,i #aae? ,,congress #b;d ,session ,h4 ,r4 #eieh ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,may #bd1 #bjah,mr4 ,coll9s ( ,georgia 7= himself1 ,mr4 ,c>t] ( ,georgia1 ,mr4 ,duncan ( ,t5nessee1 & ,mr4 ,gonzalez ( ,texas7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,ways & ,means1 = 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 ph>macy-negotiat$ price concessions & ph>macy inc5tive paym5ts & adju/m5ts to be includ$ 9 negotiat$ prices at ! po9t-(-sale "u "p ,d ( ! ,m$ic>e program1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,phair ,pric+ ,act ( #bjah4 #b4 ,requir+ ph>macy-negotiat$ price concessions & ph>macy inc5tive paym5ts & adju/m5ts to be includ$ 9 negotiat$ prices at ! po9t-(-sale "u "p ,d ( ! ,m$ic>e program ,section #ahfj;,d-#b7;d77#a77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;d77#a77;,b77 is am5d$-- 7#a7 by /rik+ prices4--,= purposes & ins]t+ 8prices4-- 7i7 ,9 g5]al ,= purposes 2 & 7#b7 by add+ at ! end ! foll[+ new clauses3 7ii7 ,prices negotiat$ ) ph>macy at po9t-(-sale 7,i7 ,9 g5]al ,subject to subclause 7,,iii71 = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjai1 negotiat$ prices = cov]$ "p ,d drugs describ$ 9 clause 7i7 provid$ "u a prescription drug plan1 includ+ all ph>macy price concessions & all inc5tive paym5ts & adju/m5ts negotiat$ ) ! ph>macy disp5s+ su* drug1 %all be provid$ at ! po9t-(-sale ( ! cov]$ "p ,d drug4 ,if ! negotiat$ price ( su* drug1 includ+ all ph>macy price concessions & all inc5tive paym5ts & adju/m5ts negotiat$ ) su* ph>macy1 is n possible to calculate at ! po9t-(-sale1 ! ,,pdp sponsor ( su* plan %all use an e/imat$ negotiat$ price1 includ+ all e/imat$ ph>macy negotiat$ price concessions & inc5tive paym5ts & adju/m5ts & tak+ into acc\nt ! negotiat$ price ( su* drug 9 ! prior ye> 7if available74 7,,ii7 ,application ( inc5tive paym5ts & adju/m5ts ,= plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjai1 9 ! case t a ,,pdp sponsor uses inc5tive paym5ts & adju/m5ts ) respect to paym5t to a ph>macy = a cov]$ "p ,d drug1 su* paym5ts & adju/m5ts %all be det]m9$ ?r\gh ! use ( a quality measure approv$ by ! ,secret>y & e/abli%$ by ! work+ gr\p e/abli%$ "u clause 7iii74 7,,iii7 ,no increase 9 co/ %>+ ,subclause 7,i7 %all n apply 9 ! case :]e application ( su* subclause w\ld increase ! am\nt ow$ by an individual 9 co/ %>+ above ! am\nt su* individual w\ld h ow$ 9 co/ %>+ )\t application ( su* subclause4 7,,iv7 ,discrepancies betwe5 negotiat$ prices & actual reimbursem5t ,9 ! case t ! ,secret>y det]m9es t ! negotiat$ price ( a ,,pdp sponsor appli$ at ! po9t-(-sale ) respect to a cov]$ "p ,d drug = a ye> disp5s$ by a ph>macy 0 n equal to ! total reimbursem5t made to su* ph>macy = su* drug = su* ye> 7tak+ into acc\nt any inc5tive paym5ts & adju/m5ts & ph>macy price concessions1 reg>dless ( :5 su* paym5ts & adju/m5ts or price concessions 7 appli$71 su* sponsor %all1 n lat] ?an #ij days aft] receiv+ notice ( su* det]m9ation1 furni% to ! ph>macy t disp5s$ su* drug & to ! ,secret>y a writt5 explanation ( :y su* negotiat$ price 0 n equal to su* reimbursem5t4 7,v7 ,def9itions ,9 ?is clause3 7aa7 ,inc5tive paym5ts & adju/m5ts ,! t]m inc5tive paym5ts & adju/m5ts means1 ) respect to paym5t to a ph>macy by a ,,pdp sponsor = a cov]$ "p ,d drug1 any prospective or retrospective price concessions1 rebates1 disc\nts1 fees1 reconciliation adju/m5ts1 bonuses1 p]=mance paym5ts1 inc5tives1 & any o!r adju/m5t to su* paym5t det]m9$ ?r\gh ! use ( a quality measure1 & any o!r adju/m5t made ) respect to su* paym5t1 reg>dless ( :5 su* paym5ts & adju/m5ts are appli$4 ,su* t]m does n include any manufactur] rebates or concessions made ) respect to su* drug4 7bb7 ,,pdp sponsor ,! t]m ,,pdp sponsor includes an ,,ma organization (f]+ an ,,ma-,,pd plan "u "p ,c & an entity t contracts ) su* sponsor or organization1 su* z a ph>macy b5efit manag]4 7cc7 ,quality measure ,! t]m quality measure means p]=mance crit]ia e/abli%$ by a ,,pdp sponsor 7includ+ an entity t contracts ) su* sponsor1 su* z a ph>macy b5efit manag]7 to det]m9e ! am\nt or applicability ( inc5tive paym5ts & adju/m5ts4 7iii7 ,quality measure work+ gr\p 7,i7 ,9 g5]al ,n lat] ?an ,septemb] #a1 #bjah1 ! ,secret>y %all conv5e a quality measures work+ gr\p 79 ?is clause ref]r$ to z ! work+ gr\p7 = purposes ( e/abli%+ quality measures 7z def9$ 9 clause 7ii77,,iv77 t may be us$ by a ,,pdp sponsor 7z def9$ 9 clause 7ii77 "u ?is "p4 7,,ii7 ,composition ,! work+ gr\p %all consi/ ( repres5tatives f ea* ! foll[+3 7aa7 ,,pdp sponsors4 7bb7 ,ph>macies repres5t+ all ph>macy practice types4 7cc7 ,ph>macy b5efit manag]s4 7dd7 ,pati5t advocacy organizations4 7ee7 ,su* o!r entities z ! ,secret>y det]m9es appropriate4 7,,iii7 ,duties ,! work+ gr\p %all provide = ! e/abli%m5t ( quality measures t may be us$ by a ,,pdp sponsor 7z def9$ 9 clause 7ii77 ) respect to inc5tive paym5ts & adju/m5ts 7z def9$ 9 clause 7ii77,,iv77 = a ph>macy "u ?is "p4 ,su* measures e/abli%$ by su* gr\p %all include only su* measures t-- 7aa7 are reasonable & relevant ) respect to ! practice type ( ! applicable ph>macy2 & 7bb7 evaluate crit]ia ov] :i* ! ph>macy has mean+ful control & ability to influ5ce1 consi/5t ) ! ph>macy's practice type4 4 #c4 ,ph>macy b5efit manag] provision ( in=mation 7a7 ,9 g5]al ,section #aaej;,a7b77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#bc7;b77#b77 is am5d$ by /rik+ exclud+ & ins]t+ includ+4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply ) respect to contract ye>s beg9n+ on or aft] ,janu>y #a1 #bjai4