,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #ajce  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,febru>y #g1 #bjai,mr4
 ,coll9s ( ,georgia 7= himself1 ,mr4    
,loebsack1 ,mr4 ,david ,p4 ,roe (       
,t5nessee1 ,mr4 ,we/]man1 ,miss ,rice ( 
,new ,york1 ,mr4 ,k+ ( ,i[a1 ,ms4 ,cl>ke
 ( ,new ,york1 ,mr4 ,au/9 ,scott (      
,georgia1 ,mr4 ,hice ( ,georgia1 ,mr4   
,vela1 ,mr4 ,rask91 ,mrs4 ,rodg]s (     
,wa%+ton1 ,mr4 ,wel*1 ,mr4 ,c>t] (      
,georgia1 ,mr4 ,craw=d1 ,mr4 ,pet]son1 &
 ,mr4 ,byrne7 introduc$ ! foll[+ bill2  
:i* 0 ref]r$ to ! ,committee on ,en]gy &
 ,comm]ce1 & 9 addition to ! ,committees
 on ,ways & ,means1 & ,ov]sight & ,re=m1
 = 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 provide = ph>macy b5efits      
manag] /&>ds "u ! ,m$ic>e prescription  
drug program & ,m$ic>e ,advantage       
program to fur!r transp>5cy ( paym5t    

me?odologies to ph>macies1 & = o!r      
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,prescription ,drug ,price 
,transp>5cy ,act4  #b4 ,ph>macy b5efits 
manag] /&>ds "u ! ,m$ic>e program =     
prescription drug plans & ,,ma-,,pd     
plans  7a7 ,9 g5]al ,section            
#ahfj;,d-#ab7;b7 ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #aciew-#aab7;b77 is 
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#h7 ,ph>macy b5efits manag] 
transp>5cy requirem5ts ,ea* contract    
ent]$ into ) a ,,pdp sponsor "u ?is "p )
 respect to a prescription drug plan    
(f]$ by su* sponsor or ) an ,,ma        
organization (f]+ an ,,ma-,,pd plan "u  
"p ,c %all provide t ! sponsor or       
organization1 respectively1 may n ent]  
into a contract ) any ph>macy b5efits   
manag] 7ref]r$ to 9 ?is p>agraph z a    
,,pbm7 to manage ! prescription drug    
cov]age provid$ "u su* plan1 or to      
control ! co/s ( ! prescription drug    
cov]age "u su* plan1 if ! ,,pbm--  7,a7 
requires t a plan enrollee use a retail 

ph>macy1 mail ord] ph>macy1 specialty   
ph>macy1 or o!r ph>macy entity provid+  
ph>macy s]vices 9 :i* ! ,,pbm has an    
own]%ip int]e/ or t has an own]%ip      
int]e/ 9 ! ,,pbm2 or  7,b7 provides an  
inc5tive 7includ+ a r$uc$ copaym5t or   
co9surance7 to a plan enrollee to       
enc\rage ! enrollee to use a retail     
ph>macy1 mail ord] ph>macy1 specialty   
ph>macy1 or o!r ph>macy entity provid+  
ph>macy s]vices 9 :i* ! ,,pbm has an    
own]%ip int]e/ or t has an own]%ip      
int]e/ 9 ! ,,pbm1 if ! inc5tive is      
applicable only to su* ph>macies4  4    
7b7 ,regul> update ( prescription drug  
pric+ /&>d ,p>agraph 7#f7 ( section     
#ahfj;,d-#ab7;b7 ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #aciew-#aab7;b77 is 
am5d$ to read z foll[s3  7#f7 ,regul>   
update ( prescription drug pric+ /&>d   
7,a7 ,9 g5]al ,if ! ,,pdp sponsor ( a   
prescription drug plan 7or ,,ma         
organization (f]+ an ,,ma-,,pd plan7    
uses a /&>d = reimbursem5t 7z describ$ 9
 subp>agraph 7,b77 ( ph>macies bas$ on !

 co/ ( a drug1 ea* contract ent]$ into )
 su* sponsor "u ?is "p 7or organization 
"u "p ,c7 ) respect to ! plan %all      
provide t ! sponsor 7or organization7   
%all--  7i7 update su* /&>d n less      
frequ5tly ?an once e #g days1 beg9n+ )  
an initial update on ,janu>y #a ( ea*   
ye>1 to accurately reflect ! m>ket price
 ( acquir+ ! drug2  7ii7 disclose to    
applicable ph>macies & ! respective     
contract+ entities ( su* ph>macies !    
s\rces us$ = mak+ any su* update        
imm$iately )\t requirem5t ( reque/2     
7iii7 if ! s\rce = su* a /&>d =         
reimbursem5t is n publicly available1   
disclose to ! applicable ph>macies & !  
respective contract+ entities ( su*     
ph>macies all individual drug prices to 
be s updat$ 9 advance ( ! use ( su*     
prices = ! reimbursem5t ( claims2  7iv7 
e/abli% a process = applicable ph>macies
 & respective contract+ entities to     
appeal1 inve/igate1 & resolve disputes  
reg>d+ individual drug prices t are less
 ?an ! ph>macy acquisition price = su*  

drug1 :i* mu/ be adjudicat$ )9 #g days (
 ! ph>macy fil+ its appeal2 &  7v7      
provide to applicable ph>macies &       
respective contract+ entities all su*   
pric+ data 9 an 4xml spread%eet =mat or 
a comp>able easily accessible & complete
 spread%eet =mat4  7,b7 ,prescription   
drug pric+ /&>d def9$ ,= purposes (     
subp>agraph 7,a71 a /&>d = reimbursem5t 
( a ph>macy is any me?odology or =mula =
 v>y+ ! pric+ ( a drug or drugs dur+ !  
t]m ( ! ph>macy reimbursem5t contract t 
is bas$ on ! co/ ( ! drug involv$1      
includ+ drug pric+ ref]5ces & am\nts t  
are bas$ ^u av]age :olesale price1      
:olesale av]age co/1 av]age manufactur] 
price1 av]age sales price1 maximum      
all[able co/ 7,,mac71 or o!r co/s1 :e!r 
publicly available or n4  4  7c7        
,effective date ,! am5dm5ts made by ?is 
section %all apply to plan ye>s beg9n+  
on or aft] ,janu>y #a1 #bjbj4  #c4      
,prescription drug transp>5cy 9 ! ,f$]al
 ,employees ,heal? ,b5efits program  7a7
 ,9 g5]al ,section #hijb ( title #e1    

,unit$ ,/ates ,code1 is am5d$ by add+ at
 ! end ! foll[+ new subsections3  7p7 ,a
 contract may n be made or a plan       
approv$ "u ?is *apt] "u :i* a c>ri] has 
an agreem5t ) a ph>macy b5efits manag]  
79 ?is subsection ref]r$ to z a ,,pbm7  
to manage prescription drug cov]age or  
to control ! co/s ( ! prescription drug 
cov]age if ! ,,pbm--  7#a7 requires t an
 individual enroll$ "u su* contract or  
plan use a retail ph>macy1 mail ord]    
ph>macy1 specialty ph>macy1 or o!r      
ph>macy entity provid+ ph>macy s]vices 9
 :i* ! ,,pbm has an own]%ip int]e/ or t 
has an own]%ip int]e/ 9 ! ,,pbm2 or     
7#b7 provides an inc5tive 7includ+ a    
r$uc$ copaym5t or co9surance7 to a plan 
enrollee to enc\rage ! enrollee to use a
 retail ph>macy1 mail ord] ph>macy1     
specialty ph>macy1 or o!r ph>macy entity
 provid+ ph>macy s]vices 9 :i* ! ,,pbm  
has an own]%ip int]e/ or t has an       
own]%ip int]e/ 9 ! ,,pbm1 if ! inc5tive 
is applicable only to su* ph>macies4    
7q7  7#a7 ,if a contract made or plan   

approv$ "u ?is *apt] provides = a /&>d =
 reimbursem5t 7z describ$ 9 p>agraph    
7#b77 ) respect to a prescription drug  
plan1 su* contract or plan %all provide 
t ! applicable c>ri]--  7,a7 update su* 
/&>d n less frequ5tly ?an once e #g     
days1 beg9n+ ) an initial update on     
,janu>y #a ( ea* ye>1 to accurately     
reflect ! m>ket price ( acquir+ ! drug2 
7,b7 disclose to applicable ph>macies & 
! respective contract+ entities ( su*   
ph>macies ! s\rces us$ = mak+ any su*   
update imm$iately )\t requirem5t (      
reque/2  7,c7 if ! s\rce = su* a /&>d = 
reimbursem5t is n publicly available1   
disclose to ! applicable ph>macies &    
respective contract+ entities ( su*     
ph>macies all individual drug prices to 
be s updat$ 9 advance ( ! use ( su*     
prices = ! reimbursem5t ( claims2  7,d7 
e/abli% a process = applicable ph>macies
 & respective contract+ entities to     
appeal1 inve/igate1 & resolve disputes  
reg>d+ individual drug prices t are less
 ?an ! ph>macy acquisition price = su*  

drug1 :i* mu/ be adjudicat$ )9 #g days (
 ! ph>macy fil+ its appeal2 &  7,e7     
provide to applicable ph>macies &       
respective contract+ entities all su*   
pric+ data 9 an 4xml spread%eet =mat or 
a comp>able easily accessible & complete
 spread%eet =mat4  7#b7 ,= purposes (   
p>agraph 7#a71 a /&>d = reimbursem5t ( a
 ph>macy is any me?odology or =mula =   
v>y+ ! pric+ ( a drug or drugs dur+ !   
t]m ( ! ph>macy reimbursem5t contract t 
is bas$ on ! co/ ( ! drug involv$1      
includ+ drug pric+ ref]5ces & am\nts t  
are bas$ ^u av]age :olesale price1      
:olesale av]age co/1 av]age manufactur] 
price1 av]age sales price1 maximum      
all[able co/1 or o!r co/s1 :e!r publicly
 available or n4  4  7b7 ,application ,!
 am5dm5t made by subsection 7a7 %all    
apply to any contract ent]$ into "u     
section #hijb ( title #e1 ,unit$ ,/ates 
,code1 on or aft] ! date ( enactm5t (   
?is section4