,i #aafth ,,congress #ast ,session ,h4 ,r4 #ajce ,,in ,,the ,,house ,,of ,,representatives ,february #g1 #bjai,mr4 ,collins of ,georgia 7for himself1 ,mr4 ,loebsack1 ,mr4 ,david ,p4 ,roe of ,tennessee1 ,mr4 ,westerman1 ,miss ,rice of ,new ,york1 ,mr4 ,king of ,iowa1 ,ms4 ,clarke of ,new ,york1 ,mr4 ,austin ,scott of ,georgia1 ,mr4 ,hice of ,georgia1 ,mr4 ,vela1 ,mr4 ,raskin1 ,mrs4 ,rodgers of ,washington1 ,mr4 ,welch1 ,mr4 ,carter of ,georgia1 ,mr4 ,crawford1 ,mr4 ,peterson1 and ,mr4 ,byrne7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means1 and ,oversight and ,reform1 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 and ,medicare ,advantage program to further transparency of payment methodologies to pharmacies1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,prescription ,drug ,price ,transparency ,act4 #b4 ,pharmacy benefits manager standards under the ,medicare program for prescription drug plans and ,,ma-,,pd plans 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 paragraph3 7#h7 ,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 or with an ,,ma organization offering an ,,ma-,,pd plan under part ,c shall provide that the sponsor or organization1 respectively1 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 if the ,,pbm-- 7,a7 requires 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 ,,pbm2 or 7,b7 provides an incentive 7including a reduced copayment or coinsurance7 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 7or ,,ma organization offering an ,,ma-,,pd plan7 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 7or organization under part ,c7 with respect to the plan shall provide that the sponsor 7or organization7 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 and the respective contracting entities of such pharmacies the sources used for making any such update immediately without requirement of request2 7iii7 if the source for such a standard for reimbursement is not publicly available1 disclose to the applicable pharmacies and the respective contracting entities of such pharmacies all individual drug prices to be so updated in advance of the use of such prices for the reimbursement of claims2 7iv7 establish a process for applicable pharmacies and respective contracting entities to appeal1 investigate1 and resolve disputes regarding individual drug prices that are less than the pharmacy acquisition price for such drug1 which must be adjudicated within #g days of the pharmacy filing its appeal2 and 7v7 provide to applicable pharmacies and respective contracting entities all such pricing data in an 4xml spreadsheet format or a comparable easily accessible and complete spreadsheet format4 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 #bjbj4 #c4 ,prescription drug transparency in the ,federal ,employees ,health ,benefits program 7a7 ,in general ,section #hijb of title #e1 ,united ,states ,code1 is amended by adding at the end the following new subsections3 7p7 ,a contract may not be made or a plan approved under this chapter under which a carrier has an agreement with a pharmacy benefits manager 7in this subsection referred to as a ,,pbm7 to manage prescription drug coverage or to control the costs of the prescription drug coverage if the ,,pbm-- 7#a7 requires that an individual enrolled under such contract or plan 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 ,,pbm2 or 7#b7 provides an incentive 7including a reduced copayment or coinsurance7 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 7q7 7#a7 ,if a contract made or plan approved under this chapter provides for a standard for reimbursement 7as described in paragraph 7#b77 with respect to a prescription drug plan1 such contract or plan shall provide that the applicable carrier-- 7,a7 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 7,b7 disclose to applicable pharmacies and the respective contracting entities of such pharmacies the sources used for making any such update immediately without requirement of request2 7,c7 if the source for such a standard for reimbursement is not publicly available1 disclose to the applicable pharmacies and respective contracting entities of such pharmacies all individual drug prices to be so updated in advance of the use of such prices for the reimbursement of claims2 7,d7 establish a process for applicable pharmacies and respective contracting entities to appeal1 investigate1 and resolve disputes regarding individual drug prices that are less than the pharmacy acquisition price for such drug1 which must be adjudicated within #g days of the pharmacy filing its appeal2 and 7,e7 provide to applicable pharmacies and respective contracting entities all such pricing data in an 4xml spreadsheet format or a comparable easily accessible and complete spreadsheet format4 7#b7 ,for purposes of paragraph 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 cost1 or other costs1 whether publicly available or not4 4 7b7 ,application ,the amendment made by subsection 7a7 shall apply to any contract entered into under section #hijb of title #e1 ,united ,states ,code1 on or after the date of enactment of this section4