,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #bbdg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,july #bd1 #bjai ,mr4  
,k5n$y 7= himself1 ,mr4 ,te/]1 ,mrs4    
,capito1 ,mr4 ,br[n1 ,mr4 ,cassidy1 ,mr4
 ,lank=d1 ,mr4 ,da9es1 ,mr4 ,cram]1     
,mrs4 ,hyde-,smi?1 ,mr4 ,man*91 & ,mr4  
,wick]7 introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d titles ,,xi
 & ,,xviii ( ! ,social ,security ,act to
 provide great] transp>5cy ( disc\nts   
provid$ by drug manufactur]s1 to e/abli%
 requirem5ts relat+ to ph>macy-negotiat$
 price concessions1 & = o!r purposes4   
#a4 ,%ort title  ,?is ,act may be cit$ z
 ! ,phair ,relief ,act ( #bjai4  #b4    
,public disclosure ( drug disc\nts  7a7 
,9 g5]al ,section #aaej;,a ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acbj;b-#bc7 is am5d$-- 7#a7 9          
subsection 7c71 9 ! matt] prec$+        
p>agraph 7#a71 by /rik+ ?is section &   
ins]t+ subsection 7b77#a72 &  7#b7 by   
add+ at ! end ! foll[+ new subsection3  

7e7 ,public availability ( c]ta9        
in=mation ,9 ord] to all[ pati5ts &     
employ]s to comp>e ,p,b,ms' ability to  
negotiate rebates1 disc\nts1 & price    
concessions & ! am\nt ( su* rebates1    
disc\nts1 & price concessions t are     
pass$ ?r\gh to plan sponsors1 beg9n+    
,janu>y #a1 #bjbj1 ! ,secret>y %all make
 available on ! ,int]net website ( !    
,dep>tm5t ( ,heal? & ,human ,s]vices !  
in=mation provid$ to ! ,secret>y "u     
p>agraphs 7#b7 & 7#c7 ( subsection 7b7 )
 respect to ea* ,,pbm4 ,! ,secret>y %all
 ensure t su* in=mation is display$ 9 a 
mann] t prev5ts ! disclosure ( in=mation
 on rebates1 disc\nts1 & price          
concessions ) respect to an individual  
drug or an individual plan4  4  7b7     
,effective date ,! am5dm5ts made by     
subsection 7a7 %all take effect on      
,janu>y #a1 #bjbj4  #c4 ,m9imum drug    
disc\nts requir$ to be pass$ ?r\gh to ! 
plan sponsor  7a7 ,9 g5]al ,section     
#aaej;,a ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #acbj;b-#bc71 z am5d$ by     

section #b7;a77#b71 is am5d$--  7#a7 9 !
 head+1 by ins]t+ 2 m9imum drug disc\nts
 requir$ to be pass$ ?r\gh to ! plan    
sponsor be=e ! p]iod at ! end2 &  7#b7  
by add+ at ! end ! foll[+ new           
subsection3  7f7 ,m9imum drug disc\nts  
requir$ ,to be pass$ ?r\gh to ! plan    
sponsor  7#a7 ,requirem5t ,beg9n+       
,janu>y #a1 #bjbb1 a ,,pbm t manages    
prescription drug cov]age "u a contract 
) a ,,pdp sponsor or ,,ma organization  
describ$ 9 subsection 7b77#a7 or a      
qualifi$ heal? b5efits plan describ$ 9  
subsection 7b77#b71 %all1 ) respect to !
 plan sponsor ( a heal? b5efits plan1   
pass ?r\gh to ! plan sponsor a m9imum   
p]c5t 7z e/abli%$ by ! ,secret>y7 ( !   
aggregate am\nt ( ! rebates1 disc\nts1  
or price concessions t ! ,,pbm          
negotiates t are attributable to pati5t 
utilization "u ! plan4  7#b7 ,e/abli%m5t
 ,! ,secret>y %all e/abli% ! m9imum     
p]c5t describ$ 9 p>agraph 7#a7 9 su* a  
mann] z w ensure t pati5ts receive !    
maximum b5efit ( rebates1 disc\nts1 or  

price concessions :ile tak+ into acc\nt 
! co/s ( negotiat+ su* rebates1         
disc\nts1 & price concessions4  7#c7    
,en=cem5t ,a ,,pdp sponsor ( a          
prescription drug plan or an ,,ma       
organization (f]+ an ,,ma-,,pd plan "u  
"p ,d ( title ,,xviii may n contract ) a
 ,,pbm t is n 9 compliance ) !          
requirem5t "u p>agraph 7#a74  4  7b7    
,effective date ,! am5dm5ts made by     
subsection 7a7 %all take effect on      
,janu>y #a1 #bjbb4  #d4 ,requirem5ts    
relat+ to ph>macy-negotiat$ price       
concessions & ph>macy inc5tive paym5ts  
,section #ahfj;,d-#b7;d77#a77;,b7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ajb7;d77#a77;,b77 is am5d$--    
7#a7 by /rik+ prices4--,= purposes &    
ins]t+ 8prices4--  7i7 ,9 g5]al ,=      
purposes  2 &  7#b7 by add+ at ! end !  
foll[+ new clauses3  7ii7 ,prices       
negotiat$ ) ph>macy at po9t-(-sale  7,i7
 ,tempor>y freeze on dir paym5ts        
,subject to subclause 7,,iv71 = plan    
ye>s beg9n+ on or aft] ,janu>y #a1      

#bjba1 & be=e ,janu>y #a1 #bjbf1        
negotiat$ prices = cov]$ "p ,d drugs    
describ$ 9 clause 7i7 provid$ "u all    
phases ( cov]age "u a prescription drug 
plan1 includ+ all cont+5t & noncont+5t  
concessions1 paym5ts1 & fees negotiat$ )
 ! ph>macy disp5s+ su* drug1 %all be    
provid$ at ! po9t-(-sale ( su* drug4 ,= 
purposes ( ! prec$+ s5t5ce1 su*         
negotiat$ price %all n include any      
inc5tive paym5ts paid to ph>macies4     
7,,ii7 ,application ( price concessions 
,= plan ye>s beg9n+ on or aft] ,janu>y  
#a1 #bjbf1 ! ,secret>y %all promulgate  
regulations prohibit+ ! application (   
any ph>macy price concessions t are n   
bas$ on quality measures e/abli%$ or    
approv$ by ! ,secret>y "u subclause     
7,,iii74  7,,iii7 ,/&>d ph>macy quality 
measures ,subject to subclause 7,i71 n  
lat] ?an ,janu>y #a1 #bjba1 ! ,secret>y 
%all e/abli% or approve /&>d quality    
measures = use 9 ! application ( ph>macy
 price concessions & inc5tive paym5ts ) 
respect to paym5t = cov]$ "p ,d drugs   

disp5s$ by a ph>macy4 ,su* measures %all
 be--  7aa7 focus$ on improv+ pati5t    
heal? outcomes2  7bb7 /&>diz$ across    
,,pdp sponsors2  7cc7 ph>macy-specific 9
 application2  7dd7 relevant to ! type (
 ph>macy conc]n$ 7su* z specialty       
ph>macies71 tak+ into acc\nt ! items &  
s]vices furni%$ by ! ph>macy & ! pati5t 
population s]v$ by ! ph>macy2  7ee7     
appli$ only :5 relevant to ! specific   
drug 7or drug class ( su* drug7 be+     
furni%$ by ! ph>macy or :5 relevant to  
managem5t ( ! condition = :i* su* drug  
has be5 prescrib$2 &  7ff7 bas$ on      
a*ievable & prov5 crit]ia measur+       
ph>macy p]=mance ov] :i* ! ph>macy has  
mean+ful control & ability to influ5ce4 
,9 e/abli%+ su* /&>ds1 ! ,secret>y %all 
consult ) /akehold]s1 includ+ ,,pdp     
sponsors & ,,ma organizations1 ph>macies
 across ph>macy practice types1 ph>macy 
b5efit manag]s1 pati5t advocacy         
organizations1 drug manufactur]s1       
appropriate /&>d-sett+ organizations1   
pr(essional ph>macy organizations1 & o!r

 entities det]m9$ appropriate by !      
,secret>y4 ,! ,secret>y %all review &   
update ! /&>d ph>macy quality measures  
on an ongo+ basis ) appropriate notice &
 p]iod = comm5ts f /akehold]s4  7,,iv7  
,no increase 9 co/ %>+ dur+ tempor>y    
freeze ,subclause 7,i7 %all n apply 9 ! 
case :]e application ( su* subclause    
w\ld increase ! am\nt ow$ by an         
individual 9 co/ %>+ above ! am\nt su*  
individual w\ld h ow$ 9 co/ %>+ )\t     
application ( su* subclause4  7,v7      
,discrepancies betwe5 negotiat$ prices &
 actual reimbursem5t ,9 ! case t !      
,secret>y det]m9es t ! negotiat$ price (
 a ,,pdp sponsor appli$ at ! po9t-(-sale
 ) respect to a cov]$ "p ,d drug = a ye>
 disp5s$ by a ph>macy 0 great] ?an !    
total reimbursem5t made to su* ph>macy =
 su* drug = su* ye>1 su* sponsor %all1 n
 lat] ?an #ij days aft] receiv+ notice (
 su* det]m9ation1 furni% to ! ph>macy t 
disp5s$ su* drug & to ! ,secret>y a     
writt5 explanation ( :y su* negotiat$   
price 0 great] ?an su* reimbursem5t4    

7,,vi7 ,specialty ph>macy ,= purposes ( 
c>ry+ out ?is clause 7includ+ subclause 
7,,iii77dd771 ! ,secret>y %all1 n lat]  
?an ,decemb] #ca1 #bjbj1 def9e ! t]m    
specialty ph>macy 9 consultation )      
relevant /akehold]s4  7,,vii7           
,def9itions ,9 ?is clause3 7aa7 ,quality
 measure ,! t]m quality measure means   
crit]ia us$ by a ,,pdp sponsor 7includ+ 
an entity t contracts ) su* sponsor1 su*
 z a ph>macy b5efit manag]7 to det]m9e !
 am\nt or applicability ( inc5tive      
paym5ts & ph>macy price concessions4    
7bb7 ,,pdp sponsor ,! t]m ,,pdp sponsor 
includes an ,,ma organization (f]+ an   
,,ma-,,pd plan "u "p ,c & an entity t   
contracts ) su* sponsor or organization1
 su* z a ph>macy b5efit manag]4  7iii7  
,audits ( ,,pdp sponsors & negotiat$    
price  7,i7 ,9 g5]al ,beg9n+ ,janu>y #a1
 #bjba1 ! ,secret>y %all conduct annual 
audits ( ,,pdp sponsors by review+ a    
repres5tative sample ( claims betwe5    
,,pdp sponsors or o!r int]m$i>y         
contract+ organizations & all ph>macy   

types & ^? ph>macies' l[e/ actual       
acquisition & disp5s+ co/s to assess    
:e!r reimbursem5t = individual network  
ph>macies is bel[ ! ph>macy's l[e/      
actual co/ ( acquir+ & disp5s+ cov]$ "p 
,d drugs & provid+ ph>macy s]vices      
necess>y = disp5s+ su* drugs4 ,9        
conduct+ su* audits1 ! ,secret>y %all   
focus on det]m9+ :e!r or n ! requirem5ts
 "u clause 7ii7 are negatively impact+  
network ph>macy p>ticipation 9 ! program
 "u ?is "p & b5efici>y access to ph>macy
 provid]s4 ,su* audits %all occur n less
 ?an annually & :5 reque/$ by ! ,m$ic>e 
,ph>maceutical & ,te*nology ,ombudsman4 
7,,ii7 ,appeal ,if a network ph>macy    
believes t a ,,pdp sponsor has reimburs$
 = a cov]$ "p ,d drug bel[ ! ph>macy's  
l[e/ actual acquisition & disp5s+ co/s1 
! ph>macy may appeal ! reimbursem5t1 9  
writ+1 to ! ,m$ic>e ,ph>maceutical &    
,te*nology ,ombudsman )9 #fj days foll[+
 notification ( ! reimbursem5t & provide
 necess>y docum5tation to support its   
claim4  7,,iii7 ,annual report to       

congress ,n lat] ?an ,janu>y #a1 #bjbb1 
& annually !reaft]1 ! ,secret>y %all    
submit to ,congress a report t conta9s a
 summ>y ( ! audits conduct$ "u subclause
 7,i7 & activity "u subclause 7,,ii71   
toge!r ) recomm5dations = su*           
legislation & adm9i/rative action z !   
,secret>y det]m9es appropriate4  7iv7   
,claim reimbursem5t disclosure          
requirem5ts ,) respect to paym5t made by
 a ,,pdp sponsor to a ph>macy = a cov]$ 
"p ,d drug furni%$ by su* ph>macy dur+ a
 plan ye> beg9n+ on or aft] ,janu>y #a1 
#bjbj1 su* sponsor %all promptly furni% 
all pric+ compon5ts includ+ ! ,network  
,reimbursem5t ,,id us$ to price ! claim1
 any fees1 ph>macy price concessions1   
disc\nts1 inc5tives or any o!r =ms (    
remun]ation to or f ! ph>macy t affect  
paym5t & pric+ ( ! claim z "p ( ! claim 
adjudication response at ! po9t-(-sale4 
,ea* ( ! a=em5tion$ data elem5ts %all   
ea* be id5tifi$ 9 a pr$et]m9$ l9e item 9
 ! remittance advice t is /&>d across ! 
indu/ry1 :i* %all include suitable      

claim-level detail ne$$ to prop]ly      
id5tify ! claim1 includ+ ! ,claim       
,au?orization ,numb]1 date ( s]vice1    
date ( paym5t remittance1 +r$i5t co/    
reimburs$1 disp5s+ fee reimburs$1 paym5t
 am\nts includ+ ! specific doll> am\nts 
& ! appropriate qualifi] codes = ea*    
paym5t adju/m5t includ+ fees1 ph>macy   
price concessions1 or inc5tives4  7v7   
,violation process ,a ,,pdp sponsor %all
 p>ticipate 9 any process e/abli%$ by ! 
,secret>y = purposes ( det]m9+ :e!r su* 
sponsor has violat$ a provision ( clause
 7ii7 or 7iii74  4  #e4 ,ph>macy b5efit 
manag] provision ( in=mation  7a7 ,9    
g5]al ,section #aaej;,a7b77#b7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acbj;b-#bc7;b77#b77 is am5d$ by /rik+  
exclud+ & ins]t+ includ+4  7b7          
,effective date ,! am5dm5t made by      
subsection 7a7 %all apply ) respect to  
contract ye>s beg9n+ on or aft] ,janu>y 
#a1 #bjbj4