,,ii  #aagth ,,congress  #b;d ,session  
,s4 #djaa  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,april #f1     
#bjbb,mr4 ,warnock 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 provide   
for a cap on beneficiary liability under
 part ,d of the ,medicare program1 and  
for other purposes4  #a4 ,short title   
,this ,act may be cited as the ,capping 
,drug ,costs for ,seniors ,act of #bjbb4
  #b4 ,medicare part ,d benefit redesign
  7a7 ,benefit structure redesign       
,section #ahfj;,d-#b7;b7 of the ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajb7;b77 is amended-- 7#a7 in   
paragraph 7#b7-- 7,a7 in subparagraph   
7,a71 in the matter preceding clause    
7i71 by inserting for a year preceding  
#bjbe and for costs above the annual    
deductible specified in paragraph 7#a7  
and up to the annual out-of-pocket      
threshold specified in paragraph        

7#d77;,b7 for #bjbe and each subsequent 
year after paragraph 7#c72  7,b7 in     
subparagraph 7,c7-- 7i7 in clause 7i71  
in the matter preceding subclause 7,i71 
by inserting for a year preceding #bjbe1
 after paragraph 7#d712 and  7ii7 in    
clause 7ii77,,iii71 by striking #bjbj   
and each subsequent year and inserting  
each of years #bjbj through #bjbd1 2 and
  7,c7 in subparagraph 7,d7-- 7i7 in    
clause 7i7-- 7,i7 in the matter         
preceding subclause 7,i71 by inserting  
for a year preceding #bjbe1 after       
paragraph 7#d712 and  7,,ii7 in         
subclause 7,i77bb71 by striking a year  
after #bjah and inserting each of years 
#bjah through #bjbd2 and  7ii7 in clause
 7ii77,v71 by striking #bjai and each   
subsequent year and inserting each of   
years #bjai through #bjbd2  7#b7 in     
paragraph 7#c77;,a7-- 7,a7 in the matter
 preceding clause 7i71 by inserting for 
a year preceding #bjbe1 after and 7#d712
 and  7,b7 in clause 7ii71 by striking  
for a subsequent year and inserting for 

each of years #bjjg through #bjbd2 and  
7#c7 in paragraph 7#d7-- 7,a7 in        
subparagraph 7,a7-- 7i7 in clause 7i7-- 
7,i7 by redesignating subclauses 7,i7   
and 7,,ii7 as items 7aa7 and 7bb71      
respectively1 and moving the margin of  
each such redesignated item #b ems to   
the right2  7,,ii7 in the matter        
preceding item 7aa71 as redesignated by 
subclause 7,i71 by striking is equal to 
the greater of-- and inserting 8is equal
 to--  7,i7 for a year preceding #bjbe1 
the greater of--  2  7,,iii7 by striking
 the period at the end of item 7bb71 as 
redesignated by subclause 7,i71 and     
inserting 2 and2 and  7,,iv7 by adding  
at the end the following3  7,,ii7 for   
#bjbe and each succeeding year1 #j4  2  
and  7ii7 in clause 7ii7-- 7,i7 by      
striking clause 7i77,i7 and inserting   
clause 7i77,i77aa72 and  7,,ii7 by      
adding at the end the following new     
sentence3 ,the ,secretary shall continue
 to calculate the dollar amounts        
specified in clause 7i77,i77aa71        

including with the adjustment under this
 clause1 after #bjbd for purposes of    
section #ahfj;,d-#ad7;a77#a77;,d77iii742
  7,b7 in subparagraph 7,b7-- 7i7 in    
clause 7i7-- 7,i7 in subclause 7,v71 by 
striking or at the end2  7,,ii7 in      
subclause 7,,vi7-- 7aa7 by striking for 
a subsequent year and inserting for each
 of years #bjba through #bjbd2 and  7bb7
 by striking the period at the end and  
inserting a semicolon2 and  7,,iii7 by  
adding at the end the following new     
subclauses3  7,,vii7 for #bjbe1 is equal
 to #b1jjj2 or  7,,viii7 for a          
subsequent year1 is equal to the amount 
specified in this subparagraph for the  
previous year1 increased by the annual  
percentage increase described in        
paragraph 7#f7 for the year involved4  2
 and  7ii7 in clause 7ii71 by striking  
clause 7i77,,ii7 and inserting clause   
7i72  7,c7 in subparagraph 7,c77i71 by  
striking and for amounts and inserting  
and1 for a year preceding #bjbe1 for    
amounts2 and  7,d7 in subparagraph 7,e71

 by striking ,in applying and inserting 
,for each of years #bjaa through #bjbd1 
in applying4  7b7 ,reinsurance payment  
amount ,section #ahfj;,d-#ae7;b77#a7 of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#aae7;b77#a77 is       
amended-- 7#a7 by striking equal to #hj 
percent and inserting 8equal to--  7,a7 
for a year preceding #bjbe1 #hj percent 
2  7#b7 in subparagraph 7,a71 as added  
by subparagraph 7,a71 by striking the   
period at the end and inserting 2 and2  
and  7#c7 by adding at the end the      
following new subparagraph3  7,b7 for   
#bjbe and each subsequent year1 the sum 
of-- 7i7 with respect to applicable     
drugs 7as defined in section            
#ahfj;,d-#ad;,b7g77#b771 an amount equal
 to #bj percent of such allowable       
reinsurance costs attributable to that  
portion of gross covered prescription   
drug costs as specified in paragraph    
7#c7 incurred in the coverage year after
 such individual has incurred costs that
 exceed the annual out-of-pocket        

threshold specified in section          
#ahfj;,d-#b7;b77#d77;,b72 and  7ii7 with
 respect to covered part ,d drugs that  
are not applicable drugs 7as so         
defined71 an amount equal to #dj percent
 of such allowable reinsurance costs    
attributable to that portion of gross   
covered prescription drug costs as      
specified in paragraph 7#c7 incurred in 
the coverage year after such individual 
has incurred costs that exceed the      
annual out-of-pocket threshold specified
 in section #ahfj;,d-#b7;b77#d77;,b74  4
  7c7 ,manufacturer discount program    
7#a7 ,in general ,part ,d of title      
,,xviii of the ,social ,security ,act   
7#db ,u4,s4,c4 #aciew-#aja et seq47 is  
amended by inserting after section      
#ahfj;,d-#ad;,a the following new       
section3  #ahfj;,d-#ad;,b4 ,manufacturer
 discount program  7a7 ,establishment   
,the ,secretary shall establish a       
manufacturer discount program 7in this  
section referred to as the program74    
,under the program1 the ,secretary shall

 enter into agreements described in     
subsection 7b7 with manufacturers and   
provide for the performance of the      
duties described in subsection 7c74  7b7
 ,terms of agreement  7#a7 ,in general  
7,a7 ,agreement ,an agreement under this
 section shall require the manufacturer 
to provide1 in accordance with this     
section1 access to discounted prices for
 applicable drugs of the manufacturer   
that are dispensed to applicable        
beneficiaries on or after ,january #a1  
#bjbe4  7,b7 ,clarification ,nothing in 
this section shall be construed as      
affecting-- 7i7 the application of a    
coinsurance of #be percent of the       
negotiated price1 as applied under      
paragraph 7#b77;,a7 of section          
#ahfj;,d-#b7;b71 for costs described in 
such paragraph2 or  7ii7 the application
 of the copayment amount described in   
paragraph 7#d77;,a7 of such section1    
with respect to costs described in such 
paragraph4  7,c7 ,timing of agreement   
7i7 ,special rule for #bjbe ,in order   

for an agreement with a manufacturer to 
be in effect under this section with    
respect to the period beginning on      
,january #a1 #bjbe1 and ending on       
,december #ca1 #bjbe1 the manufacturer  
shall enter into such agreement not     
later than ,march #a1 #bjbd4  7ii7 #bjbf
 and subsequent years ,in order for an  
agreement with a manufacturer to be in  
effect under this section with respect  
to plan year #bjbf or a subsequent plan 
year1 the manufacturer shall enter into 
such agreement 7or such agreement shall 
be renewed under paragraph 7#d77;,a77   
not later than a calendar quarter or    
semi-annual deadline established by the 
,secretary4  7#b7 ,provision of         
appropriate data ,each manufacturer with
 an agreement in effect under this      
section shall collect and have available
 appropriate data1 as determined by the 
,secretary1 to ensure that it can       
demonstrate to the ,secretary compliance
 with the requirements under the        
program4  7#c7 ,compliance with         

requirements for administration of      
program ,each manufacturer with an      
agreement in effect under this section  
shall comply with requirements imposed  
by the ,secretary for purposes of       
administering the program1 including any
 determination under subparagraph 7,a7  
of subsection 7c77#a7 or procedures     
established under such subsection       
7c77#a74  7#d7 ,length of agreement     
7,a7 ,in general ,an agreement under    
this section shall be effective for an  
initial period of not less than #ab     
months and shall be automatically       
renewed for a period of not less than #a
 year unless terminated under           
subparagraph 7,b74  7,b7 ,termination   
7i7 ,by the ,secretary ,the ,secretary  
may provide for termination of an       
agreement under this section for a      
knowing and willful violation of the    
requirements of the agreement or other  
good cause shown4 ,such termination     
shall not be effective earlier than #cj 
days after the date of notice to the    

manufacturer of such termination4 ,the  
,secretary shall provide1 upon request1 
a manufacturer with a hearing concerning
 such a termination1 and such hearing   
shall take place prior to the effective 
date of the termination with sufficient 
time for such effective date to be      
repealed if the ,secretary determines   
appropriate4  7ii7 ,by a manufacturer ,a
 manufacturer may terminate an agreement
 under this section for any reason4 ,any
 such termination shall be effective1   
with respect to a plan year-- 7,i7 if   
the termination occurs before ,january  
#ca of a plan year1 as of the day after 
the end of the plan year2 and  7,,ii7 if
 the termination occurs on or after     
,january #ca of a plan year1 as of the  
day after the end of the succeeding plan
 year4  7iii7 ,effectiveness of         
termination ,any termination under this 
subparagraph shall not affect discounts 
for applicable drugs of the manufacturer
 that are due under the agreement before
 the effective date of its termination4 

7c7 ,duties described ,the duties       
described in this subsection are the    
following3 7#a7 ,administration of      
program ,administering the program1     
including-- 7,a7 the determination of   
the amount of the discounted price of an
 applicable drug of a manufacturer2     
7,b7 the establishment of procedures to 
ensure that1 not later than the         
applicable number of calendar days after
 the dispensing of an applicable drug by
 a pharmacy or mail order service1 the  
pharmacy or mail order service is       
reimbursed for an amount equal to the   
difference between-- 7i7 the negotiated 
price of the applicable drug2 and  7ii7 
the discounted price of the applicable  
drug2  7,c7 the establishment of        
procedures to ensure that the discounted
 price for an applicable drug under this
 section is applied before any coverage 
or financial assistance under other     
health benefit plans or programs that   
provide coverage or financial assistance
 for the purchase or provision of       

prescription drug coverage on behalf of 
applicable beneficiaries as the         
,secretary may specify2 and  7,d7       
providing a reasonable dispute          
resolution mechanism to resolve         
disagreements between manufacturers and 
applicable beneficiaries4  7#b7         
,monitoring compliance ,the ,secretary  
shall monitor compliance by a           
manufacturer with the terms of an       
agreement under this section4  7#c7     
,collection of data from prescription   
drug plans and ,,ma-,,pd plans ,the     
,secretary may collect appropriate data 
from prescription drug plans and        
,,ma-,,pd plans in a timeframe that     
allows for discounted prices to be      
provided for applicable drugs under this
 section4  7d7 ,administration  7#a7 ,in
 general ,subject to paragraph 7#b71 the
 ,secretary shall provide for the       
implementation of this section1         
including the performance of the duties 
described in subsection 7c74  7#b7      
,limitation ,in providing for the       

implementation of this section1 the     
,secretary shall not receive or         
distribute any funds of a manufacturer  
under the program4  7#c7 ,implementation
 ,the ,secretary may implement the      
program under this section by program   
instruction or otherwise4  7#d7         
,administration ,chapter #ce of title   
#dd1 ,united ,states ,code1 shall not   
apply to the program under this section4
  7e7 ,enforcement  7#a7 ,audits ,each  
manufacturer with an agreement in effect
 under this section shall be subject to 
periodic audit by the ,secretary4  7#b7 
,civil money penalty  7,a7 ,in general  
,the ,secretary may impose a civil money
 penalty on a manufacturer that fails to
 provide discounts for applicable drugs 
of the manufacturer dispensed to        
applicable beneficiaries in accordance  
with such agreement for each such       
failure in an amount the ,secretary     
determines is equal to the sum of-- 7i7 
the amount that the manufacturer would  
have paid with respect to such discounts

 under the agreement1 which will then be
 used to pay the discounts which the    
manufacturer had failed to provide2 and 
7ii7 #be percent of such amount4  7,b7  
,application ,the provisions of section 
#aabh;,a 7other than subsections 7a7 and
 7b77 shall apply to a civil money      
penalty under this paragraph in the same
 manner as such provisions apply to a   
penalty or proceeding under section     
#aabh;,a7a74  7f7 ,clarification        
regarding availability of other covered 
part ,d drugs ,nothing in this section  
shall prevent an applicable beneficiary 
from purchasing a covered part ,d drug  
that is not an applicable drug          
7including a generic drug or a drug that
 is not on the formulary of the         
prescription drug plan or ,,ma-,,pd plan
 that the applicable beneficiary is     
enrolled in74  7g7 ,definitions ,in this
 section3 7#a7 ,applicable beneficiary  
,the term applicable beneficiary means  
an individual who1 on the date of       
dispensing a covered part ,d drug-- 7,a7

 is enrolled in a prescription drug plan
 or an ,,ma-,,pd plan2  7,b7 is not     
enrolled in a qualified retiree         
prescription drug plan2 and  7,c7 has   
incurred costs1 as determined in        
accordance with section                 
#ahfj;,d-#b7;b77#d77;,c71 for covered   
part ,d drugs in the year that exceed   
the annual deductible for such year1 as 
specified in section                    
#ahfj;,d-#b7;b77#a74  7#b7 ,applicable  
drug ,the term applicable drug1 with    
respect to an applicable beneficiary1   
means a covered part ,d drug-- 7,a7     
approved under a new drug application   
under section #eje7;c7 of the ,federal  
,food1 ,drug1 and ,cosmetic ,act or1 in 
the case of a biologic product1 licensed
 under section #cea of the ,public      
,health ,service ,act2 and  7,b7 7i7 if 
the ,,pdp sponsor of the prescription   
drug plan or the ,,ma organization      
offering the ,,ma-,,pd plan uses a      
formulary1 which is on the formulary of 
the prescription drug plan or ,,ma-,,pd 

plan that the applicable beneficiary is 
enrolled in2  7ii7 if the ,,pdp sponsor 
of the prescription drug plan or the    
,,ma organization offering the ,,ma-,,pd
 plan does not use a formulary1 for     
which benefits are available under the  
prescription drug plan or ,,ma-,,pd plan
 that the applicable beneficiary is     
enrolled in2 or  7iii7 is provided      
through an exception or appeal4  7#c7   
,applicable number of calendar days ,the
 term applicable number of calendar days
 means-- 7,a7 with respect to claims for
 reimbursement submitted electronically1
 #ad days2 and  7,b7 with respect to    
claims for reimbursement submitted      
otherwise1 #cj days4  7#d7 ,discounted  
price  7,a7 ,in general ,the term       
discounted price means1 with respect to 
an applicable drug of a manufacturer    
dispensed during a year to an applicable
 beneficiary-- 7i7 who has not incurred 
costs1 as determined in accordance with 
section #ahfj;,d-#b7;b77#d77;,c71 for   
covered part ,d drugs in the year that  

are equal to or exceed the annual       
out-of-pocket threshold specified in    
section #ahfj;,d-#b7;b77#d77;,b77i7 for 
the year1 #ij percent of the negotiated 
price of such drug2 and  7ii7 who has   
incurred such costs1 as so determined1  
in the year that are equal to or exceed 
such threshold for the year1 #hj percent
 of the negotiated price of such drug4  
7,b7 ,clarification ,nothing in this    
section shall be construed as affecting 
the responsibility of an applicable     
beneficiary for payment of a dispensing 
fee for an applicable drug4  7,c7       
,special case for certain claims  7i7   
,claims spanning deductible ,in the case
 where the entire amount of the         
negotiated price of an individual claim 
for an applicable drug with respect to  
an applicable beneficiary does not fall 
above the annual deductible specified in
 section #ahfj;,d-#b7;b77#a7 for the    
year1 the manufacturer of the applicable
 drug shall provide the discounted price
 under this section on only the portion 

of the negotiated price of the          
applicable drug that falls above such   
annual deductible4  7ii7 ,claims        
spanning out-of-pocket threshold ,in the
 case where the entire amount of the    
negotiated price of an individual claim 
for an applicable drug with respect to  
an applicable beneficiary does not fall 
entirely below or entirely above the    
annual out-of-pocket threshold specified
 in section #ahfj;,d-#b7;b77#d77;,b77i7 
for the year1 the manufacturer of the   
applicable drug shall provide the       
discounted price-- 7,i7 in accordance   
with subparagraph 7,a77i7 on the portion
 of the negotiated price of the         
applicable drug that falls below such   
threshold2 and  7,,ii7 in accordance    
with subparagraph 7,a77ii7 on the       
portion of such price of such drug that 
falls at or above such threshold4  7#e7 
,manufacturer ,the term manufacturer    
means any entity which is engaged in the
 production1 preparation1 propagation1  
compounding1 conversion1 or processing  

of prescription drug products1 either   
directly or indirectly by extraction    
from substances of natural origin1 or   
independently by means of chemical      
synthesis1 or by a combination of       
extraction and chemical synthesis4 ,such
 term does not include a wholesale      
distributor of drugs or a retail        
pharmacy licensed under ,state law4     
7#f7 ,negotiated price ,the term        
negotiated price has the meaning given  
such term for purposes of section       
#ahfj;,d-#b7;d77#a77;,b71 except that   
such negotiated price shall not include 
any dispensing fee for the applicable   
drug4  7#g7 ,qualified retiree          
prescription drug plan ,the term        
qualified retiree prescription drug plan
 has the meaning given such term in     
section #ahfj;,d-#bb7;a77#b74  4  7#b7  
,sunset of ,medicare coverage gap       
discount program ,section               
#ahfj;,d-#ad;,a of the ,social ,security
 ,act 7#db ,u4,s4,c4 #acie-aad;a7 is    
amended-- 7,a7 in subsection 7a71 in the

 first sentence1 by striking ,the       
,secretary and inserting ,subject to    
subsection 7h71 the ,secretary2 and     
7,b7 by adding at the end the following 
new subsection3  7h7 ,sunset of program 
7#a7 ,in general ,the program shall not 
apply with respect to applicable drugs  
dispensed on or after ,january #a1      
#bjbe1 and1 subject to paragraph 7#b71  
agreements under this section shall be  
terminated as of such date4  7#b7       
,continued application for applicable   
drugs dispensed prior to sunset ,the    
provisions of this section 7including   
all responsibilities and duties7 shall  
continue to apply after ,january #a1    
#bjbe1 with respect to applicable drugs 
dispensed prior to such date4  4  7#c7  
,inclusion of actuarial value of        
manufacturer discounts in bids ,section 
#ahfj;,d-#aa of the ,social ,security   
,act 7#db ,u4,s4,c4 #aciew-#aaa7 is     
amended-- 7,a7 in subsection            
7b77#b77;,c77iii7-- 7i7 by striking     
assumptions regarding the reinsurance an

 inserting 8assumptions regarding--     
7,i7 the reinsurance  2 and  7ii7 by    
adding at the end the following3  7,,ii7
 for #bjbe and each subsequent year1 the
 manufacturer discounts provided under  
section #ahfj;,d-#ad;,b subtracted from 
the actuarial value to produce such bid2
 and  2 and  7,b7 in subsection         
7c77#a77;,c7-- 7i7 by striking an       
actuarial valuation of the reinsurance  
and inserting 8an actuarial valuation   
of--  7i7 the reinsurance  2  7ii7 in   
clause 7i71 as inserted by clause 7i7 of
 this subparagraph1 by adding and at the
 end2 and  7iii7 by adding at the end   
the following3  7ii7 for #bjbe and each 
subsequent year1 the manufacturer       
discounts provided under section        
#ahfj;,d-#ad;,b2  4  7d7 ,conforming    
amendments  7#a7 ,section #ahfj;,d-#b of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #aciew-#ajb7 is amended-- 7,a7
 in subsection 7a77#b77;,a77i77,i71 by  
striking 1 or an increase in the initial
 and inserting or1 for a year preceding 

#bjbe1 an increase in the initial2  7,b7
 in subsection 7c77#a77;,c7-- 7i7 in the
 subparagraph heading1 by striking at   
initial coverage limit2 and  7ii7 by    
inserting for a year preceding #bjbe or 
the annual out-of-pocket threshold      
specified in subsection 7b77#d77;,b7 for
 the year for #bjbe and each subsequent 
year after subsection 7b77#c7 for the   
year each place it appears2 and  7,c7 in
 subsection 7d77#a77;,a71 by striking or
 an initial and inserting or1 for a year
 preceding #bjbe1 an initial4  7#b7     
,section #ahfj;,d-#d7;a77#d77;,b77i7 of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#ajd7;a77#d77;,b77i77  
is amended by striking the initial and  
inserting for a year preceding #bjbe1   
the initial4  7#c7 ,section             
#ahfj;,d-#ad7;a7 of the ,social         
,security ,act 7#db ,u4,s4,c4           
#aciew-#aad7;a77 is amended-- 7,a7 in   
paragraph 7#a7-- 7i7 in subparagraph    
7,c71 by striking ,the continuation and 
inserting ,for a year preceding #bjbe1  

the continuation2  7ii7 in subparagraph 
7,d77iii71 by striking                  
#ahfj;,d-#b7;b77#d77;,a77i77,i7 and     
inserting                               
#ahfj;,d-#b7;b77#d77;,a77i77,i77aa72 and
  7iii7 in subparagraph 7,e71 by        
striking ,the elimination and inserting 
,for a year preceding #bjbe1 the        
elimination2 and  7,b7 in paragraph     
7#b7-- 7i7 in subparagraph 7,c71 by     
striking ,the continuation and inserting
 ,for a year preceding #bjbe1 the       
continuation2 and  7ii7 in subparagraph 
7,e71 by striking                       
#ahfj;,d-#b7;b77#d77;,a77i77,i7 and     
inserting                               
#ahfj;,d-#b7;b77#d77;,a77i77,i77aa7 7for
 a year preceding #bjbe74  7#d7 ,section
 #ahfj;,d-#ba7;d77#g7 of the ,social    
,security ,act 7#db ,u4,s4,c4           
#aciew-#aca7;d77#g77 is amended by      
striking section                        
#ahfj;,d-#b7;b77#d77;,b77i7 and         
inserting section                       
#ahfj;,d-#b7;b77#d77;,c77i74  7#e7      

,section #ahfj;,d-#bb7;a77#b77;,a7 of   
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#acb7;a77#b77;,a77 is  
amended-- 7,a7 by striking the value of 
any discount and inserting the          
following3 the value of-- 7i7 for years 
prior to #bjbe1 any discount  2  7,b7 in
 clause 7i71 as inserted by subparagraph
 7,a7 of this paragraph1 by striking the
 period at the end and inserting 2 and2 
and  7,c7 by adding at the end the      
following new clause3  7ii7 for #bjbe   
and each subsequent year1 any discount  
provided pursuant to section            
#ahfj;,d-#ad;,b4  4  7#f7 ,section      
#ahfj;,d-#da7;a77#f7 of the ,social     
,security ,act 7#db ,u4,s4,c4           
#aciew-#aea7;a77#f77 is amended-- 7,a7  
by inserting for a year before #bjbe    
after #ahfj;,d-#b7;b77#c72 and  7,b7 by 
inserting for such year before the      
period4  7#g7 ,section #ahfj;,d-#dc of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#aec7 is amended-- 7,a7
 in subsection 7a7-- 7i7 by striking    

paragraph 7#a7 and inserting the        
following3  7#a7 participate in-- 7,a7  
for #bjaa through #bjbd1 the ,medicare  
coverage gap discount program under     
section #ahfj;,d-#ad;,a2 and  7,b7 for  
#bjbe and each subsequent year1 the     
manufacturer discount program under     
section #ahfj;,d-#ad;,b2  2  7ii7 by    
striking paragraph 7#b7 and inserting   
the following3  7#b7 have entered into  
and have in effect-- 7,a7 for #bjaa     
through #bjbd1 an agreement described in
 subsection 7b7 of section              
#ahfj;,d-#ad;,a with the ,secretary2 and
  7,b7 for #bjbe and each subsequent    
year1 an agreement described in         
subsection 7b7 of section               
#ahfj;,d-#ad;,b with the ,secretary2 and
  2 and  7iii7 in paragraph 7#c71 by    
striking such section and inserting     
section #ahfj;,d-#ad;,a2 and  7,b7 by   
striking subsection 7b7 and inserting   
the following3  7b7 ,effective date     
,paragraphs 7#a77;,a71 7#b77;,a71 and   
7#c7 of subsection 7a7 shall apply to   

covered part ,d drugs dispensed under   
this part on or after ,january #a1      
#bjaa1 and before ,january #a1 #bjbe1   
and paragraphs 7#a77;,b7 and 7#b77;,b7  
of such subsection shall apply to       
covered part ,d drugs dispensed under   
this part on or after ,january #a1      
#bjbe4  4  7#h7 ,section #aibg of the   
,social ,security ,act 7#db ,u4,s4,c4   
#acifr-#h7 is amended-- 7,a7 in         
subsection 7c77#a77;,c77i77,,vi71 by    
inserting before the period at the end  
the following3 or under the manufacturer
 discount program under section         
#ahfj;,d-#ad;,b2 and  7,b7 in subsection
 7k77#a77;,b77i77,v71 by inserting      
before the period at the end the        
following3 or under section             
#ahfj;,d-#ad;,b4  7e7 ,effective date   
,the amendments made by this section    
shall apply with respect to plan year   
#bjbe and subsequent plan years4