#ac771 h access at !    
po9t-(-sale to ! in=mation necess>y to  
det]m9e valid prescrib+ & disp5s+       
au?ority4