,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #aihg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #bf1 #bjai,mr4   
,m]kley introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to require ! ,secret>y (    
,heal? & ,human ,s]vices to e/abli%     
ref]5ce prices = prescription drugs =   
purposes ( ,f$]al heal? programs1 & =   
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,end ,price ,g\g+ =    
,m$ications ,act4  #b4 ,ref]5ce prices =
 prescription drugs  7a7 ,ref]5ce prices
 ,! ,secret>y ( ,heal? & ,human ,s]vices
 7ref]r$ to 9 ?is section z !           
,secret>y71 9 accordance ) subsection   
7b71 %all e/abli% annual ref]5ce prices 
= ea* prescription drug4 ,not)/&+ any   
o!r provision ( law1 ) respect to       
enrollees or b5efici>ies 9 any ( !      
,f$]al heal? programs describ$ 9        
subsection 7c71 ! retail li/ price = a  
drug %all n exce$ ! ref]5ce price = su* 
drug4  7b7 ,crit]ia  7#a7 ,9 g5]al ,ea* 

ye>1 ! ,secret>y %all e/abli% ! ref]5ce 
price = ea* prescription drug "u        
subsection 7a7--  7,a7 by det]m9+ !     
m$ian retail li/ price = ! drug among ! 
ref]5ce c\ntries 9 :i* ! drug is        
available1 if drug pric+ in=mation is   
available = at lea/ #c ( su* c\ntries2  
or  7,b7 9 ! case ( a drug = :i* drug   
pric+ in=mation or dosage equival5ts are
 n available = at lea/ #c ( ! ref]5ce   
c\ntries1 by det]m9+ an appropriate     
price bas$ on ! ,secret>y's det]m9ation 
(--  7i7 ! add$ !rapeutic effect ( !    
drug2  7ii7 ! value ( ! drug2  7iii7    
pati5t access to ! drug2  7iv7 ! co/s   
associat$ ) rese>*+ & develop+ ! drug2 &
  7v7 o!r factors1 z ! ,secret>y        
det]m9es appropriate4  7#b7 ,ref]5ce    
c\ntries ,= purposes ( p>agraph 7#a71 ! 
ref]5ce c\ntries are ,japan1 ,g]many1 ! 
,unit$ ,k+dom1 ,france1 ,italy1 ,canada1
 ,au/ralia1 ,spa91 ! ,ne!rl&s1          
,switz]l&1 & ,sw$54  7c7 ,f$]al heal?   
programs ,! ref]5ce prices e/abli%$ "u  
subsection 7a7 %all apply ) respect to  

cov]$ inpati5t & outpati5t drugs "u--   
7#a7 ! ,m$ic>e program "u title ,,xviii 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acie et seq472  7#b7 a ,/ate 
,m$icaid plan "u title ,,xix ( ! ,social
 ,security ,act 7#db ,u4,s4,c4 #acif et 
seq472  7#c7 ! ,/ate ,*ildr5's ,heal?   
,insurance ,program "u title ,,xxi ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acig;aa et seq472  7#d7 ! ,,tric>e     
program "u *apt] #ee ( title #aj1 ,unit$
 ,/ates ,code2  7#e7 hospital c>e &     
m$ical s]vices furni%$ by ! ,dep>tm5t ( 
,vet]ans ,affairs "u *apt]s #ag & #ah ( 
title #ch1 ,unit$ ,/ates ,code2  7#f7 ! 
,f$]al ,employees ,heal? ,b5efits       
,program e/abli%$ "u *apt] #hi ( title  
#e1 ,unit$ ,/ates ,code2 &  7#g7 any    
heal? program1 s]vice1 function1        
activity1 or facility fund$1 9 :ole or  
"p1 "u ! ,indian ,heal? ,c>e ,improvem5t
 ,act 7#be ,u4,s4,c4 #afja et seq471    
includ+ ?r\gh direct or contract c>e    
provid$ "u su* ,act or ?r\gh a contract 
or compact "u ! ,indian                 

,self-,det]m9ation & ,education         
,assi/ance ,act 7#be ,u4,s4,c4 #ecjd et 
seq474  7d7 ,applicability to o!r       
pur*as]s ( drugs ,not)/&+ any o!r       
provision ( law1 a drug manufactur] %all
 (f] prescription drugs at ! ref]5ce    
price to all individuals1 includ+       
individuals :o are n insur$ &           
individuals :o are cov]$ "u a gr\p heal?
 plan or gr\p or individual heal?       
insurance cov]age4 ,9 ! case (          
individuals cov]$ by a gr\p heal? plan  
or gr\p or individual heal? insurance   
cov]age1 su* requirem5t is met if !     
am\nt cov]$ "u su* plan or cov]age plus 
! co/-%>+ am\nt does n exce$ ! ref]5ce  
price4  7e7 ,en=cem5t  7#a7 ,civil      
p5alty ,a drug manufactur] :o does n    
comply ) ! requirem5ts ( subsection 7a7 
%all be subject to a civil p5alty1 = ea*
 ye> 9 :i* ! violation occurs & )       
respect to ea* drug = :i* ! violation   
occurs1 9 an am\nt equal to #e times !  
diff]5ce betwe5--  7,a7 ! total am\nt   
receiv$ by ! manufactur] = sales ( !    

drug "u ! ,f$]al heal? programs "u      
subsection 7c7 = ! ye>2 less  7,b7 !    
total am\nt ! manufactur] w\ld h receiv$
 = sales ( ! drug "u su* programs = !   
ye> if ! manufactur] _h compli$ )       
subsection 7a74  7#b7 ,am\nts collect$  
,ea* ye>1 ! ,secret>y ( ! ,treasury %all
 transf] to ! ,director ( ! ,national   
,in/itutes ( ,heal? an am\nt equal to ! 
am\nt collect$ 9 civil p5alties "u      
subsection 7e7 = ! previ\s ye>4 ,!      
,director ( ! ,national ,in/itutes (    
,heal? %all use am\nts s transf]r$ =    
purposes ( conduct+ drug rese>* &       
developm5t4  7f7 ,applicability to br& &
 g5]ic drugs ,! ref]5ce price e/abli%$  
"u subsection 7a7 %all apply to drugs   
approv$ "u subsection 7c7 or 7j7 (      
section #eje ( ! ,f$]al ,food1 ,drug1 & 
,cosmetic ,act 7#ba ,u4,s4,c4 #cee7 or  
"u subsection 7a7 or 7k7 ( section #cea 
( ! ,public ,heal? ,s]vice ,act 7#db    
,u4,s4,c4 #bfb74