,,ii  #aaeth ,,congress  #ast ,session  
,s4 #dac  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,february #af1      
#bjag,mrs4 ,capito 7for herself1 ,mr4   
,tester1 ,mr4 ,lankford1 ,mr4 ,grassley1
 ,ms4 ,heitkamp1 ,mr4 ,wicker1 ,mr4     
,boozman1 and ,mr4 ,cotton7 introduced  
the following bill2 which was read twice
 and referred to the ,committee on      
,finance  ,a ,,bill  ,to amend title    
,,xviii of the ,social ,security ,act to
 prohibit prescription drug plan        
sponsors and ,,ma-,,pd organizations    
under the ,medicare program from        
retroactively reducing payment on clean 
claims submitted by pharmacies4  #a4    
,short title ,this ,act may be cited as 
the ,improving ,transparency and        
,accuracy in ,medicare ,part ,d         
,spending ,act4  #b4 ,prohibiting       
,medicare ,,pdp sponsors and ,,ma-,,pd  
organizations from retroactively        
reducing payment on clean claims        
submitted by pharmacies  7a7 ,in general
 ,section #ahfj;,d-#ab7;b77#d77;,a7 of  

the ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#aab7;b77#d77;,a77 is  
amended by adding at the end the        
following new clause3  7iv7 ,prohibiting
 retroactive reductions in payments on  
clean claims ,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 after the date of receipt of a     
clean claim submitted by a pharmacy1 the
 ,,pdp sponsor 7or an agent of the ,,pdp
 sponsor7 may not retroactively reduce  
payment on such claim directly or       
indirectly through aggregated effective 
rate or otherwise except in the case    
such claim is found to not be a clean   
claim 7such as in the case of a claim   
lacking required substantiating         
documentation7 during the course of a   
routine audit as permitted pursuant to  
written agreement between the ,,pdp     
sponsor 7or such an agent7 and such     
pharmacy4 ,the previous sentence shall  
not prohibit any retroactive increase in

 payment to a pharmacy pursuant to a    
written agreement between a ,,pdp       
sponsor 7or an agent of such sponsor7   
and such pharmacy4  4  7b7 ,effective   
date ,the amendment made by subsection  
7a7 shall apply with respect to         
contracts entered into on or after      
,january #a1 #bjah4