,i #aafth ,,congress #ast ,session ,h4 ,r4 #didf ,,in ,,the ,,house ,,of ,,representatives ,october #ca1 #bjai,mr4 ,welch 7for himself1 ,mr4 ,griffith1 ,mr4 ,loebsack1 ,mr4 ,carter of ,georgia1 ,mr4 ,gonzalez of ,texas1 ,mr4 ,crawford1 ,mr4 ,westerman1 ,mr4 ,david ,p4 ,roe of ,tennessee1 ,mrs4 ,rodgers of ,washington1 ,mrs4 ,axne1 ,mr4 ,allen1 and ,mr4 ,peterson7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 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 ensure equal access of ,medicare beneficiaries to community pharmacies in underserved areas as network pharmacies under ,medicare prescription drug coverage1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,ensuring ,seniors ,access to ,local ,pharmacies ,act of #bjai4 #b4 ,allowing any ,state licensed pharmacy serving an underserved area to become a network pharmacy under ,medicare prescription drug coverage 7a7 ,in general ,section #ahfj;,d-#d7;b77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;b77#a77;,b77 is amended-- 7#a7 by striking ,discounts allowed for network pharmacies4--,for and inserting the following3 8,discounts allowed for network pharmacies4-- 7i7 ,in general ,for 2 and 7#b7 by adding at the end the following new clause3 7ii7 ,inclusion of pharmacies located in underserved areas in networks ,for plan years beginning on or after ,january #a1 #bjbj1 in the case of a prescription drug plan that has1 in its network of pharmacies1 one or more pharmacies located in a health professional shortage area 7as defined in section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act71 in a medically underserved area 7according to a designation under section #ccj7;b77#c77;,a7 of the ,public ,health ,service ,act71 among a medically underserved population 7as defined in such section #ccj7;b77#c77;,a7 of such ,act71 or in a rural area 7as defined by the ,federal ,office of ,rural ,health ,policy71 and that provides a reduction in coinsurance or copayments described in clause 7i7 for covered part ,d drugs dispensed through such pharmacies1 such plan shall extend to any pharmacy located in such area or among such population the option to be an in-network pharmacy with respect to such plan under terms and conditions 7including the reductions described in clause 7i77 comparable to those the plan has agreed upon with other in-network pharmacies located in such area or among such population4 4 #c4 ,reasonable reimbursement requirements ,section #ahfj;,d-#b7;d77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;d77#a77;,b77 is amended-- 7#a7 by striking ,prices4--,for purposes and inserting 8,prices4-- 7i7 ,in general ,for purposes 2 and 7#b7 by adding at the end the following new clauses3 7ii7 ,reasonable reimbursement ,for plan years beginning on or after ,january #a1 #bjbj1 a ,,pdp sponsor and a ,medicare ,advantage organization shall ensure that-- 7,i7 each prescription drug plan or ,,ma-,,pd plan offered by the sponsor or organization does not reimburse a pharmacy or pharmacist an amount less than the amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate 7as defined in clause 7iv77 providing the same pharmacist services2 and 7,,ii7 in no case may the negotiated price for a covered part ,d drug furnished by a pharmacy under a prescription drug plan or ,,ma-,,pd plan offered by the sponsor or organization1 be less than such pharmacy's cost of purchasing and dispensing such drug and providing such other services associated with furnishing such drug as may be specified by the ,secretary4 7iii7 ,claim reimbursement disclosure requirements ,with respect to payment made by a ,,pdp sponsor or a ,medicare ,advantage organization to a pharmacy for a covered part ,d drug furnished by such pharmacy during a plan year beginning on or after ,january #a1 #bjbj1 such sponsor or organization shall promptly furnish all pricing components including the ,network ,reimbursement ,,id used to price the claim1 any fees1 pharmacy price concessions1 discounts1 subsidies1 rebates1 incentives1 or any other forms of direct or indirect remuneration that affect payment and pricing of the claim as part of the claim adjudication response at the point-of sale4 ,all pricing components described in the preceding sentence shall each be identified in a predetermined line item in the remittance advice that is standard across the industry4 ,the ,,pdp sponsor or ,medicare ,advantage organization shall include suitable claim-level detail on the electronic remittance advice that accompanies each payment4 ,this claim-level detail shall include1 in an industry standardized format1 all fields needed to properly identify the claim1 including the ,claim ,authorization ,number1 date of service1 date of payment remittance1 ingredient cost reimbursed1 dispensing fee reimbursed1 payment amounts including the ,network ,,id used to price the claim1 the specific dollar amounts and the appropriate qualifier codes for each payment adjustment including fees1 pharmacy price concessions1 or incentives4 7iv7 ,pharmacy benefits manager affiliate defined ,for purposes of clause 7ii71 the term pharmacy benefits manager affiliate means a pharmacy or pharmacist that directly or indirectly1 through one or more intermediaries1 owns or controls1 is owned or controlled by1 or is under common ownership or control with a pharmacy benefits manager4 4