,,ii  #aafth ,,congress  #ast ,session  
,s4 #aihg  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,june #bf1     
#bjai,mr4 ,merkley introduced the       
following bill2 which was read twice and
 referred to the ,committee on ,health1 
,education1 ,labor1 and ,pensions  ,a   
,,bill  ,to require the ,secretary of   
,health and ,human ,services to         
establish reference prices for          
prescription drugs for purposes of      
,federal health programs1 and for other 
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,end ,price ,gouging
 for ,medications ,act4  #b4 ,reference 
prices for prescription drugs  7a7      
,reference prices ,the ,secretary of    
,health and ,human ,services 7referred  
to in this section as the ,secretary71  
in accordance with subsection 7b71 shall
 establish annual reference prices for  
each prescription drug4 ,notwithstanding
 any other provision of law1 with       
respect to enrollees or beneficiaries in
 any of the ,federal health programs    

described in subsection 7c71 the retail 
list price for a drug shall not exceed  
the reference price for such drug4  7b7 
,criteria  7#a7 ,in general ,each year1 
the ,secretary shall establish the      
reference price for each prescription   
drug under subsection 7a7--  7,a7 by    
determining the median retail list price
 for the drug among the reference       
countries in which the drug is          
available1 if drug pricing information  
is available for at least #c of such    
countries2 or  7,b7 in the case of a    
drug for which drug pricing information 
or dosage equivalents are not available 
for at least #c of the reference        
countries1 by determining an appropriate
 price based on the ,secretary's        
determination of--  7i7 the added       
therapeutic effect of the drug2  7ii7   
the value of the drug2  7iii7 patient   
access to the drug2  7iv7 the costs     
associated with researching and         
developing the drug2 and  7v7 other     
factors1 as the ,secretary determines   

appropriate4  7#b7 ,reference countries 
,for purposes of paragraph 7#a71 the    
reference countries are ,japan1         
,germany1 the ,united ,kingdom1 ,france1
 ,italy1 ,canada1 ,australia1 ,spain1   
the ,netherlands1 ,switzerland1 and     
,sweden4  7c7 ,federal health programs  
,the reference prices established under 
subsection 7a7 shall apply with respect 
to covered inpatient and outpatient     
drugs under--  7#a7 the ,medicare       
program under title ,,xviii of the      
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq472  7#b7 a ,state ,medicaid
 plan under title ,,xix of the ,social  
,security ,act 7#db ,u4,s4,c4 #acif et  
seq472  7#c7 the ,state ,children's     
,health ,insurance ,program under title 
,,xxi of the ,social ,security ,act 7#db
 ,u4,s4,c4 #acig;aa et seq472  7#d7 the 
,,tricare program under chapter #ee of  
title #aj1 ,united ,states ,code2  7#e7 
hospital care and medical services      
furnished by the ,department of         
,veterans ,affairs under chapters #ag   

and #ah of title #ch1 ,united ,states   
,code2  7#f7 the ,federal ,employees    
,health ,benefits ,program established  
under chapter #hi of title #e1 ,united  
,states ,code2 and  7#g7 any health     
program1 service1 function1 activity1 or
 facility funded1 in whole or part1     
under the ,indian ,health ,care         
,improvement ,act 7#be ,u4,s4,c4 #afja  
et seq471 including through direct or   
contract care provided under such ,act  
or through a contract or compact under  
the ,indian ,self-,determination and    
,education ,assistance ,act 7#be        
,u4,s4,c4 #ecjd et seq474  7d7          
,applicability to other purchasers of   
drugs ,notwithstanding any other        
provision of law1 a drug manufacturer   
shall offer prescription drugs at the   
reference price to all individuals1     
including individuals who are not       
insured and individuals who are covered 
under a group health plan or group or   
individual health insurance coverage4   
,in the case of individuals covered by a

 group health plan or group or          
individual health insurance coverage1   
such requirement is met if the amount   
covered under such plan or coverage plus
 the cost-sharing amount does not exceed
 the reference price4  7e7 ,enforcement 
7#a7 ,civil penalty ,a drug manufacturer
 who does not comply with the           
requirements of subsection 7a7 shall be 
subject to a civil penalty1 for each    
year in which the violation occurs and  
with respect to each drug for which the 
violation occurs1 in an amount equal to 
#e times the difference between--  7,a7 
the total amount received by the        
manufacturer for sales of the drug under
 the ,federal health programs under     
subsection 7c7 for the year2 less  7,b7 
the total amount the manufacturer would 
have received for sales of the drug     
under such programs for the year if the 
manufacturer had complied with          
subsection 7a74  7#b7 ,amounts collected
 ,each year1 the ,secretary of the      
,treasury shall transfer to the         

,director of the ,national ,institutes  
of ,health an amount equal to the amount
 collected in civil penalties under     
subsection 7e7 for the previous year4   
,the ,director of the ,national         
,institutes of ,health shall use amounts
 so transferred for purposes of         
conducting drug research and            
development4  7f7 ,applicability to     
brand and generic drugs ,the reference  
price established under subsection 7a7  
shall apply to drugs approved under     
subsection 7c7 or 7j7 of section #eje of
 the ,federal ,food1 ,drug1 and         
,cosmetic ,act 7#ba ,u4,s4,c4 #cee7 or  
under subsection 7a7 or 7k7 of section  
#cea of the ,public ,health ,service    
,act 7#db ,u4,s4,c4 #bfb74