,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #becd  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,april #f1 #bjbc,ms4  
,spanb]g] 7= h]self & ,mr4 ,johnson (   
,s\? ,dakota7 introduc$ ! foll[+ bill2  
:i* 0 ref]r$ to ! ,committee on ,en]gy &
 ,comm]ce1 & 9 addition to ! ,committee 
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xxvii ( ! ,public ,heal? ,s]vice ,act 
to ensure ! equitable treatm5t ( cov]$  
entities & ph>macies p>ticipat+ 9 !     
#cdj;,b drug disc\nt program1 & = o!r   
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,pres]v+ ,rules ,ord]$ = ,!
 ,entities ,cov]$ ,?r\gh #cdj;,b ,act ( 
#bjbc or ! ,,protect #cdj;,b ,act (     
#bjbc4  #b4 ,f9d+s & purpose  7a7 ,f9d+s
 ,congress f9ds ! foll[+3 7#a7 ,!       
#cdj;,b drug pric+ program is an        
ess5tial "p ( ! ,nation's heal? c>e     
safety net4  7#b7 #cdj;,b enables       

safety-net provid]s to /ret* sc>ce      
res\rces fur!r to (f] s]vices & treat   
pati5ts ?r\gh ! sav+s ^! provid]s       
receive "u ! program4  7#c7 #cdj;,b     
sav+s support hospitals1 cl9ics1 & heal?
 c5t]s' c>e = pati5ts :o h l[ incomes1  
includ+ ^? ) l[ incomes enroll$ 9       
,m$ic>e & ,m$icaid4  7#d7 #cdj;,b sav+s 
are critically important to rural       
hospitals t op]ate on v slim m>g9s &    
s]ve pati5ts 9 isolat$ areas ) limit$   
access to heal? c>e4  7#e7 #cdj;,b      
supports c>e = ^? 9 ne$ )\t us+ taxpay] 
doll>s4  7#f7 ,"s comm]cial pay]s &     
ph>macy b5efit manag]s are pay+ less to 
#cdj;,b cov]$ entities & _! contract    
ph>macies = #cdj;,b drugs1 requir+      
id5tification ( #cdj;,b drug claims or  
o!rwise discrim9at+ aga9/ #cdj;,b cov]$ 
entities & _! contract ph>macies on !   
basis ( _! /atus z provid]s or ph>macies
 t disp5se #cdj;,b drugs4  7#g7 ,^!     
types ( discrim9atory actions und]m9e ! 
purpose ( ! #cdj;,b program & h>m !     
pati5ts s]v$ by #cdj;,b cov]$ entities4 

,comm]cial pay]s & ph>macy b5efit       
manag]s' imposition ( requirem5ts on a  
#cdj;,b ph>macy because x is a ph>macy t
 disp5ses #cdj;,b drugs1 or requirem5ts 
) respect to ! use ( & bill+ = drugs    
pur*as$ "u #cdj;,b because !y are       
#cdj;,b drugs is inconsi/5t ) public    
policy because ( ! delet]i\s effects on 
! nation's heal? c>e safety net4  7b7   
,purposes ,! purposes ( ?is ,act are !  
foll[+3 7#a7 ,to prohibit discrim9atory 
actions1 includ+ sev]al specifi$        
actions1 by a ph>macy b5efit manag]1 a  
gr\p heal? plan1 a heal? insurance issu]
 (f]+ gr\p or individual heal?          
insurance1 or a sponsor ( a ,m$ic>e "p  
,d prescription drug plan aga9/ #cdj;,b 
cov]$ entities & _! ph>macies & requir+ 
!m to be treat$ z any o!r provid] or    
ph>macy4  7#b7 ,to provide = !          
imposition ( civil monet>y p5alties on  
ph>macy b5efit manag]s t violate ! new  
protections & require ! ,heal? ,s]vices 
& ,res\rces ,adm9i/ration to promulgate 
implem5t+ regulations4  7#c7 ,to        

au?orize ! ,secret>y to contract ) a    
?ird-p>ty entity to collect & review    
data f ,/ate ,m$icaid ag5cies & cov]$   
entities to prev5t ,m$icaid duplicate   
disc\nts4  #c4 ,ensur+ ! equitable      
treatm5t ( cov]$ entities & ph>macies   
p>ticipat+ 9 ! #cdj;,b drug disc\nt     
program  7a7 ,gr\p heal? plan & heal?   
insurance issu] requirem5ts ,subp>t ,,ii
 ( "p ,a ( title ,,xxvii ( ! ,public    
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#aa et seq47 is am5d$ by add+ at
 ! end ! foll[+ new section3  #bgcj4    
,requirem5ts relat+ to ! #cdj;,b drug   
disc\nt program  7a7 ,9 g5]al ,a gr\p   
heal? plan1 a heal? insurance issu] (f]+
 gr\p or individual heal? insurance     
cov]age1 or a ph>macy b5efit manag] may 
n discrim9ate aga9/ a cov]$ entity 7z   
def9$ 9 subsection 7d77#a771 a specifi$ 
ph>macy 7z def9$ 9 subsection 7d77#b771 
or a p>ticipant1 b5efici>y1 or enrollee 
( su* plan or cov]age by impos+         
requirem5ts1 exclusions1 reimbursem5t   
t]ms1 or o!r conditions on su* entity or

 ph>macy t diff] f ^? appli$ to entities
 or ph>macies t are n cov]$ entities or 
specifi$ ph>macies on ! basis t ! entity
 or ph>macy is a cov]$ entity or        
specifi$ ph>macy or t ! entity or       
ph>macy disp5ses #cdj;,b drugs1 includ+ 
by tak+ any action prohibit$ "u         
subsection 7b74  7b7 ,specifi$ prohibit$
 actions ,a gr\p heal? plan1 a heal?    
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age1 or a ph>macy   
b5efit manag] may n discrim9ate aga9/ a 
cov]$ entity1 a specifi$ ph>macy1 or a  
p>ticipant1 b5efici>y1 or enrollee ( su*
 plan or cov]age by do+ any ( ! foll[+3 
7#a7 ,reimburs+ a cov]$ entity or       
specifi$ ph>macy = a quantity ( a       
#cdj;,b drug 7z def9$ 9 subsection 7d77 
9 an am\nt less ?an su* plan1 issu]1 or 
manag] 7z applicable7 w\ld pay to any   
o!r simil>ly situat$ 7z specifi$ by !   
,secret>y7 entity or ph>macy t is n a   
cov]$ entity or a specifi$ ph>macy = su*
 quantity ( su* drug on ! basis t !     
entity or ph>macy is a cov]$ entity or  

specifi$ ph>macy or t ! entity or       
ph>macy disp5ses #cdj;,b drugs4  7#b7   
,impos+ any t]ms or conditions on cov]$ 
entities or specifi$ ph>macies ) respect
 to any ( ! foll[+ t diff] f su* t]ms or
 conditions appli$ to o!r simil>ly      
situat$ entities or ph>macies t are n   
cov]$ entities or specifi$ ph>macies on 
! basis t ! entity or ph>macy is a cov]$
 entity or specifi$ ph>macy or t !      
entity or ph>macy disp5ses #cdj;,b      
drugs3 7,a7 ,fees1 *>gebacks1 clawbacks1
 adju/m5ts1 or o!r assessm5ts4  7,b7    
,pr(essional disp5s+ fees4  7,c7        
,re/rictions or requirem5ts reg>d+      
p>ticipation 9 /&>d or pref]r$ ph>macy  
networks4  7,d7 ,requirem5ts relat+ to !
 frequ5cy or scope ( audits or to       
inv5tory managem5t sy/ems us+ g5]ally   
accept$ acc\nt+ pr9ciples4  7,e7 ,any   
o!r re/rictions1 conditions1 practices1 
or policies t1 z specifi$ by !          
,adm9i/rator ( ! ,heal? ,res\rces &     
,s]vices ,adm9i/ration1 int]f]e ) !     
ability ( a cov]$ entity to maximize !  

value ( disc\nts provid$ "u section     
#cdj;,b4  7#c7 ,int]f]+ ) an            
individual's *oice to receive a #cdj;,b 
drug f a cov]$ entity or specifi$       
ph>macy1 :e!r 9 p]son or via direct     
deliv]y1 mail1 or o!r =m ( %ipm5t4  7#d7
 ,requir+ a cov]$ entity or specifi$    
ph>macy to id5tify1 ei!r directly or    
?r\gh a ?ird p>ty1 #cdj;,b drugs4  7#e7 
,refus+ to contract ) a cov]$ entity or 
specifi$ ph>macy = reasons o!r ?an ^? t 
apply equally to entities or ph>macies t
 are n cov]$ entities or specifi$       
ph>macies1 or on ! basis t-- 7,a7 !     
entity or ph>macy is a cov]$ entity or a
 specifi$ ph>macy2 or  7,b7 ! entity or 
ph>macy is describ$ 9 any ( subp>agraphs
 7,a7 ?r\gh 7,o7 ( section              
#cdj;,b7a77#d74  7#f7 ,) respect to a   
gr\p heal? plan or heal? insurance issu]
 = heal? insurance cov]age1 d5y+ cov]age
 ( a drug on ! basis t su* drug is a    
#cdj;,b drug4  7c7 ,en=cem5t me*anism = 
ph>macy b5efit manag]s ,! ,secret>y %all
 impose a civil monet>y p5alty on any   

ph>macy b5efit manag] t violates !      
requirem5ts ( ?is section4 ,su* p5alty  
%all n exce$ #e1jjj p] violation p] day4
 ,! ,secret>y %all issue propos$        
regulations to implem5t ?is subsection n
 lat] ?an #fj days aft] ! date ( !      
enactm5t ( ?is subsection & %all f9alize
 su* regulations n lat] ?an #ahj days   
aft] su* date ( enactm5t4  7d7          
,def9itions ,= purposes ( ?is section3  
7#a7 ,cov]$ entity ,! t]m cov]$ entity  
has ! mean+ giv5 su* t]m 9 section      
#cdj;,b7a77#d74  7#b7 ,specifi$ ph>macy 
,! t]m specifi$ ph>macy means a ph>macy 
) :i* a cov]$ entity has contract$ to   
disp5se #cdj;,b drugs on behalf ( !     
cov]$ entity :e!r di/ribut$ 9 p]son or  
via mail4  7#c7 #cdj;,b drug ,! t]m     
#cdj;,b drug means a drug t is-- 7,a7 a 
cov]$ outpati5t drug 7z def9$ = purposes
 ( section #cdj;,b72 &  7,b7 pur*as$ "u 
an agreem5t 9 effect "u su* section4  4 
7b7 ,application ( requirem5ts to       
,m$ic>e  7#a7 ,"p ,d ,section           
#ahfj;,d-#ab7;b7 ( ! ,social ,security  

,act 7#db ,u4,s4,c4 #aciew-#aab7;b77 is 
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#h7 ,application (          
requirem5ts relat+ to ! #cdj;,b drug    
disc\nt program ,ea* contract ent]$ into
 "u ?is subsection ) a ,,pdp sponsor    
%all provide t ! requirem5ts ( section  
#bgcj ( ! ,public ,heal? ,s]vice ,act   
apply to su* sponsor1 & to any ph>macy  
b5efit manag] t contracts ) su* sponsor1
 9 ! same mann] z su* requirem5ts apply 
) respect to a gr\p heal? plan1 a heal? 
insurance issu]1 or a ph>macy b5efit    
manag] describ$ 9 su* section4  4  7#b7 
,"p ,c ,section #aheg7;f77#c7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bg7;f77#c77 is am5d$ by add+ at 
! end ! foll[+ new subp>agraph3  7,e7   
#cdj;,b drug disc\nt program ,section   
#ahfj;,d-#ab7;b77#h74  4  7c7 ,m$icaid  
requirem5ts  7#a7 ,9 g5]al ,section     
#aibg ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acifr-#h7 is am5d$ by add+ at
 ! end ! foll[+ new subsection3  7l7    
,review ,to prev5t duplicate disc\nts   

7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! 
date ( ! enactm5t ( ?is subsection1 !   
,secret>y %all ent] into a contract ) a 
?ird-p>ty entity 7:o %all be free (     
conflicts ( int]e/1 z specifi$ by !     
,secret>y7 = purposes (-- 7,a7 id5tify+ 
claims = #cdj;,b drugs 7z def9$ 9       
section #bgcj7;d7 ( ! ,public ,heal?    
,s]vice ,act7 = :i* reimbursem5t 0 made 
"u a ,/ate plan 7or waiv] ( su* plan72 &
  7,b7 ensur+ su* claims are n includ$ 9
 any ,/ate rebate reque/ "u ?is section 
9 violation ( section                   
#cdj;,b7a77#e77;,a7 ( ! ,public ,heal?  
,s]vice ,act or section                 
#aijc7m77#b77;,a77xiii7 or              
#aibg7;j77#a74  7#b7 ,duties ( contract+
 entity  7,a7 ,9 g5]al ,! entity ) a    
contract 9 effect "u p>agraph 7#a7      
%all-- 7i7 reque/ & review1 9 ! mo/     
effici5t & lea/ burd5some mann]         
practicable-- 7,i7 claims level data f  
cov]$ entities 7z def9$ 9 section       
#cdj;,b ( ! ,public ,heal? ,s]vice ,act7
 itemiz+ #cdj;,b drugs disp5s$ to       

individuals enroll$ "u a ,/ate plan 7or 
waiv] ( su* plan72 &  7,,ii7 claims     
level rebate file data f ,/ate ag5cies  
adm9i/]+ su* plan 7or su* waiv]72  7ii7 
reque/1 receive1 & ma9ta9 data describ$ 
9 ei!r ( subclauses 7,i7 & 7,,ii7 (     
clause 7i7 9 a confid5tial mann]2 &     
7iii7 notify ! ,/ate & ! ,secret>y ( any
 violation describ$ 9 p>agraph 7#a77;,b7
 to ensure t su* violation is rem$i$4   
7,b7 ,retrospective submission ( data ,9
 reque/+ & review+ claims level data    
describ$ 9 subp>agraph 7,a77i77,i7 f a  
cov]$ entity1 ! entity ) a contract 9   
effect "u p>agraph 7#a7 %all all[ su*   
cov]$ entity ! option ( submitt+ su*    
data on a retrospective basis ?r\gh a   
data file or ano!r me?od t does n       
exclusively require po9t-(-sale         
id5tification4  4  7#b7 ,ensur+ access  
to in=mation  7,a7 ,cov]$ entity        
requirem5t ,section #cdj;,b7a77#e7 ( !  
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bef;b7a77#e77 is am5d$ by    
add+ at ! end ! foll[+ new subp>agraph3 

7,e7 ,provision ( in=mation to contract$
 entity = ,m$icaid claims review ,a     
cov]$ entity %all furni% to ! entity ) a
 contract 9 effect "u section #aibg7l7 (
 ! ,social ,security ,act1 ^u reque/ (  
su* entity1 ! data describ$ 9 p>agraph  
7#b77;,a77i7 ( su* section4  4  7,b7    
,/ate plan requirem5t ,section #aijb7;a7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acif;a7a77 is am5d$-- 7i7 9  
p>agraph 7#hf71 by /rik+ & at ! end2    
7ii7 9 p>agraph 7#hg77;,d71 by /rik+ !  
p]iod & ins]t+ 2 &2 &  7iii7 by ins]t+  
aft] p>agraph 7#hg7 ! foll[+ new        
p>agraph3  7#hh7 provide = a me*anism to
 furni% to ! entity ) a contract 9      
effect "u section #aibg7l71 ^u reque/ ( 
su* entity1 ! data describ$ 9 p>agraph  
7#b77;,a77ii7 ( su* section & remove f  
any rebate reque/ describ$ 9 p>agraph   
7#a77;,b7 ( su* section any claim t is !
 subject ( a notice submitt$ by su*     
entity "u p>agraph 7#b77;,c7 ( su*      
section4  4  7d7 ,prohibition on c]ta9  
use ( funds ,no funds appropriat$ "u any

 ,act may be us$ to implem5t ,executive 
,ord] #acicg publi%$ on ,july #bi1      
#bjbj1 or to o!rwise specify or limit ! 
am\nt t a cov]$ entity 7z def9$ 9       
section #cdj;,b7a77#d7 ( ! ,public      
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bef;b7a77#d777 *>ges pati5ts = #cdj;,b 
drugs 7z def9$ 9 section #bgcj7;d7 ( !  
,public ,heal? ,s]vice ,act1 z add$ by  
subsection 7a774