,i  #aacth ,,congress  #b;d ,session    
,h4 ,r4 #ddcg  ,,in ,,the ,,house ,,of  
,,representatives  ,april #i1 #bjad ,mr4
 ,collins of ,georgia 7for himself and  
,mr4 ,loebsack7 introduced the following
 bill2 which was referred to the        
,committee on ,energy and ,commerce1 and
 in addition to the ,committee on ,ways 
and ,means1 for a period to be          
subsequently determined by the ,speaker1
 in each case for consideration of such 
provisions as fall within the           
jurisdiction of the committee concerned 
,a ,,bill  ,to amend title ,,xviii of   
the ,social ,security ,act to provide   
for pharmacy benefits manager standards 
under the ,medicare prescription drug   
program to further transparency of      
payment methodologies to pharmacies1 and
 for other purposes4  #a4 ,short title  
,this ,act may be cited as the ,generic 
,drug ,pricing ,fairness ,act4  #b4     
,pharmacy benefits manager standards    
under the ,medicare program  7a7 ,in    
general ,section #ahfj;,d-#ab7;b7 of the

 ,social ,security ,act 7#db ,u4,s4,c4  
#aciew-#aab7;b77 is amended by adding at
 the end the following new paragraphs3  
7#g7 ,pharmacy benefits manager         
transparency requirements ,each contract
 entered into with a ,,pdp sponsor under
 this part with respect to a            
prescription drug plan offered by such  
sponsor shall provide that the ,,pdp may
 not enter into a contract with any     
pharmacy benefits manager 7referred to  
in this paragraph as a ,,pbm7 to manage 
the prescription drug coverage provided 
under such plan1 or to control the costs
 of the prescription drug coverage under
 such plan1 unless the ,,pbm adheres to 
the following criteria when handling    
personally identifiable utilization and 
claims data or other sensitive patient  
data3  7,a7 ,the ,,pbm may not transmit 
any personally identifiable utilization 
or claims data1 with respect to a plan  
enrollee1 to a pharmacy owned by a ,,pbm
 if the plan enrollee has not           
voluntarily elected in writing or via   

secure electronic means to fill that    
particular prescription at the          
,,pbm-owned pharmacy4  7,b7 ,the ,,pbm  
may not require that a plan enrollee use
 a retail pharmacy1 mail order pharmacy1
 specialty pharmacy1 or other pharmacy  
entity providing pharmacy services in   
which the ,,pbm has an ownership        
interest or that has an ownership       
interest in the ,,pbm or provide an     
incentive to a plan enrollee to         
encourage the enrollee to use a retail  
pharmacy1 mail order pharmacy1 specialty
 pharmacy1 or other pharmacy entity     
providing pharmacy services in which the
 ,,pbm has an ownership interest or that
 has an ownership interest in the ,,pbm1
 if the incentive is applicable only to 
such pharmacies4  4  7b7 ,regular update
 of prescription drug pricing standard  
,paragraph 7#f7 of section              
#ahfj;,d-#ab7;b7 of the ,social         
,security ,act 7#db ,u4,s4,c4           
#aciew-#aab7;b77 is amended to read as  
follows3  7#f7 ,regular update of       

prescription drug pricing standard  7,a7
 ,in general ,if the ,,pdp sponsor of a 
prescription drug plan uses a standard  
for reimbursement 7as described in      
subparagraph 7,b77 of pharmacies based  
on the cost of a drug1 each contract    
entered into with such sponsor under    
this part with respect to the plan shall
 provide that the sponsor shall--  7i7  
update such standard not less frequently
 than once every #g days1 beginning with
 an initial update on ,january #a of    
each year1 to accurately reflect the    
market price of acquiring the drug2     
7ii7 disclose to applicable pharmacies  
the sources used for making any such    
update2  7iii7 if the source for such a 
standard for reimbursement is not       
publicly available1 disclose to the     
applicable pharmacies all individual    
drug prices to be so updated in advance 
of the use of such prices for the       
reimbursement of claims2 and  7iv7      
establish a process to appeal1          
investigate1 and resolve disputes       

regarding individual drug prices that   
are less than the pharmacy acquisition  
price for such drug4  7,b7 ,prescription
 drug pricing standard defined ,for     
purposes of subparagraph 7,a71 a        
standard for reimbursement of a pharmacy
 is any methodology or formula for      
varying the pricing of a drug or drugs  
during the term of the pharmacy         
reimbursement contract that is based on 
the cost of the drug involved1 including
 drug pricing references and amounts    
that are based upon average wholesale   
price1 wholesale average cost1 average  
manufacturer price1 average sales price1
 maximum allowable cost 7,,mac71 or     
other costs1 whether publicly available 
or not4  4  7c7 ,effective date ,the    
amendments made by this section shall   
apply to plan years beginning on or     
after ,january #a1 #bjae4