,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #bhag  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,novemb] #g1 #bjai,mr4 
,m]kley 7= himself & ,mr4 ,durb97       
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% an  
annual ref]5ce price = insul9 products =
 purposes ( ,f$]al heal? programs1 & =  
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,end ,price ,g\g+ =    
,insul9 ,act4  #b4 ,ref]5ce price =     
insul9 products  7a7 ,ref]5ce price ,!  
,secret>y ( ,heal? & ,human ,s]vices    
7ref]r$ to 9 ?is section z ! ,secret>y71
 9 accordance ) subsection 7b71 %all    
e/abli% an annual ref]5ce price = insul9
 products4 ,not)/&+ any o!r provision ( 
law1 includ+ section #ahfj;,d-#aa7;i7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#aciew-#aaa7;i771 ) respect to enrollees
 or b5efici>ies 9 any ( ! ,f$]al heal?  
programs describ$ 9 subsection 7c71 !   

:olesale acquisition co/ = insul9       
products1 includ+ ! co/-%>+ am\nt1 %all 
n exce$ ! ref]5ce price = ! applicable  
ye>4  7b7 ,crit]ia  7#a7 ,9 g5]al ,n    
lat] ?an #f mon?s aft] ! date ( enactm5t
 ( ?is ,act & e #f mon?s !reaft]1 !     
,secret>y %all e/abli% ! ref]5ce price =
 insul9 products--  7,a7 by det]m9+ !   
m$ian :olesale acquisition co/ or !     
comm5surate li/ price 9 ! ref]5ce       
c\ntries = insul9 products among !      
ref]5ce c\ntries 9 :i* su* products are 
available1 if insul9 product pric+      
in=mation is available = at lea/ ?ree ( 
su* c\ntries2 or  7,b7 9 ! case t insul9
 product pric+ in=mation or dosage      
equival5ts are n available = at lea/    
?ree ( ! ref]5ce c\ntries1 by det]m9+ an
 appropriate price bas$ on--  7i7 !     
cl9ical & !rapeutic effect & value ( !  
product2  7ii7 pati5t access to !       
product2  7iii7 ! co/s associat$ )      
manufactur+1 m>ket+1 rese>*+1 & develop+
 ! product2  7iv7 total rev5ues1 net    
pr(it1 & executive comp5sation associat$

 ) ! manufactur] ( ! product2 &  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 price e/abli%$ "u subsection 7a7
 %all apply ) respect to cov]$ insul9   
products "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 ( insul9 products ,not)/&+ any 
o!r provision ( law1 an insul9 product  
manufactur] %all (f] su* product 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  7e7 ,civil p5alty ,!
 ,secret>y %all en=ce ?is section by    
impos+ a civil p5alty ^u any insul9     
product manufactur] :o does n comply ) !
 requirem5ts ( subsection 7a71 = ea* ye>
 9 :i* ! violation occurs1 9 an am\nt   

equal to #aj times ! diff]5ce betwe5--  
7#a7 ! total am\nt receiv$ by !         
manufactur] = sales ( insul9 products "u
 ! ,f$]al heal? programs "u subsection  
7c7 = ! ye>2 less  7#b7 ! total am\nt ! 
manufactur] w\ld h receiv$ = sales (    
insul9 products "u su* programs = ! ye> 
if ! manufactur] _h compli$ ) subsection
 7a74  7f7 ,use ( am\nts collect$ ,ea*  
ye>1 ! ,secret>y ( ! ,treasury %all     
allocate ! am\nt collect$ "u subsection 
7e7 = ! previ\s ye> z foll[s3  7#a7     
,half ( su* am\nt %all be deposit$ 9 !  
,f$]al ,hospital ,insurance ,tru/ ,fund 
& ! ,f$]al ,supplem5t>y ,m$ical         
,insurance ,tru/ ,fund 7includ+ !       
,m$ic>e ,prescription ,drug ,acc\nt )9  
su* ,tru/ ,fund7 9 su* proportion z !   
,secret>y ( ,heal? & ,human ,s]vices    
det]m9es appropriate4  7#b7 ,half ( su* 
am\nt %all be transf]r$ to ! ,national  
,in/itutes ( ,heal?1 = purposes ( c>ry+ 
out drug rese>* & developm5t4  7g7      
,applicability to br& & g5]ic insul9    
products ,! ref]5ce price e/abli%$ "u   

subsection 7a7 %all apply to insul9     
products 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