,,ii #aagth ,,congress #ast ,session ,s4 #aiji ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #bg1 #bjba,mr4 ,tester 7for himself1 ,mrs4 ,capito1 ,mr4 ,brown1 and ,mr4 ,lankford7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to reform requirements with respect to direct and indirect remuneration under ,medicare part ,d1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,pharmacy ,,dir ,reform ,to ,reduce ,senior ,drug ,costs ,act4 #b4 ,requiring pharmacy-negotiated price concessions1 payment1 and fees to be included in negotiated prices at the point-of-sale under part d of the medicare program ,section #ahfj;,d-#b7;d77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;d77#a77;,b77 is amended-- 7#a7 by striking prices4--,for purposes and inserting 8prices4-- 7i7 ,in general ,for purposes 2 and 7#b7 by adding at the end the following new clause3 7ii7 ,prices negotiated with pharmacy at point-of-sale ,for plan years beginning on or after ,january #a1 #bjbb1 a negotiated price for a covered part ,d drug described in clause 7i7 shall include price concessions1 payments1 and fees negotiated with such pharmacy as defined by the ,secretary1 but shall not include incentive payments based on pharmacy performance paid or to be paid to such pharmacy4 ,such negotiated price shall be provided at the point-of-sale of such drug4 4 #c4 ,disclosure to pharmacy of post-point-of-sale pharmacy price concessions and incentive payments ,section #ahfj;,d-#b7;d77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;d77#b77 is amended-- 7#a7 by striking disclosure4--,a ,,pdp sponsor and inserting 8disclosure4-- 7,a7 ,to the ,secretary ,a ,,pdp sponsor 2 and 7#b7 by adding at the end the following new subparagraph3 7,b7 ,to pharmacies 7i7 ,in general ,for plan year #bjbb and subsequent plan years1 a ,,pdp sponsor offering a prescription drug plan and an ,,ma organization offering an ,,ma-,,pd plan shall report any pharmacy price concession or incentive payment that occurs with respect to a pharmacy after payment for covered part ,d drugs at the point-of-sale1 including by an intermediary organization with which a ,,pdp sponsor or ,,ma organization has contracted1 to the pharmacy4 7ii7 ,timing ,the reporting of price concessions and incentive payments to a pharmacy under clause 7i7 shall be made on a periodic basis 7but in no case less frequently than annually74 7iii7 ,claim level ,the reporting of price concessions and incentive payments to a pharmacy under clause 7i7 shall be at the claim level or approximated at the claim level if the price concession or incentive payment was applied at a level other than at the claim level4 4 #d4 ,establishment of pharmacy performance measures under medicare part ,d ,section #ahfj;,d-#d7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77 is amended-- 7#a7 by redesignating paragraph 7#f71 as added by section #ejced of division ,e of the ,bipartisan ,budget ,act of #bjah 7,public ,law #aae-abc71 as paragraph 7#g72 and 7#b7 by adding at the end the following new paragraph3 7#h7 ,application of standardized pharmacy performance measures 7,a7 ,in general ,a ,,pdp sponsor and ,,ma-,,pd plan that makes incentive payments to a pharmacy or receives price concessions paid by a pharmacy based on performance measures shall1 for the purposes of such incentive payments and price concessions with respect to covered part ,d drugs dispensed by such pharmacy1 only use measures-- 7i7 established or adopted by the ,secretary under subparagraph 7,b71 as listed under clause 7ii7 of such subparagraph2 and 7ii7 that are relevant to the performance of such pharmacy with respect to areas that the pharmacy can impact based on covered part ,d drugs dispensed and managed4 7,b7 ,standardized pharmacy performance measures 7i7 ,in general ,notwithstanding any other provision of law1 the ,secretary shall establish or adopt standardized pharmacy performance measures from one or more multi-stakeholder1 consensus organizations representing all pharmacy types 7including specialty pharmacies7 to be used by a ,,pdp sponsor and ,,ma-,,pd plan for the purposes of determining incentive payments and price concessions described in subparagraph 7,a74 ,such measures shall be evidence-based and focus on pharmacy performance on patient health outcomes and other areas1 as determined by the ,secretary1 that the pharmacy can impact based on covered part ,d drugs dispensed and managed4 7ii7 ,maintenance of list ,the ,secretary shall maintain a single list of measures established or adopted under this subparagraph and measures shall be evaluated and updated on an ongoing basis through stakeholder consensus organizations to ensure they are transparent1 achievable1 and clinically meaningful4 7iii7 ,application to star ratings ,the ,secretary shall require the development of measures to apply in the star rating system under this part to assess the use of a standard set of pharmacy performance measures by ,,pdp sponsors and ,,ma-,,pd plans4 7,c7 ,specialty pharmacy ,for purposes of subparagraph 7,b77i71 the ,secretary shall1 not later than ,december #ca1 #bjbb1 define the term specialty pharmacy in consultation with relevant stakeholders4 7,d7 ,effective date ,the requirement under subparagraph 7,a7 shall take effect for plan years beginning on ,january #a1 #bjbb1 or such earlier date specified by the ,secretary if the ,secretary determines there are sufficient measures established or adopted under subparagraph 7,b7 for the purposes of the requirement under subparagraph 7,a74 4