,,ii  #aag? ,,congress  #a/ ,session    
,s4 #aiji  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #bg1 #bjba,mr4    
,te/] 7= himself1 ,mrs4 ,capito1 ,mr4   
,br[n1 & ,mr4 ,lank=d7 introduc$ !      
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to am5d title ,,xviii ( ! ,social      
,security ,act to re=m requirem5ts )    
respect to direct & indirect remun]ation
 "u ,m$ic>e "p ,d1 & = o!r purposes4    
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,ph>macy ,,dir ,re=m ,to ,r$uce ,s5ior
 ,drug ,co/s ,act4  #b4 ,requir+        
ph>macy-negotiat$ price concessions1    
paym5t1 & fees to be includ$ 9 negotiat$
 prices at ! po9t-(-sale "u "p d ( !    
m$ic>e program ,section                 
#ahfj;,d-#b7;d77#a77;,b7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajb7;d77#a77;,b77 is am5d$--    
7#a7 by /rik+ prices4--,= purposes &    
ins]t+ 8prices4--  7i7 ,9 g5]al ,=      
purposes  2 &  7#b7 by add+ at ! end !  
foll[+ new clause3  7ii7 ,prices        

negotiat$ ) ph>macy at po9t-(-sale ,=   
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjbb1 a negotiat$ price = a cov]$ "p ,d
 drug describ$ 9 clause 7i7 %all include
 price concessions1 paym5ts1 & fees     
negotiat$ ) su* ph>macy z def9$ by !    
,secret>y1 b %all n include inc5tive    
paym5ts bas$ on ph>macy p]=mance paid or
 to be paid to su* ph>macy4 ,su*        
negotiat$ price %all be provid$ at !    
po9t-(-sale ( su* drug4  4  #c4         
,disclosure to ph>macy ( po/-po9t-(-sale
 ph>macy price concessions & inc5tive   
paym5ts ,section #ahfj;,d-#b7;d77#b7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciew-#ajb7;d77#b77 is am5d$-- 7#a7 by 
/rik+ disclosure4--,a ,,pdp sponsor &   
ins]t+ 8disclosure4--  7,a7 ,to !       
,secret>y ,a ,,pdp sponsor  2 &  7#b7 by
 add+ at ! end ! foll[+ new subp>agraph3
  7,b7 ,to ph>macies  7i7 ,9 g5]al ,=   
plan ye> #bjbb & subsequ5t plan ye>s1 a 
,,pdp sponsor (f]+ a prescription drug  
plan & an ,,ma organization (f]+ an     
,,ma-,,pd plan %all report any ph>macy  

price concession or inc5tive paym5t t   
occurs ) respect to a ph>macy aft]      
paym5t = cov]$ "p ,d drugs at !         
po9t-(-sale1 includ+ by an int]m$i>y    
organization ) :i* a ,,pdp sponsor or   
,,ma organization has contract$1 to !   
ph>macy4  7ii7 ,tim+ ,! report+ ( price 
concessions & inc5tive paym5ts to a     
ph>macy "u clause 7i7 %all be made on a 
p]iodic basis 7b 9 no case less         
frequ5tly ?an annually74  7iii7 ,claim  
level ,! report+ ( price concessions &  
inc5tive paym5ts to a ph>macy "u clause 
7i7 %all be at ! claim level or         
approximat$ at ! claim level if ! price 
concession or inc5tive paym5t 0 appli$  
at a level o!r ?an at ! claim level4  4 
#d4 ,e/abli%m5t ( ph>macy p]=mance      
measures "u m$ic>e "p ,d ,section       
#ahfj;,d-#d7;c7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77 is 
am5d$-- 7#a7 by r$esignat+ p>agraph     
7#f71 z add$ by section #ejced (        
division ,e ( ! ,bip>tisan ,budget ,act 
( #bjah 7,public ,law #aae-abc71 z      

p>agraph 7#g72 &  7#b7 by add+ at ! end 
! foll[+ new p>agraph3  7#h7            
,application ( /&>diz$ ph>macy p]=mance 
measures  7,a7 ,9 g5]al ,a ,,pdp sponsor
 & ,,ma-,,pd plan t makes inc5tive      
paym5ts to a ph>macy or receives price  
concessions paid by a ph>macy bas$ on   
p]=mance measures %all1 = ! purposes (  
su* inc5tive paym5ts & price concessions
 ) respect to cov]$ "p ,d drugs disp5s$ 
by su* ph>macy1 only use measures-- 7i7 
e/abli%$ or adopt$ by ! ,secret>y "u    
subp>agraph 7,b71 z li/$ "u clause 7ii7 
( su* subp>agraph2 &  7ii7 t are        
relevant to ! p]=mance ( su* ph>macy )  
respect to areas t ! ph>macy c impact   
bas$ on cov]$ "p ,d drugs disp5s$ &     
manag$4  7,b7 ,/&>diz$ ph>macy p]=mance 
measures  7i7 ,9 g5]al ,not)/&+ any o!r 
provision ( law1 ! ,secret>y %all       
e/abli% or adopt /&>diz$ ph>macy        
p]=mance measures f "o or m             
multi-/akehold]1 cons5sus organizations 
repres5t+ all ph>macy types 7includ+    
specialty ph>macies7 to be us$ by a     

,,pdp sponsor & ,,ma-,,pd plan = !      
purposes ( det]m9+ inc5tive paym5ts &   
price concessions describ$ 9 subp>agraph
 7,a74 ,su* measures %all be            
evid5ce-bas$ & focus on ph>macy p]=mance
 on pati5t heal? outcomes & o!r areas1 z
 det]m9$ by ! ,secret>y1 t ! ph>macy c  
impact bas$ on cov]$ "p ,d drugs disp5s$
 & manag$4  7ii7 ,ma9t5ance ( li/ ,!    
,secret>y %all ma9ta9 a s+le li/ (      
measures e/abli%$ or adopt$ "u ?is      
subp>agraph & measures %all be evaluat$ 
& updat$ on an ongo+ basis ?r\gh        
/akehold] cons5sus organizations to     
ensure !y are transp>5t1 a*ievable1 &   
cl9ically mean+ful4  7iii7 ,application 
to /> rat+s ,! ,secret>y %all require ! 
developm5t ( measures to apply 9 ! />   
rat+ sy/em "u ?is "p to assess ! use ( a
 /&>d set ( ph>macy p]=mance measures by
 ,,pdp sponsors & ,,ma-,,pd plans4  7,c7
 ,specialty ph>macy ,= purposes (       
subp>agraph 7,b77i71 ! ,secret>y %all1 n
 lat] ?an ,decemb] #ca1 #bjbb1 def9e !  
t]m specialty ph>macy 9 consultation )  

relevant /akehold]s4  7,d7 ,effective   
date ,! requirem5t "u subp>agraph 7,a7  
%all take effect = plan ye>s beg9n+ on  
,janu>y #a1 #bjbb1 or su* e>li] date    
specifi$ by ! ,secret>y if ! ,secret>y  
det]m9es !re are suffici5t measures     
e/abli%$ or adopt$ "u subp>agraph 7,b7 =
 ! purposes ( ! requirem5t "u           
subp>agraph 7,a74  4