,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #dfdi  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,octob] #aa1 #bjai,mr4
 ,hors=d 7= himself & ,ms4 ,k5dra ,s4   
,horn ( ,oklahoma7 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 provide = a cap on b5efici>y        
liability "u "p ,d ( ! ,m$ic>e program1 
& = o!r purposes4  #a4 ,%ort title ,?is 
,act may be cit$ z ! ,capp+ ,drug ,co/s 
= ,s5iors ,act ( #bjai4  #b4 ,m$ic>e "p 
,d b5efit r$esign  7a7 ,b5efit /ructure 
r$esign ,section #ahfj;,d-#b7;b7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ajb7;b77 is am5d$--  7#a7 9     
p>agraph 7#b7-- 7,a7 9 subp>agraph 7,a71
 9 ! matt] prec$+ clause 7i71 by ins]t+ 
= a ye> prec$+ #bjbb & = co/s above !   

annual d$uctible specifi$ 9 p>agraph    
7#a7 & up to ! annual out-(-pocket      
?re%old specifi$ 9 p>agraph 7#d77;,b7 = 
#bjbb & ea* subsequ5t ye> aft] p>agraph 
7#c72  7,b7 9 subp>agraph 7,c7-- 7i7 9  
clause 7i71 9 ! matt] prec$+ subclause  
7,i71 by ins]t+ = a ye> prec$+ #bjbb1   
aft] p>agraph 7#d712 &  7ii7 9 clause   
7ii77,,iii71 by /rik+ & ea* subsequ5t   
ye> & ins]t+ & #bjba2 &  7,c7 9         
subp>agraph 7,d7--  7i7 9 clause 7i7--  
7,i7 9 ! matt] prec$+ subclause 7,i71 by
 ins]t+ = a ye> prec$+ #bjbb1 aft]      
p>agraph 7#d712 &  7,,ii7 9 subclause   
7,i77bb71 by /rik+ a ye> aft] #bjah &   
ins]t+ ea* ( ye>s #bjah ?r\gh #bjba2 &  
7ii7 9 clause 7ii77,v71 by /rik+ #bjai &
 ea* subsequ5t ye> & ins]t+ ea* ( ye>s  
#bjai ?r\gh #bjba2  7#b7 9 p>agraph     
7#c77;,a7-- 7,a7 9 ! matt] prec$+ clause
 7i71 by ins]t+ = a ye> prec$+ #bjbb1   
aft] & 7#d712 &  7,b7 9 clause 7ii71 by 
/rik+ = a subsequ5t ye> & ins]t+ = ea* (
 ye>s #bjjg ?r\gh #bjba2 &  7#c7 9      
p>agraph 7#d7--  7,a7 9 subp>agraph     

7,a7-- 7i7 9 clause 7i7--  7,i7 by      
r$esignat+ subclauses 7,i7 & 7,,ii7 z   
items 7aa7 & 7bb71 respectively1 & mov+ 
! m>g9 ( ea* su* r$esignat$ item #b ems 
to ! "r2  7,,ii7 9 ! matt] prec$+ item  
7aa71 z r$esignat$ by subclause 7,i71 by
 /rik+ is equal to ! great] (-- & ins]t+
 8is equal to--  7,i7 = a ye> prec$+    
#bjbb1 ! great] (--  2  7,,iii7 by /rik+
 ! p]iod at ! end ( item 7bb71 z        
r$esignat$ by subclause 7,i71 & ins]t+ 2
 &2 &  7,,iv7 by add+ at ! end ! foll[+3
  7,,ii7 = #bjbb & ea* succe$+ ye>1 #j4 
2 &  7ii7 9 clause 7ii7--  7,i7 by /rik+
 clause 7i77,i7 & ins]t+ clause         
7i77,i77aa72 &  7,,ii7 by add+ at ! end 
! foll[+ new s5t5ce3 ,! ,secret>y %all  
cont9ue to calculate ! doll> am\nts     
specifi$ 9 clause 7i77,i77aa71 includ+ )
 ! adju/m5t "u ?is clause1 aft] #bjba = 
purposes ( section                      
#ahfj;,d-#ad7;a77#a77;,d77iii742  7,b7 9
 subp>agraph 7,b7-- 7i7 9 clause 7i7--  
7,i7 9 subclause 7,v71 by /rik+ or at ! 
end2  7,,ii7 9 subclause 7,,vi7--  7aa7 

by /rik+ = a subsequ5t ye> & ins]t+ =   
#bjba2 &  7bb7 by /rik+ ! p]iod at ! end
 & ins]t+ a semicolon2 &  7,,iii7 by    
add+ at ! end ! foll[+ new subclauses3  
7,,vii7 = #bjbb1 is equal to #b1jjj2 or 
7,,viii7 = a subsequ5t ye>1 is equal to 
! am\nt specifi$ 9 ?is subp>agraph = !  
previ\s ye>1 increas$ by ! annual       
p]c5tage increase describ$ 9 p>agraph   
7#f7 = ! ye> involv$4  2 &  7ii7 9      
clause 7ii71 by /rik+ clause 7i77,,ii7 &
 ins]t+ clause 7i72  7,c7 9 subp>agraph 
7,c77i71 by /rik+ & = am\nts & ins]t+ &1
 = a ye> prec$+ #bjbb1 = am\nts2 &  7,d7
 9 subp>agraph 7,e71 by /rik+ ,9 apply+ 
& ins]t+ ,= ea* ( ye>s #bjaa ?r\gh      
#bjba1 9 apply+4  7b7 ,decreas+         
re9surance paym5t am\nt ,section        
#ahfj;,d-#ae7;b77#a7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciew-#aae7;b77#a77 is am5d$ by ins]t+ 
aft] #hj p]c5t ! foll[+3 7or1 ) respect 
to a cov]age ye> aft] #bjba1 #bj p]c5t74
  7c7 ,manufactur] disc\nt program  7#a7
 ,9 g5]al ,"p ,d ( title ,,xviii ( !    

,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#aja et seq47 is am5d$ by ins]t+ 
aft] section #ahfj;,d-#ad;,a ! foll[+   
new section3  #ahfj;,d-#ad;,b4          
,manufactur] disc\nt program  7a7       
,e/abli%m5t ,! ,secret>y %all e/abli% a 
manufactur] disc\nt program 79 ?is      
section ref]r$ to z ! program74 ,"u !   
program1 ! ,secret>y %all ent] into     
agreem5ts describ$ 9 subsection 7b7 )   
manufactur]s & provide = ! p]=mance ( ! 
duties describ$ 9 subsection 7c74 ,!    
,secret>y %all e/abli% a model agreem5t 
= use "u ! program by n lat] ?an ,janu>y
 #a1 #bjba1 9 consultation )            
manufactur]s1 & all[ = comm5t on su*    
model agreem5t4  7b7 ,t]ms ( agreem5t   
7#a7 ,9 g5]al  7,a7 ,agreem5t ,an       
agreem5t "u ?is section %all require !  
manufactur] to provide applicable       
b5efici>ies access to disc\nt$ prices = 
applicable drugs ( ! manufactur] t are  
disp5s$ on or aft] ,janu>y #a1 #bjbb4   
7,b7 ,provision ( disc\nt$ prices at !  
po9t-(-sale ,! disc\nt$ prices describ$ 

9 subp>agraph 7,a7 %all be provid$ to ! 
applicable b5efici>y at ! ph>macy or by 
! mail ord] s]vice at ! po9t-(-sale ( an
 applicable drug4  7,c7 ,tim+ ( agreem5t
  7i7 ,special rule = #bjbb ,9 ord] = an
 agreem5t ) a manufactur] to be 9 effect
 "u ?is section ) respect to ! p]iod    
beg9n+ on ,janu>y #a1 #bjbb1 & end+ on  
,decemb] #ca1 #bjbb1 ! manufactur] %all 
ent] into su* agreem5t n lat] ?an #cj   
days aft] ! date ( ! e/abli%m5t ( a     
model agreem5t "u subsection 7a74  7ii7 
#bjbc & subsequ5t ye>s ,9 ord] = an     
agreem5t ) a manufactur] to be 9 effect 
"u ?is section ) respect to plan ye>    
#bjbc or a subsequ5t plan ye>1 !        
manufactur] %all ent] into su* agreem5t 
7or su* agreem5t %all be r5ew$ "u       
p>agraph 7#d77;,a77 n lat] ?an ,janu>y  
#cj ( ! prec$+ ye>4  7#b7 ,provision (  
appropriate data ,ea* manufactur] ) an  
agreem5t 9 effect "u ?is section %all   
collect & h available appropriate data1 
z det]m9$ by ! ,secret>y1 to ensure t x 
c demon/rate to ! ,secret>y compliance )

 ! requirem5ts "u ! program4  7#c7      
,compliance ) requirem5ts = adm9i/ration
 ( program ,ea* manufactur] ) an        
agreem5t 9 effect "u ?is section %all   
comply ) requirem5ts impos$ by !        
,secret>y or a ?ird p>ty ) a contract "u
 subsection 7d77#c71 z applicable1 =    
purposes ( adm9i/]+ ! program1 includ+  
any det]m9ation "u subp>agraph 7,a7 (   
subsection 7c77#a7 or proc$ures e/abli%$
 "u su* subsection 7c77#a74  7#d7 ,l5g? 
( agreem5t  7,a7 ,9 g5]al ,an agreem5t  
"u ?is section %all be effective = an   
initial p]iod ( n less ?an #ab mon?s &  
%all be automatically r5ew$ = a p]iod ( 
n less ?an #a ye> unless t]m9at$ "u     
subp>agraph 7,b74  7,b7 ,t]m9ation  7i7 
,by ! ,secret>y ,! ,secret>y may provide
 = t]m9ation ( an agreem5t "u ?is       
section = a kn[+ & willful violation ( !
 requirem5ts ( ! agreem5t or o!r good   
cause %[n4 ,su* t]m9ation %all n be     
effective e>li] ?an #cj days aft] ! date
 ( notice to ! manufactur] ( su*        
t]m9ation4 ,! ,secret>y %all provide1 ^u

 reque/1 a manufactur] ) a he>+ conc]n+ 
su* a t]m9ation1 & su* he>+ %all take   
place prior to ! effective date ( !     
t]m9ation ) suffici5t "t = su* effective
 date to be repeal$ if ! ,secret>y      
det]m9es appropriate4  7ii7 ,by a       
manufactur] ,a manufactur] may t]m9ate  
an agreem5t "u ?is section = any reason4
 ,any su* t]m9ation %all be effective1 )
 respect to a plan ye>--  7,i7 if !     
t]m9ation occurs be=e ,janu>y #cj ( a   
plan ye>1 z ( ! day aft] ! end ( ! plan 
ye>2 &  7,,ii7 if ! t]m9ation occurs on 
or aft] ,janu>y #cj ( a plan ye>1 z ( ! 
day aft] ! end ( ! succe$+ plan ye>4    
7iii7 ,effectiv5ess ( t]m9ation ,any    
t]m9ation "u ?is subp>agraph %all n     
affect disc\nts = applicable drugs ( !  
manufactur] t are due "u ! agreem5t be=e
 ! effective date ( its t]m9ation4  7iv7
 ,notice to ?ird p>ty ,! ,secret>y %all 
provide notice ( su* t]m9ation to a ?ird
 p>ty ) a contract "u subsection 7d77#c7
 )9 n less ?an #cj days be=e ! effective
 date ( su* t]m9ation4  7c7 ,duties     

describ$ ,! duties describ$ 9 ?is       
subsection are ! foll[+3 7#a7           
,adm9i/ration ( program ,adm9i/]+ !     
program1 includ+--  7,a7 ! det]m9ation (
 ! am\nt ( ! disc\nt$ price ( an        
applicable drug ( a manufactur]2  7,b7 !
 e/abli%m5t ( proc$ures "u :i* disc\nt$ 
prices are provid$ to applicable        
b5efici>ies at ph>macies or by mail ord]
 s]vice at ! po9t-(-sale ( an applicable
 drug2  7,c7 ! e/abli%m5t ( proc$ures to
 ensure t1 n lat] ?an ! applicable numb]
 ( cal5d> days aft] ! disp5s+ ( an      
applicable drug by a ph>macy or mail    
ord] s]vice1 ! ph>macy or mail ord]     
s]vice is reimburs$ = an am\nt equal to 
! diff]5ce betwe5--  7i7 ! negotiat$    
price ( ! applicable drug2 &  7ii7 !    
disc\nt$ price ( ! applicable drug2     
7,d7 ! e/abli%m5t ( proc$ures to ensure 
t ! disc\nt$ price = an applicable drug 
"u ?is section is appli$ be=e any       
cov]age or f9ancial assi/ance "u o!r    
heal? b5efit plans or programs t provide
 cov]age or f9ancial assi/ance = !      

pur*ase or provision ( prescription drug
 cov]age on behalf ( applicable         
b5efici>ies z ! ,secret>y may specify2 &
  7,e7 provid+ a reasonable dispute     
resolution me*anism to resolve          
disagreem5ts betwe5 manufactur]s1       
applicable b5efici>ies1 & ! ?ird p>ty ) 
a contract "u subsection 7d77#c74  7#b7 
,monitor+ compliance  7,a7 ,9 g5]al ,!  
,secret>y %all monitor compliance by a  
manufactur] ) ! t]ms ( an agreem5t "u   
?is section4  7,b7 ,notification ,if a  
?ird p>ty ) a contract "u subsection    
7d77#c7 det]m9es t ! manufactur] is n 9 
compliance ) su* agreem5t1 ! ?ird p>ty  
%all notify ! ,secret>y ( su*           
noncompliance = appropriate en=cem5t "u 
subsection 7e74  7#c7 ,collection ( data
 f prescription drug plans & ,,ma-,,pd  
plans ,! ,secret>y may collect          
appropriate data f prescription drug    
plans & ,,ma-,,pd plans 9 a timeframe t 
all[s = disc\nt$ prices to be provid$ = 
applicable drugs "u ?is section4  7d7   
,adm9i/ration  7#a7 ,9 g5]al ,subject to

 p>agraph 7#b71 ! ,secret>y %all provide
 = ! implem5tation ( ?is section1       
includ+ ! p]=mance ( ! duties describ$ 9
 subsection 7c74  7#b7 ,limitation ,9   
provid+ = ! implem5tation ( ?is section1
 ! ,secret>y %all n receive or di/ribute
 any funds ( a manufactur] "u ! program4
  7#c7 ,contract ) ?ird p>ties ,!       
,secret>y %all ent] into a contract ) "o
 or m ?ird p>ties to adm9i/] !          
requirem5ts e/abli%$ by ! ,secret>y 9   
ord] to c>ry out ?is section4 ,at a     
m9imum1 ! contract ) a ?ird p>ty "u !   
prec$+ s5t5ce %all require t ! ?ird     
p>ty--  7,a7 receive & transmit         
in=mation betwe5 ! ,secret>y1           
manufactur]s1 & o!r individuals or      
entities ! ,secret>y det]m9es           
appropriate2  7,b7 receive1 di/ribute1  
or facilitate ! di/ribution ( funds (   
manufactur]s to appropriate individuals 
or entities 9 ord] to meet ! obligations
 ( manufactur]s "u agreem5ts "u ?is     
section2  7,c7 provide adequate & timely
 in=mation to manufactur]s1 consi/5t ) !

 agreem5t ) ! manufactur] "u ?is        
section1 z necess>y = ! manufactur] to  
fulfill its obligations "u ?is section2 
&  7,d7 p]mit manufactur]s to conduct   
p]iodic audits1 directly or ?r\gh       
contracts1 ( ! data & in=mation us$ by !
 ?ird p>ty to det]m9e disc\nts =        
applicable drugs ( ! manufactur] "u !   
program4  7#d7 ,p]=mance requirem5ts ,! 
,secret>y %all e/abli% p]=mance         
requirem5ts = a ?ird p>ty ) a contract  
"u p>agraph 7#c7 & safegu>ds to protect 
! indep5d5ce & integrity ( ! activities 
c>ri$ out by ! ?ird p>ty "u ! program "u
 ?is section4  7#e7 ,implem5tation ,!   
,secret>y may implem5t ! program "u ?is 
section by program in/ruction or        
o!rwise4  7#f7 ,adm9i/ration ,*apt] #ce 
( title #dd1 ,unit$ ,/ates ,code1 %all n
 apply to ! program "u ?is section4  7e7
 ,en=cem5t  7#a7 ,audits ,ea*           
manufactur] ) an agreem5t 9 effect "u   
?is section %all be subject to p]iodic  
audit by ! ,secret>y4  7#b7 ,civil money
 p5alty  7,a7 ,9 g5]al ,! ,secret>y may 

impose a civil money p5alty on a        
manufactur] t fails to provide          
applicable b5efici>ies disc\nts =       
applicable drugs ( ! manufactur] 9      
accordance ) su* agreem5t = ea* su*     
failure 9 an am\nt ! ,secret>y det]m9es 
is comm5surate ) ! sum (--  7i7 ! am\nt 
t ! manufactur] w\ld h paid ) respect to
 su* disc\nts "u ! agreem5t1 :i* w !n be
 us$ to pay ! disc\nts :i* ! manufactur]
 _h fail$ to provide2 &  7ii7 #be p]c5t 
( su* am\nt4  7,b7 ,application ,!      
provisions ( section #aabh;,a 7o!r ?an  
subsections 7a7 & 7b77 %all apply to a  
civil money p5alty "u ?is p>agraph 9 !  
same mann] z su* provisions apply to a  
p5alty or proce$+ "u section            
#aabh;,a7a74  7f7 ,cl>ification reg>d+  
availability ( o!r cov]$ "p ,d drugs    
,no?+ 9 ?is section %all prev5t an      
applicable b5efici>y f pur*as+ a cov]$  
"p ,d drug t is n an applicable drug    
7includ+ a g5]ic drug or a drug t is n  
on ! =mul>y ( ! prescription drug plan  
or ,,ma-,,pd plan t ! applicable        

b5efici>y is enroll$ 974  7g7           
,def9itions ,9 ?is section3 7#a7        
,applicable b5efici>y ,! t]m applicable 
b5efici>y means an individual :o1 on !  
date ( disp5s+ a cov]$ "p ,d drug--     
7,a7 is enroll$ 9 a prescription drug   
plan or an ,,ma-,,pd plan2  7,b7 is n   
enroll$ 9 a qualifi$ retiree            
prescription drug plan2 &  7,c7 has     
incurr$ co/s = cov]$ "p ,d drugs 9 ! ye>
 t are equal to or exce$ ! annual       
d$uctible specifi$ 9 section            
#ahfj;,d-#b7;b77#a7 = su* ye>4  7#b7    
,applicable drug ,! t]m applicable drug1
 ) respect to an applicable b5efici>y   
means a cov]$ "p ,d drug-- 7,a7 approv$ 
"u a new drug application "u section    
#eje7;b7 ( ! ,f$]al ,food1 ,drug1 &     
,cosmetic ,act or1 9 ! case ( a biologic
 product1 lic5s$ "u section #cea ( !    
,public ,heal? ,s]vice ,act2 &  7,b7    
7i7 if ! ,,pdp sponsor ( ! prescription 
drug plan or ! ,,ma organization (f]+ ! 
,,ma-,,pd plan uses a =mul>y1 :i* is on 
! =mul>y ( ! prescription drug plan or  

,,ma-,,pd plan t ! applicable b5efici>y 
is enroll$ 92  7ii7 if ! ,,pdp sponsor (
 ! prescription drug plan or ! ,,ma     
organization (f]+ ! ,,ma-,,pd plan does 
n use a =mul>y1 = :i* b5efits are       
available "u ! prescription drug plan or
 ,,ma-,,pd plan t ! applicable b5efici>y
 is enroll$ 92 or  7iii7 is provid$     
?r\gh an exception or appeal4  7#c7     
,applicable numb] ( cal5d> days ,! t]m  
applicable numb] ( cal5d> days means--  
7,a7 ) respect to claims = reimbursem5t 
submitt$ electronically1 #ad days2 &    
7,b7 ) respect to claims = reimbursem5t 
submitt$ o!rwise1 #cj days4  7#d7       
,disc\nt$ price  7,a7 ,9 g5]al ,! t]m   
disc\nt$ price means1 ) respect to an   
applicable drug ( a manufactur] furni%$ 
dur+ a ye> to an applicable b5efici>y-- 
7i7 :o has n incurr$ co/s = cov]$ "p ,d 
drugs 9 ! ye> t are equal to or exce$ ! 
annual out-(-pocket ?re%old specifi$ 9  
section #ahfj;,d-#b7;b77#d77;,b77i7 = ! 
ye>1 #ij p]c5t ( ! negotiat$ price ( su*
 drug2 &  7ii7 :o has incurr$ su* co/s 9

 ! ye> t are equal to or exce$ su*      
?re%old = ! ye>1 #gj p]c5t ( ! negotiat$
 price ( su* drug4  7,b7 ,cl>ification  
,no?+ 9 ?is section %all be con/ru$ z   
affect+ ! responsibility ( an applicable
 b5efici>y = paym5t ( a disp5s+ fee = an
 applicable drug4  7,c7 ,special case = 
c]ta9 claims  7i7 ,claims spann+        
d$uctible ,9 ! case :]e ! entire am\nt (
 ! negotiat$ price ( an individual claim
 = an applicable drug ) respect to an   
applicable b5efici>y does n fall at or  
above ! annual d$uctible specifi$ 9     
section #ahfj;,d-#b7;b77#a7 = ! ye>1 !  
manufactur] ( ! applicable drug %all    
provide ! disc\nt$ price "u ?is section 
on only ! portion ( ! negotiat$ price ( 
! applicable drug t falls at or above   
su* annual d$uctible4  7ii7 ,claims     
spann+ out-(-pocket ?re%old ,9 ! case   
:]e ! entire am\nt ( ! negotiat$ price (
 an individual claim = an applicable    
drug ) respect to an applicable         
b5efici>y does n fall entirely bel[ or  
entirely above ! annual out-(-pocket    

?re%old specifi$ 9 section              
#ahfj;,d-#b7;b77#d77;,b77i7 = ! ye>1 !  
manufactur] ( ! applicable drug %all    
provide ! disc\nt$ price--  7,i7 9      
accordance ) subp>agraph 7,a77i7 on !   
portion ( ! negotiat$ price ( !         
applicable drug t falls bel[ su*        
?re%old2 &  7,,ii7 9 accordance )       
subp>agraph 7,a77ii7 on ! portion ( su* 
price ( su* drug t falls at or above su*
 ?re%old4  7#e7 ,manufactur] ,! t]m     
manufactur] means any entity :i* is     
engag$ 9 ! production1 prep>ation1      
propagation1 comp\nd+1 conv]sion1 or    
process+ ( prescription drug products1  
ei!r directly or indirectly by          
extraction f sub/ances ( natural orig91 
or indep5d5tly by means ( *emical       
syn!sis1 or by a comb9ation ( extraction
 & *emical syn!sis4 ,su* t]m does n     
include a :olesale di/ributor ( drugs or
 a retail ph>macy lic5s$ "u ,/ate law4  
7#f7 ,negotiat$ price ,! t]m negotiat$  
price has ! mean+ giv5 su* t]m 9 section
 #dbc4ajj ( title #db1 ,code ( ,f$]al   

,regulations 7z 9 effect on ! date (    
enactm5t ( section #ahfj;,d-#ad;,a71    
except t su* negotiat$ price %all n     
include any disp5s+ fee = ! applicable  
drug4  7#g7 ,qualifi$ retiree           
prescription drug plan ,! t]m qualifi$  
retiree prescription drug plan has !    
mean+ giv5 su* t]m 9 section            
#ahfj;,d-#bb7;a77#b74  4  7#b7 ,sunset (
 ,m$ic>e cov]age gap disc\nt program    
,section #ahfj;,d-#ad;,a ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acie-aad;a7 is am5d$--  7,a7 9         
subsection 7a71 9 ! fir/ s5t5ce1 by     
/rik+ ,! ,secret>y & ins]t+ ,subject to 
subsection 7h71 ! ,secret>y2 &  7,b7 by 
add+ at ! end ! foll[+ new subsection3  
7h7 ,sunset ( program  7#a7 ,9 g5]al ,! 
program %all n apply ) respect to       
applicable drugs disp5s$ on or aft]     
,janu>y #a1 #bjbb1 &1 subject to        
p>agraph 7#b71 agreem5ts "u ?is section 
%all be t]m9at$ z ( su* date4  7#b7     
,cont9u$ application = applicable drugs 
disp5s$ prior to sunset ,! provisions ( 

?is section 7includ+ all                
responsibilities & duties7 %all cont9ue 
to apply aft] ,janu>y #a1 #bjbb1 )      
respect to applicable drugs disp5s$     
prior to su* date4  4  7#c7 ,inclusion (
 actu>ial value ( manufactur] disc\nts 9
 bids ,section #ahfj;,d-#aa ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#aaa7 is am5d$-- 7,a7 9          
subsection 7b77#b77;,c77iii7--  7i7 by  
/rik+ assumptions reg>d+ ! re9surance an
 ins]t+ 8assumptions reg>d+--  7,i7 !   
re9surance  2 &  7ii7 by add+ at ! end !
 foll[+3  7,,ii7 = #bjbb & ea* subsequ5t
 ye>1 ! manufactur] disc\nts provid$ "u 
section #ahfj;,d-#ad;,b subtract$ f !   
actu>ial value to produce su* bid2 &  2 
&  7,b7 9 subsection 7c77#a77;,c7-- 7i7 
by /rik+ an actu>ial valuation ( !      
re9surance & ins]t+ 8an actu>ial        
valuation (--  7i7 ! re9surance  2  7ii7
 9 clause 7i71 z ins]t$ by clause 7i7 ( 
?is subp>agraph1 by add+ & at ! end2 &  
7iii7 by add+ at ! end ! foll[+3  7ii7 =
 #bjbb & ea* subsequ5t ye>1 !           

manufactur] disc\nts provid$ "u section 
#ahfj;,d-#ad;,b2  4  7d7 ,con=m+        
am5dm5ts  7#a7 ,section #ahfj;,d-#b ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ajb7 is am5d$-- 7,a7 9          
subsection 7a77#b77;,a77i77,i71 by /rik+
 1 or an increase 9 ! initial & ins]t+  
or1 = a ye> prec$+ #bjbb1 an increase 9 
! initial2  7,b7 9 subsection           
7c77#a77;,c7-- 7i7 9 ! subp>agraph      
head+1 by /rik+ at initial cov]age      
limit2 &  7ii7 by ins]t+ = a ye> prec$+ 
#bjbb or ! annual out-(-pocket ?re%old  
specifi$ 9 subsection 7b77#d77;,b7 = !  
ye> = #bjbb & ea* subsequ5t ye> aft]    
subsection 7b77#c7 = ! ye> ea* place x  
appe>s2 &  7,c7 9 subsection            
7d77#a77;,a71 by /rik+ or an initial &  
ins]t+ or1 = a ye> prec$+ #bjbb1 an     
initial4  7#b7 ,section                 
#ahfj;,d-#d7;a77#d77;,b77i7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajd7;a77#d77;,b77 is am5d$ by   
/rik+ ! initial & ins]t+ = a ye> prec$+ 
#bjbb1 ! initial4  7#c7 ,section        

#ahfj;,d-#ad7;a7 ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is 
am5d$-- 7,a7 9 p>agraph 7#a7--  7i7 9   
subp>agraph 7,c71 by /rik+ ,!           
cont9uation & ins]t+ ,= a ye> prec$+    
#bjbb1 ! cont9uation2  7ii7 9           
subp>agraph 7,d77iii71 by /rik+         
#ahfj;,d-#b7;b77#d77;,a77i77,i7 & ins]t+
 #ahfj;,d-#b7;b77#d77;,a77i77,i77aa72 & 
7iii7 9 subp>agraph 7,e71 by /rik+ ,!   
elim9ation & ins]t+ ,= a ye> prec$+     
#bjbb1 ! elim9ation2 &  7,b7 9 p>agraph 
7#b7--  7i7 9 subp>agraph 7,c71 by /rik+
 ,! cont9uation & ins]t+ ,= a ye> prec$+
 #bjbb1 ! cont9uation2 &  7ii7 9        
subp>agraph 7,e7--  7,i7 by ins]t+ = a  
ye> prec$+ #bjbb1 aft] subsection 7c72 &
  7,,ii7 by /rik+                       
#ahfj;,d-#b7;b77#d77;,a77i77,i7 & ins]t+
 #ahfj;,d-#b7;b77#d77;,a77i77,i77aa74   
7#d7 ,section #ahfj;,d-#ba7;d77#g7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#aca7;d77#g77 is am5d$ by /rik+  
section #ahfj;,d-#b7;b77#d77;,b77i7 &   
ins]t+ section                          

#ahfj;,d-#b7;b77#d77;,c77i74  7#e7      
,section #ahfj;,d-#bb7;a77#b77;,a7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#acb7;a77#b77;,a77 is am5d$--    
7,a7 by /rik+ ! value ( any disc\nt &   
ins]t+ ! foll[+3  ! value (-- 7i7 = ye>s
 prior to #bjbb1 any disc\nt  2  7,b7 9 
clause 7i71 z ins]t$ by subp>agraph 7,a7
 ( ?is p>agraph1 by /rik+ ! p]iod at !  
end & ins]t+ 2 &2 &  7,c7 by add+ at !  
end ! foll[+ new clause3  7ii7 = #bjbb &
 ea* subsequ5t ye>1 any disc\nt provid$ 
pursuant to section #ahfj;,d-#ad;,b4  4 
7#f7 ,section #ahfj;,d-#da7;a77#f7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#aea7;a77#f77 is am5d$-- 7,a7 by 
ins]t+ = a ye> be=e #bjbb aft]          
#ahfj;,d-#b7;b77#c72 &  7,b7 by ins]t+ =
 su* ye> be=e ! p]iod4  7#g7 ,p>agraph  
7#a7 ( section #ahfj;,d-#dc7;a7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#aec7;a77 is am5d$ to read z     
foll[s3  7#a7 p>ticipate 9-- 7,a7 =     
#bjaa ?r\gh #bjba1 ! ,m$ic>e cov]age gap
 disc\nt program "u section             

#ahfj;,d-#ad;,a2 &  7,b7 = #bjbb & ea*  
subsequ5t ye>1 ! manufactur] disc\nt    
program "u section #ahfj;,d-#ad;,b2  4  
7e7 ,effective date ,! am5dm5ts made by 
?is section %all apply ) respect to plan
 ye> #bjbb & subsequ5t plan ye>s4