,i  #aaf? ,,congress  #b;d ,session  ,h4
 ,r4 #egdi  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,febru>y #d1 #bjbj,mr4
 ,cri/ 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 ,,xi 
( ! ,social ,security ,act to e/abli% ! 
,am]ican ,insul9 ,program to provide =  
l[] prices = insul9 drugs1 to ma9ta9    
ef=t ?r\gh\t ! insul9 supply *a91 & =   
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,af=dable ,insul9 =    
,all ,act4  #b4 ,provid+ = l[] prices = 
insul9 drugs ,"p ,a ( title ,,xi ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acja7 is am5d$ by add+ at ! end !      
foll[+ new section3  #aaej;,c4          
,e/abli%m5t ( program  7a7 ,9 g5]al ,!  
,secret>y %all e/abli% an ,am]ican      
,insul9 ,program 79 ?is section ref]r$  

to z ! program7 by n lat] ?an #cj days  
aft] ! date ( ! enactm5t ( ?is section4 
,"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 #bj    
days aft] ! date ( ! enactm5t ( ?is     
section1 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 individuals access to
 ,m$icaid prices = insul9 drugs ( !     
manufactur]4  7,b7 ,provision ( disc\nt$
 prices z ! po9t-(-sale  7i7 ,9 g5]al   
,subject to clause 7ii71 su* ,m$icaid   
prices %all be provid$ to ! applicable  
b5efici>y at ! ph>macy or by ! mail ord]
 s]vice at ! po9t-(-sale ( an insul9    
drug4  7ii7 ,c]tification ( unsu/a9able 
rev5ues  7,i7 ,9 g5]al ,9 ! case !      
,secret>y submits to ,congress a        

c]tification t net rev5ues f ! sale (   
insul9 drugs by manufactur]s ) an       
agreem5t "u ?is section is unsu/a9able  
because su* manufactures w be unable to 
meet ! dem& = insul9 drugs 9 ! ,unit$   
,/ates1 subject to subclause 7,,ii71 !  
,secret>y may increase ! ,m$icaid price 
by #e p]c5t4  7,,ii7 ,limitation ,!     
,secret>y may n increase ! ,m$icaid     
price 9 accordance ) subclause 7,i7 m   
?an #c times4  7,,iii7 ,applicability ( 
price increase ,an increase to !        
,m$icaid price ( insul9 drugs describ$ 9
 subclause 7,i7 %all apply to ! sale (  
insul9 drugs #ij days aft] ! date ( a   
c]tification describ$ 9 su* subclause4  
7,c7 ,tim+ ( agreem5t  7i7 ,special rule
 = #bjba ,9 ord] = an agreem5t ) a      
manufactur] to be 9 effect "u ?is       
section ) respect to ! p]iod beg9n+ on  
,janu>y #a1 #bjba1 & end+ on ,decemb]   
#ca1 #bjba1 ! manufactur] %all ent] into
 su* agreem5t n lat] ?an #cj days aft] !
 date ( ! e/abli%m5t ( a model agreem5t 
"u subsection 7a74  7ii7 #bjbb &        

subsequ5t ye>s ,9 ord] = an agreem5t ) a
 manufactur] to be 9 effect "u ?is      
section ) respect to plan ye> #bjbb 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     
clause 7i7 ( subsection 7c77#a77;,a7 or 
proc$ures e/abli%$ "u su* subsection    
7c77#a77;,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 #ah 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$+ plan ye>4    
7iii7 ,effectiv5ess ( t]m9ation ,any    
t]m9ation "u ?is subp>agraph %all n     
affect disc\nts = insul9 drugs ( !      
manufactur] t are due "u ! agreem5t be=e
 ! effective date ( its t]m9ation4  7iv7
 ,notice to ?ird p>ty ,! ,secret>y %all 
provide notice ( su* t]m9ation to a ?ird
 p>ty ) a contract "u subsection 7d77#c7
 )9 n less ?an #cj days be=e ! effective
 date ( su* t]m9ation4  7c7 ,duties     
describ$ ,! duties describ$ 9 ?is       
subsection are ! foll[+3 7#a7           
,adm9i/ration ( program ,adm9i/]+ !     
program1 includ+--  7,a7 ! det]m9ation (
 ! am\nt ( ! ,m$icaid price ( an insul9 
drug ( a manufactur] = applicable       
individuals 9 ea* ,/ate2  7,b7 except z 
provid$ 9 subp>agraph 7,c71 ! e/abli%m5t
 ( proc$ures "u :i* ,m$icaid prices are 
provid$ to applicable individuals at    
ph>macies or by mail ord] s]vice at !   
po9t-(-sale ( an insul9 drug2  7,c7 9 ! 

case :]e1 dur+ ! p]iod beg9n+ on ,janu>y
 #a1 #bjbb1 & end+ on ,decemb] #ca1     
#bjbb1 x is n practicable to provide su*
 ,m$icaid prices at ! po9t-(-sale 7z    
describ$ 9 subp>agraph 7,b771 !         
e/abli%m5t ( proc$ures to provide su*   
,m$icaid prices z soon z practicable    
aft] ! po9t-(-sale2  7,d7 ! e/abli%m5t (
 proc$ures to ensure t1 n lat] ?an !    
applicable numb] ( cal5d> days aft] !   
disp5s+ ( an insul9 drug by a ph>macy or
 mail ord] s]vice1 ! ph>macy or mail    
ord] s]vice is reimburs$ = an am\nt     
equal to ! diff]5ce betwe5--  7i7 !     
negotiat$ price ( ! insul9 drug2 &  7ii7
 ! ,m$icaid price ( ! insul9 drug2 &    
7,e7 provid+ a reasonable dispute       
resolution me*anism to resolve          
disagreem5ts betwe5 manufactur]s1       
applicable individuals1 & ! ?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 ,/ate ,m$icaid programs ,! ,secret>y 
may collect appropriate data f ea* ,/ate
 ,m$icaid program "u title ,,xix 9 a    
timeframe t all[s = ,m$icaid prices to  
be provid$ = 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  7,a7 ,9 g5]al ,subject to  
subp>agraph 7,b71 9 provid+ = su*       
implem5tation1 ! ,secret>y %all n       
receive or di/ribute any funds ( a      
manufactur] "u ! program4  7,b7         
,exception ,! limitation "u subp>agraph 
7,a7 %all n apply to ! ,secret>y )      
respect to insul9 drugs disp5s$ dur+ !  
p]iod beg9n+ on ,janu>y #a1 #bjbb1 &    

end+ on ,decemb] #ca1 #bjbb1 b only if !
 ,secret>y det]m9es t ! exception to su*
 limitation "u ?is subp>agraph is       
necess>y 9 ord] = ! ,secret>y to beg9   
implem5tation ( ?is section & provide   
applicable b5efici>ies timely access to 
,m$icaid prices dur+ su* p]iod4  7#c7   
,contract ) ?ird p>ties ,! ,secret>y    
%all ent] into a contract ) #a or m ?ird
 p>ties to adm9i/] ! requirem5ts        
e/abli%$ 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 =
 insul9 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      
monet>y p5alty  7,a7 ,9 g5]al ,!        
,secret>y %all impose a civil money     

p5alty on a manufactur] t fails to      
provide individuals ,m$icaid prices =   
insul9 drugs ( ! manufactur] 9          
accordance ) su* agreem5t = ea* su*     
failure 9 an am\nt ! ,secret>y det]m9es 
is comm5surate ) ! sum (--  7i7 ! am\nt 
t ! manufactur] w\ld h paid ) respect to
 su* disc\nts "u ! agreem5t1 :i* w !n be
 us$ 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$+ "u section            
#aabh;,a7a74  7f7 ,def9itions ,9 ?is    
section3 7#a7 ,applicable individual ,! 
t]m applicable individual means an      
individual :o has receiv$ a diagnosis ( 
diabetes4  7#b7 ,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#c7       
,insul9 drug ,! t]m insul9 drug means a 
m$ication approv$ by ! ,food & ,drug    
,adm9i/ration to treat high blood       
glucose4  7#d7 ,manufactur] ,! t]m      
manufactur] means1 ) respect to insul9  
drugs1 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 ( insul9 drugs or
 a retail ph>macy lic5s$ "u ,/ate law4  
7#e7 ,m$icaid price  7,a7 ,9 g5]al ,!   
t]m ,m$icaid price means1 ) respect to  
an individual entitl$ to m$ical         
assi/ance "u title ,,xix1 ! net receipt 
specifi$ 9 subp>agraph 7,b7 = ! dosage  
=m & /r5g? ( an insul9 drug & any       
increase due to a c]tification describ$ 

9 subsection 7b77#a77;,b77ii77,i74  7,b7
 ,net receipt specifi$ ,= purposes (    
subp>agraph 7,a71 ! net receipt specifi$
 9 ?is subp>agraph %all be equal to !   
product (--  7i7 ! total numb] ( units (
 ea* dosage =m & /r5g? pur*as$ "u !     
program 9 ! rebate p]iod 7z det]m9$ by !
 ,secret>y71 &  7ii7 ! am\nt t is ! li/ 
price ( su* drug dur+ su* rebate p]iod1 
less1 ! total am\nt ( rebates t !       
manufactur] paid ) respect to su* drug  
dur+ su* rebate p]iod4  7#f7 ,negotiat$ 
price ,! t]m negotiat$ price has ! mean+
 giv5 su* t]m 9 section #dbc4ajj ( title
 #db1 ,code ( ,f$]al ,regulations 7z 9  
effect on ! date ( enactm5t ( ?is       
section71 except t su* negotiat$ price  
%all n include any disp5s+ fee = !      
applicable drug4  4  #c4 ,ma9t5ance (   
ef=t ?r\gh\t ! insul9 supply *a9  7a7   
,elim9ation ( ,,pbm rebates ,section    
#aabh;,b7b77#c7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acbj;a-#g;b7b77#c77
 is am5d$-- 7#a7 9 subp>agraph 7,e71 by 
ins]t+ 7except = a paym5t practice t    

p]mits rebates1 disc\nts1 or price      
concessions = insul9 drugs 7z def9$ 9   
section #aaej;,c7f77#c77 to be paid by a
 manufactur] to a ,,pbm 7z def9$ 9      
section #aaej;,a7a77 be=e ! semicolon at
 ! end2 &  7#b7 9 subp>agraph 7,j7--    
7,a7 by mov+ ! m>g9 two ems to ! left2 &
  7,b7 by ins]t+ 7except = an insul9    
drug7 aft] section #ahfj;,d-#ad;,a7g74  
7b7 ,exclusion ( insul9 paym5ts f ,,mlr 
,n lat] ?an #ij days aft] ! date ( !    
enactm5t ( ?is ,act1 ! ,secret>y (      
,heal? & ,human ,s]vices %all exclude1  
beg9n+ ) plan ye>s beg9n+ on or aft]    
,janu>y #a1 #bjba1 f ! d5om9ator 7z     
def9$ 9 section #aeh4bba7;c7 ( title    
#de1 ,code ( ,f$]al ,regulations7       
section ( a m$ical loss ratio 7z        
calculat$ "u section #aeh4bba7;a7 ( su* 
title7 ( a heal? insurance issu] 7z     
def9$ 9 section #add4ajc ( su* title7 ! 
am\nt ( paym5ts t su* issu] paid dur+ a 
,,mlr report+ ye> 7z def9$ 9 section    
#add4ajc ( su* title7 = insul9 drugs    
?r\gh ! promulgation ( a regulation4    

7c7 ,maximum co/ %>+ & co9surance =     
insul9 drugs 9 c]ta9 private plans &    
,m$ic>e  7#a7 ,,phsa am5dm5t ,subp>t    
,,ii ( "p ,a ( title ,,xxvii ( ! ,public
 ,heal? ,s]vice ,act 7#db ,u4,s4,c4     
#cjj;gg-#aa et seq47 is am5d$ by ins]t+ 
aft] section #bgac ! foll[+ new section3
  #bgac;,a4 ,cov]age ( insul9 drugs  7a7
 ,9 g5]al ,beg9n+ ) plan ye>s beg9n+ #ij
 days aft] ! date ( ! enactm5t ( ?is    
section1 a gr\p heal? plan & a heal?    
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age %all1 at a      
m9imum provide cov]age & may impose co/ 
%>+ = an insul9 drug 9 accordance )     
subsection 7b7 = an individual t is     
provid$ a prescription = su* drug4  7b7 
,co/ %>+ ,beg9n+ ) plan ye>s beg9n+ #ij 
days aft] ! date ( ! enactm5t ( ?is     
section1 ! co/ %>+ incurr$ "u a plan or 
cov]age describ$ 9 subsection 7a7 = an  
insul9 drug may n exce$ #aj = ea*       
#a-mon? p]iod ( cov]age4  7c7 ,insul9   
drug def9$ ,9 ?is section1 ! t]m insul9 
drug has ! mean+ giv5 su* t]m 9 section 

#aaej;,c7f77#c7 ( ! ,social ,security   
,act4  4  7#b7 ,m$ic>e am5dm5ts  7,a7   
,co9surance limitation ,section         
#ahfj;,d-#b7;b77#b7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajb7;b77#b77 is am5d$--  7i7 9  
subp>agraph 7,a71 by /rik+ ,subject to  
subp>agraphs 7,c7 & 7,d7 & ins]t+       
,subject to subp>agraphs 7,c71 7,d71 &  
7,e72 &  7ii7 by add+ at ! end1 ! foll[+
 new subp>agraph3  7,e7 ,cov]age =      
insul9 drugs ,beg9n+ ) plan ye>s beg9n+ 
#ij days aft] ! date ( ! enactm5t ( ?is 
subp>agraph1 ! cov]age has co9surance 7=
 co/s above ! annual d$uctible specifi$ 
9 p>agraph 7#a7 & up to ! initial       
cov]age limit "u p>agraph 7#c77 = an    
insul9 drug 7z def9$ 9 section          
#ahfa7kkk77 is n m ?an #aj = ea* #a-mon?
 p]iod ( cov]age4  4  7,b7 ,insul9 drug 
def9$ ,section #ahfa ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #aciex7 is
 am5d$ by add+ at ! end ! foll[+ new    
subsection3  7kkk7 ,insul9 drug ,! t]m  
insul9 drug has ! mean+ giv5 su* t]m 9  

section #aaej;,c7f77#c7 furni%$ on or   
aft] #ij days aft] ! date ( ! enactm5t (
 ?is subsection4  4  7d7 ,freez+ (      
supplem5tal rebates 9 ,m$icaid ,section 
#aijb7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acif;a7a77 is am5d$--   
7#a7 9 p>agraph 7#he71 by /rik+ at ! end
 &2  7#b7 9 p>agraph 7#hf71 by /rik+ !  
p]iod at ! end & ins]t+ 2 &2 &  7#c7 by 
ins]t+ aft] p>agraph 7#hf71 ! foll[+ new
 p>agraph3  7#hg7 provide t ! ,/ate may 
n-- 7,a7 secure f ! manufactur] ( a drug
 payable "u ?is title a supplem5tal     
rebate t is n a rebate "u section #aibg 
t exce$s ! am\nt ( ! supplem5tal rebate 
on ! date ( ! enactm5t ( ?is p>agraph2  
or  7,b7 secure any o!r supplem5tal     
rebates4  4  7e7 ,elim9ation ( spread   
pric+ & relat$ practices 9 ,m$icaid     
7#a7 ,9 g5]al ,section #aibg7;e7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acifr-#h7;e77 is am5d$ by add+ at ! end
 ! foll[+3  7#f7 ,pass-?r\gh pric+      
requir$ ,a contract betwe5 ! ,/ate & a  
ph>macy b5efit manag] 7ref]r$ to 9 ?is  

p>agraph z a ,,pbm71 or a contract      
betwe5 ! ,/ate & a manag$ c>e entity or 
o!r specifi$ entity 7z su* t]ms are     
def9$ 9 section #aijc7m77#i77;,d77 t    
includes provisions mak+ ! entity       
responsible = cov]age ( cov]$ outpati5t 
drugs disp5s$ to individuals enroll$ ) !
 entity1 %all require t paym5t = su*    
drugs & relat$ adm9i/rative s]vices 7z  
applicable71 includ+ paym5ts made by a  
,,pbm on behalf ( ! ,/ate or entity1 is 
bas$ on a pass-?r\gh pric+ model "u     
:i*--  7,a7 any paym5t made by ! entity 
or ! ,,pbm 7z applicable7 = su* a drug--
 7i7 is limit$ to--  7,i7 +r$i5t co/2 & 
7,,ii7 a pr(essional disp5s+ fee t is n 
less ?an ! pr(essional disp5s+ fee t !  
,/ate plan or waiv] w\ld pay if ! plan  
or waiv] 0 mak+ ! paym5t directly2  7ii7
 is pass$ ?r\gh 9 its entirety by !     
entity or ,,pbm to ! ph>macy t disp5ses 
! drug2 &  7iii7 is made 9 a mann] t is 
consi/5t ) section #aijb7;a77#cj77;,a7 &
 sections #ddg4eab1 #ddg4ead1 & #ddg4eah
 ( title #db1 ,code ( ,f$]al            

,regulations 7or any successor          
regulation7 z if su* requirem5ts appli$ 
directly to ! entity or ! ,,pbm2  7,b7  
paym5t to ! entity or ! ,,pbm 7z        
applicable7 = adm9i/rative s]vices p]=m$
 by ! entity or ,,pbm is limit$ to a    
reasonable adm9i/rative fee t cov]s !   
reasonable co/ ( provid+ su* s]vices2   
7,c7 ! entity or ! ,,pbm 7z applicable7 
%all make available to ! ,/ate1 & !     
,secret>y ^u reque/1 all co/s & paym5ts 
relat$ to cov]$ outpati5t drugs &       
accompany+ adm9i/rative s]vices incurr$1
 receiv$1 or made by ! entity or !      
,,pbm1 includ+ +r$i5t co/s1 pr(essional 
disp5s+ fees1 adm9i/rative fees1        
po/-sale & po/-9-voice fees4 ,disc\nts1 
or relat$ adju/m5ts su* z direct &      
indirect remun]ation fees1 & any & all  
remun]ation2 &  7,d7 any =m ( spread    
pric+ :]eby any am\nt *>g$ or claim$ by 
! entity or ! ,,pbm 7z applicable7 t is 
9 excess ( ! am\nt paid to ! ph>macies  
on behalf ( ! entity1 includ+ any       
po/-sale or po/-invoice fees1 disc\nts1 

or relat$ adju/m5ts su* z direct &      
indirect remun]ation fees or assessm5ts 
7aft] all[+ = a reasonable adm9i/rative 
fee z describ$ 9 subp>agraph 7,b771 is n
 all[able = purposes ( claim+ ,f$]al    
mat*+ paym5ts "u ?is title4  4  7#b7    
,con=m+ am5dm5t ,clause 7xiii7 ( section
 #aijc7m77#b77;,a7 ( su* ,act 7#db      
,u4,s4,c4 #acif;b7m77#b77;,a77 is       
am5d$-- 7,a7 by /rik+ & 7,,iii7 & ins]t+
 7,,iii72 &  7,b7 by ins]t+ be=e ! p]iod
 at ! end ! foll[+3 1 & 7,,iv7 ph>macy  
b5efit managem5t s]vices provid$ by !   
entity1 or provid$ by a ph>macy b5efit  
manag] on behalf ( ! entity "u a        
contract or o!r arrangem5t betwe5 !     
entity & ! ph>macy b5efit manag]1 %all  
comply ) ! requirem5ts ( section        
#aibg7;e77#f74  7#c7 ,effective date ,! 
am5dm5ts made by ?is subsection apply to
 contracts betwe5 ,/ates & manag$ c>e   
entities1 o!r specifi$ entities1 or     
ph>macy b5efits manag]s t are ent]$ into
 or r5ew$ on or aft] ! date t is #ij    
days aft] ! date ( enactm5t ( ?is ,act4 

#d4 ,,gao report ,n lat] ?an #ahj days  
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ,congress a report on !  
feasibility & af=dability ( direct      
manufactur+ by ! ,f$]al ,gov]nm5t4