,i #aah? ,,congress #a/ ,session ,h4 ,r4 #afac ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,m>* #ag1 #bjbc,mr4 ,c>t] ( ,georgia 7= himself1 ,mr4 ,vic5te ,gonzalez ( ,texas1 ,ms4 ,/efanik1 ,ms4 ,ross1 ,mr4 ,all51 & ,mr4 ,au*9closs7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce ,a ,,bill ,to am5d title ,,xix ( ! ,social ,security ,act to improve transp>5cy & prev5t ! use ( abusive spread pric+ & relat$ practices 9 ! ,m$icaid program4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,drug ,price ,transp>5cy 9 ,m$icaid ,act ( #bjbc4 #b4 ,improv+ transp>5cy & prev5t+ ! use ( abusive spread pric+ & relat$ practices 9 ,m$icaid 7a7 ,pass-,?r\gh pric+ requir$ 7#a7 ,9 g5]al ,section #aibg7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;e77 is am5d$ by add+ at ! end ! foll[+3 7#f7 ,pass-?r\gh pric+ requir$ ,a contract betwe5 ! ,/ate & a ph>macy b5efit manag] 7ref]r$ to 9 ?is p>agraph z a ,,pbm71 or a contract betwe5 ! ,/ate & a manag$ c>e entity or o!r specifi$ entity 7z su* t]ms are def9$ 9 section #aijc7m77#i77;,d77 t includes provisions mak+ ! entity responsible = cov]age ( cov]$ outpati5t drugs disp5s$ to individuals enroll$ ) ! entity1 %all require t paym5t = su* drugs & relat$ adm9i/rative s]vices 7z applicable71 includ+ paym5ts made by a ,,pbm on behalf ( ! ,/ate or entity1 is bas$ on a pass-?r\gh pric+ model "u :i*-- 7,a7 any paym5t made by ! entity or ! ,,pbm 7z applicable7 = su* a drug-- 7i7 is limit$ to-- 7,i7 +r$i5t co/2 & 7,,ii7 a pr(essional disp5s+ fee t is n less ?an ! pr(essional disp5s+ fee t ! ,/ate plan or waiv] w\ld pay if ! plan or waiv] 0 mak+ ! paym5t directly2 7ii7 is pass$ ?r\gh 9 its entirety by ! entity or ,,pbm to ! ph>macy or provid] t disp5ses ! drug2 & 7iii7 is made 9 a mann] t is consi/5t ) section #aijb7;a77#cj77;,a7 & sections #ddg4eab1 #ddg4ead1 & #ddg4eah ( title #db1 ,code ( ,f$]al ,regulations 7or any successor regulation7 z if su* requirem5ts appli$ directly to ! entity or ! ,,pbm1 except t any paym5t by ! entity or ! ,,pbm 7z applicable7 = ! +r$i5t co/ ( a cov]$ outpati5t drug disp5s$ by provid]s & ph>macies ref]5c$ 9 clause 7i7 or 7ii7 ( section #ddg4eah7;a77#a7 ( title #db1 ,code ( ,f$]al ,regulations 7or any successor regulation7 %all be ! same z ! paym5t am\nt = ! +r$i5t co/ :5 disp5s$ by provid]s & ph>macies n ref]5c$ 9 su* clauses1 & 9 no case %all paym5t = ! +r$i5t co/ ( a cov]$ outpati5t drug be bas$ on ! actual acquisition co/ ( a drug disp5s$ by provid]s & ph>macies ref]5c$ 9 su* clauses or take into acc\nt a drug's /atus z a drug pur*as$ at a disc\nt$ price by a provid] or ph>macy ref]5c$ 9 su* clauses2 7,b7 paym5t to ! entity or ! ,,pbm 7z applicable7 = adm9i/rative s]vices p]=m$ by ! entity or ,,pbm is limit$ to a reasonable adm9i/rative fee t cov]s ! reasonable co/ ( provid+ su* s]vices2 7,c7 ! entity or ! ,,pbm 7z applicable7 %all make available to ! ,/ate1 & ! ,secret>y ^u reque/1 all co/s & paym5ts relat$ to cov]$ outpati5t drugs & accompany+ adm9i/rative s]vices incurr$1 receiv$1 or made by ! entity or ! ,,pbm1 includ+ +r$i5t co/s1 pr(essional disp5s+ fees1 adm9i/rative fees1 po/-sale & po/-invoice fees1 disc\nts1 or relat$ adju/m5ts su* z direct & indirect remun]ation fees1 & any & all o!r remun]ation2 & 7,d7 any =m ( spread pric+ :]eby any am\nt *>g$ or claim$ by ! entity or ! ,,pbm 7z applicable7 is 9 excess ( ! am\nt paid to ! ph>macies on behalf ( ! entity1 includ+ any po/-sale or po/-invoice fees1 disc\nts1 or relat$ adju/m5ts su* z direct & indirect remun]ation fees or assessm5ts 7aft] all[+ = a reasonable adm9i/rative fee z describ$ 9 subp>agraph 7,b77 is n all[able = purposes ( claim+ ,f$]al mat*+ paym5ts "u ?is title4 4 7#b7 ,con=m+ am5dm5t ,section #aijc7m77#b77;,a77xiii7 ( su* ,act 7#db ,u4,s4,c4 #acif;b7m77#b77;,a77xiii77 is am5d$-- 7,a7 by /rik+ & 7,,iii7 & ins]t+ 7,,iii72 7,b7 by ins]t+ be=e ! p]iod at ! end ! foll[+3 1 & 7,,iv7 ph>macy b5efit managem5t s]vices provid$ by ! entity1 or provid$ by a ph>macy b5efit manag] on behalf ( ! entity "u a contract or o!r arrangem5t betwe5 ! entity & ! ph>macy b5efit manag]1 %all comply ) ! requirem5ts ( section #aibg7;e77#f72 & 7,c7 by mov+ ! left m>g9 #b ems to ! left4 7#c7 ,effective date ,! am5dm5ts made by ?is subsection apply to contracts betwe5 ,/ates & manag$ c>e entities1 o!r specifi$ entities1 or ph>macy b5efits manag]s t are ent]$ into or r5ew$ on or aft] ! date t is #ah mon?s aft] ! date ( enactm5t ( ?is ,act4 7b7 ,ensur+ accurate paym5ts to ph>macies "u ,m$icaid 7#a7 ,9 g5]al ,section #aibg7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;f77 is am5d$-- 7,a7 by /rik+ & aft] ! semicolon at ! end ( p>agraph 7#a77;,a77i7 & all t prec$es x ?r\gh 7#a7 & ins]t+ ! foll[+3 7#a7 ,det]m9+ ph>macy actual acquisition co/s ,! ,secret>y %all conduct a survey ( retail community ph>macy drug prices to det]m9e ! national av]age drug acquisition co/ z foll[s3 7,a7 ,use ( v5dor ,! ,secret>y may contract s]vices =-- 7i7 ) respect to retail community ph>macies1 ! det]m9ation ( retail survey prices ( ! national av]age drug acquisition co/ = cov]$ outpati5t drugs bas$ on a mon?ly survey ( su* ph>macies2 & 2 7,b7 by add+ at ! end ( p>agraph 7#a7 ! foll[+3 7,f7 ,survey report+ ,9 ord] to meet ! requirem5t ( section #aijb7;a77#ed71 a ,/ate %all require t any retail community ph>macy 9 ! ,/ate t receives any paym5t1 reimbursem5t1 adm9i/rative fee1 disc\nt1 or rebate relat$ to ! disp5s+ ( cov]$ outpati5t drugs to individuals receiv+ b5efits "u ?is title1 reg>dless ( :e!r su* paym5t1 fee1 disc\nt1 or rebate is receiv$ f ! ,/ate or a manag$ c>e entity directly or f a ph>macy b5efit manag] or ano!r entity t has a contract ) ! ,/ate or a manag$ c>e entity1 %all respond to surveys ( retail prices conduct$ "u ?is subsection4 7,g7 ,survey in=mation ,in=mation on national drug acquisition prices obta9$ "u ?is p>agraph %all be made publicly available & %all include at lea/ ! foll[+3 7i7 ,! mon?ly response rate ( ! survey includ+ a li/ ( ph>macies n 9 compliance ) subp>agraph 7,f74 7ii7 ,! sampl+ frame & numb] ( ph>macies sampl$ mon?ly4 7iii7 ,in=mation on price concessions to ! ph>macy1 includ+ disc\nts1 rebates1 & o!r price concessions1 to ! ext5t t su* in=mation is available dur+ ! survey p]iod4 7,h7 ,report on specialty ph>macies 7i7 ,9 g5]al ,n lat] ?an #a ye> aft] ! effective date ( ?is subp>agraph1 ! ,secret>y %all submit a report to ,congress exam9+ specialty drug cov]age & reimbursem5t "u ?is title4 7ii7 ,cont5t ( report ,su* report %all include a description ( h[ ,/ate ,m$icaid programs def9e specialty drugs & specialty ph>macies1 h[ mu* ,/ate ,m$icaid programs pay = specialty drugs1 h[ ,/ates & manag$ c>e plans det]m9e paym5t = specialty drugs1 ! sett+s 9 :i* specialty drugs are disp5s$ 7su* z retail community ph>macies or specialty ph>macies71 to :at ext5t acquisition co/s = specialty drugs are captur$ 9 ! national av]age drug acquisition co/ survey or ?r\gh ano!r process1 examples ( specialty drug disp5s+ fees to support ! s]vices associat$ ) disp5s+ specialty drugs1 & recomm5dations z to :e!r specialty ph>macies %\ld be includ$ 9 ! survey ( retail prices to ensure national av]age drug acquisition co/s capture drugs sold at specialty ph>macies & h[ su* specialty ph>macies %\ld be def9$4 2 7,c7 9 p>agraph 7#b7-- 7i7 9 subp>agraph 7,a71 by ins]t+ 1 includ+ paym5ts rates "u ,m$icaid manag$ c>e plans1 aft] "u ?is title2 & 7ii7 9 subp>agraph 7,b71 by ins]t+ & ! basis = su* disp5s+ fees be=e ! semicolon2 & 7,d7 9 p>agraph 7#d71 by ins]t+ 1 & #e1jjj1jjj = fiscal ye> #bjbe & ea* fiscal ye> !reaft]1 aft] #bjaj4 7#b7 ,effective date ,! am5dm5ts made by ?is subsection take effect on ! fir/ day ( ! fir/ qu>t] t beg9s on or aft] ! date t is #ah mon?s aft] ! date ( enactm5t ( ?is ,act4