,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #cbhb  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #ae1 #bjbc,mrs4  
,h>%b>g] 7= h]self1 ,ms4 ,s*ri]1 ,mr4   
,bilirakis1 & ,ms4 ,s*ak[sky7 introduc$ 
! foll[+ bill2 :i* 0 ref]r$ to !        
,committee on ,ways & ,means1 & 9       
addition to ! ,committee on ,en]gy &    
,comm]ce1 = 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 ,,xviii ( !     
,social ,security ,act to promote       
transp>5cy ( common own]%ip int]e/s "u  
p>ts ,c & ,d ( ! ,m$ic>e program4  #a4  
,%ort title ,?is ,act may be cit$ z !   
,promot+ ,transp>5cy & ,heal?y          
,competition 9 ,m$ic>e ,act4  #b4       
,promot+ transp>5cy ( common own]%ip    
int]e/s "u p>ts ,c & ,d ( ! ,m$ic>e     
program  7a7 ,m$ic>e ,advantage ,section
 #aheg7;e7 ( ! ,social ,security ,act   
7#db ,u4,s4,c4 #aciew-#bg7;e77 is am5d$ 
by add+ at ! end ! foll[+ new p>agraph3 

7#f7 ,requir$ disclosure ( c]ta9        
in=mation relat+ to heal? c>e provid]   
own]%ip  7,a7 ,9 g5]al ,= plan ye>s     
beg9n+ on or aft] ,janu>y #a1 #bjbe1 a  
contract "u ?is section ) an ,,ma       
organization %all require ! organization
 to report to ! ,secret>y1 n lat] ?an #a
 ye> aft] ! la/ day ( su* plan ye>1 !   
in=mation describ$ 9 subp>agraph 7,b7 ) 
respect to su* plan ye>4  7,b7          
,in=mation describ$ ,= purposes (       
subp>agraph 7,a71 ! in=mation describ$ 9
 ?is subp>agraph is1 ) respect to an    
,,ma organization & a plan ye>1 !       
foll[+3 7i7 ,! numb] ( items & s]vices  
furni%$ dur+ su* plan ye> by ea*        
specifi$ provid] 7z def9$ 9 subp>agraph 
7,c77 = :i* paym5t 0 made by su*        
organization4  7ii7 ,! numb] ( items &  
s]vices furni%$ dur+ su* plan ye> by    
provid]s ( s]vices or suppli]s n        
describ$ 9 clause 7i7 = :i* paym5t 0    
made by su* organization4  7iii7 ,!     
av]age p]-enrollee numb] ( qualify+     
diagnoses 7z def9$ 9 subp>agraph 7,c77  

made dur+ su* plan ye> by specifi$      
provid]s 7includ+ ?r\gh *>t reviews &   
heal? risk assessm5ts7 ) respect to     
individuals enroll$ "u an ,,ma plan (f]$
 by su* organization1 brok5 d[n by site 
( s]vice ( su* provid]s1 z specifi$ by !
 ,secret>y4  7iv7 ,! av]age p]-enrollee 
numb] ( qualify+ diagnoses made dur+ su*
 plan ye> by provid]s ( s]vices &       
suppli]s n describ$ 9 clause 7iii7      
7includ+ ?r\gh su* reviews & assessm5ts7
 ) respect to su* individuals1 brok5 d[n
 by site ( s]vice ( su* provid]s4  7v7  
,! av]age risk score 7z calculat$ "u !  
me?odology describ$ 9 subp>agraph       
7,c77i77 = su* an individual = su* plan 
ye> :o receiv$ items & s]vices f a      
specifi$ provid] dur+ su* plan ye>4     
7vi7 ,! av]age risk score = su* an      
individual = su* plan ye> :o did n      
receive items & s]vices f a specifi$    
provid] dur+ su* plan ye>4  7vii7 ,!    
av]age risk score = su* an individual = 
su* plan ye> :o receiv$ a heal? risk    
assessm5t f an assessm5t entity t 0 a   

specifi$ assessm5t entity dur+ su* plan 
ye>4  7viii7 ,! av]age risk score = su* 
an individual = su* plan ye> :o receiv$ 
a heal? risk assessm5t f an assessm5t   
entity t 0 n a specifi$ assessm5t entity
 dur+ su* plan ye>4  7ix7 ,! numb] (    
prior au?orization reque/s = an item or 
s]vice submitt$ to su* organization dur+
 su* plan ye>1 ! numb] ( su* reque/s t 7
 approv$1 ! numb] ( su* reque/s t 7     
d5i$1 & ! numb] ( su* d5i$ reque/s t 7  
subsequ5tly appeal$ & !n approv$1 brok5 
d[n by :e!r ! entity propos+ to furni%  
su* item or s]vice 0 a specifi$ provid] 
or n a specifi$ provid]4  7x7 ,! total  
am\nt ( inc5tive-bas$ paym5ts made to1 &
 ! total am\nt ( %>$ losses rec\pm5ts   
collect$ f1 specifi$ provid]s dur+ su*  
plan ye>4  7xi7 ,! total am\nt (        
inc5tive-bas$ paym5ts made to1 & ! total
 am\nt ( %>$ losses rec\pm5ts collect$  
f1 provid]s ( s]vices & suppli]s n      
describ$ 9 clause 7x7 dur+ su* plan ye>4
  7xii7 ,= ea* ,,ma plan (f]$ by su*    
organization dur+ su* plan ye>-- 7,i7 ! 

total am\nt ( paym5ts made "u section   
#ahec7;a77#a7 to su* organization =     
cov]age ( individuals "u su* plan1 & !  
total am\nt ( paym5ts made by su*       
individuals to su* organization =       
cov]age "u su* plan2  7,,ii7 ! total    
am\nt exp5d$ "u su* plan z paym5t =     
items & s]vices furni%$ by ea* specifi$ 
provid] dur+ su* ye>2  7,,iii7 ! total  
am\nt exp5d$ "u su* plan z paym5t =     
items & s]vices furni%$ by provid]s (   
s]vices or suppli]s n describ$ 9        
subclause 7,,ii7 dur+ su* ye>2  7,,iv7 !
 m$ical loss ratio "u su* plan ) respect
 to individuals furni%$ an item or      
s]vice f a specifi$ provid] dur+ su*    
ye>2 &  7,v7 ! m$ical loss ratio "u su* 
plan ) respect to individuals n describ$
 9 subclause 7,,iv74  7,c7 ,def9itions  
,9 ?is p>agraph3 7i7 ,assessm5t entity  
,! t]m assessm5t entity means an entity 
) a focus on furni%+ 9-home m$ical      
assessm5ts1 z specifi$ by ! ,secret>y4  
7ii7 ,qualify+ diagnosis ,! t]m qualify+
 diagnosis means1 ) respect to an       

individual1 a diagnosis t is tak5 into  
acc\nt 9 calculat+ a risk score = su*   
individual "u ! risk adju/m5t me?odology
 e/abli%$ by ! ,secret>y pursuant to    
section #ahec7;a77#c74  7iii7 ,specifi$ 
assessm5t entity ,! t]m specifi$        
assessm5t entity means1 ) respect to an 
,,ma organization & a plan ye>1 an      
assessm5t entity ) respect to :i* su*   
organization 7or any p]son ) an own]%ip 
or control int]e/ 7z def9$ 9 section    
#aabd7;a77#c77 9 su* organization7 is a 
p]son ) an own]%ip or control int]e/ 7z 
s def9$74  7iv7 ,specifi$ provid] ,! t]m
 specifi$ provid] means1 ) respect to an
 ,,ma organization & a plan ye>1 a      
provid] ( s]vices or suppli] ) respect  
to :i* su* organization 7or any p]son ) 
an own]%ip or control int]e/ 7z def9$ 9 
section #aabd7;a77#c77 9 su*            
organization7 is a p]son ) an own]%ip or
 control int]e/ 7z s def9$74  7,d7      
,nonapplication ( ,pap]work ,r$uction   
,act ,*apt] #ce ( title #dd1 ,unit$     
,/ates ,code1 %all n apply to in=mation 

collect$ "u ?is p>agraph4  4  7b7       
,ph>macy b5efit manag] & ph>macy        
in=mation ,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>agraphs3  7#i7       
,provision ( in=mation relat+ to ph>macy
 own]%ip  7,a7 ,9 g5]al ,= plan ye>s    
beg9n+ on or aft] ,janu>y #a1 #bjbe1 a  
contract ent]$ into "u ?is "p ) a ,,pdp 
sponsor %all require ! sponsor to report
 to ! ,secret>y1 n lat] ?an #a ye> aft] 
! la/ day ( su* plan ye>1 ! in=mation   
describ$ 9 subp>agraph 7,b7 ) respect to
 su* plan ye>4  7,b7 ,in=mation describ$
 ,= purposes ( subp>agraph 7,a71 !      
in=mation describ$ 9 ?is subp>agraph is1
 = ea* prescription drug plan (f]$ by a 
,,pdp sponsor = a plan ye>1 ! foll[+3   
7i7 ,! negotiat$ price = ea* cov]$ "p ,d
 drug = :i* b5efits are available "u su*
 plan = ea* network ph>macy 7includ+ an 
id5tification ( :e!r ea* su* ph>macy is 
a specifi$ ph>macy74  7ii7 ,! av]age    
p]-drug am\nt ( direct & indirect       

remun]ation paid by specifi$ ph>macies =
 su* cov]$ "p ,d drugs disp5s$ dur+ su* 
plan ye> "u su* plan4  7iii7 ,! av]age  
p]-drug am\nt ( direct & indirect       
remun]ation paid by ph>macies n describ$
 9 clause 7ii7 = su* cov]$ "p ,d drugs  
disp5s$ dur+ su* plan ye> "u su* plan4  
7,c7 ,def9itions ,9 ?is p>agraph3 7i7   
,direct & indirect remun]ation ,! t]m   
direct & indirect remun]ation has !     
mean+ giv5 su* t]m 9 section #dbc4cjh ( 
title #db1 ,code ( ,f$]al ,regulations  
7or any successor regulation74  7ii7    
,network ph>macy ,! t]m network ph>macy 
has ! mean+ giv5 su* t]m 9 section      
#dbc4ajj ( title #db1 ,code ( ,f$]al    
,regulations 7or any successor          
regulation74  7iii7 ,negotiat$ price ,! 
negotiat$ price = a cov]$ "p ,d drug    
%all take into acc\nt all negotiat$     
price concessions1 su* z disc\nts1      
direct or indirect subsidies1 rebates1 &
 direct or indirect remun]ations1 = su* 
drug1 & include any disp5s+ fee = su*   
drug4  7iv7 ,specifi$ ph>macy ,! t]m    

specifi$ ph>macy means1 ) respect to an 
,,pdp sponsor & a plan ye>1 a ph>macy ) 
respect to :i* su* sponsor 7or any p]son
 ) an own]%ip or control int]e/ 7z def9$
 9 section #aabd7;a77#c77 9 su* sponsor7
 is a p]son ) an own]%ip or control     
int]e/ 7z s def9$74  7,d7               
,nonapplication ( ,pap]work ,r$uction   
,act ,*apt] #ce ( title #dd1 ,unit$     
,/ates ,code1 %all n apply to in=mation 
collect$ "u ?is p>agraph4  7#aj7        
,provision ( in=mation by ph>macy b5efit
 manag]s  7,a7 ,9 g5]al ,= plan ye>s    
beg9n+ on or aft] ,janu>y #a1 #bjbe1 a  
contract ent]$ into "u ?is "p ) a ,,pdp 
sponsor %all prohibit su* sponsor f     
ent]+ into a contract ) a specifi$      
ph>macy b5efit manag] = purposes ( p]=m+
 any s]vice ) respect to cov]$ "p ,d    
drugs disp5s$ "u any prescription drug  
plan (f]$ by su* sponsor = su* plan ye> 
unless su* manag] agrees to report to ! 
,secret>y1 n lat] ?an #a ye> aft] ! la/ 
day ( su* plan ye>1 ! in=mation describ$
 9 subp>agraph 7,b7 ) respect to ea*    

prescription drug plan = :i* su* manag] 
is provid+ any su* s]vice dur+ su* plan 
ye>1 reg>dless ( ! sponsor ( su* plan4  
7,b7 ,in=mation describ$ ,= purposes (  
subp>agraph 7,a71 ! in=mation describ$ 9
 ?is subp>agraph is1 ) respect to a     
ph>macy b5efit manag] p]=m+ s]vices "u a
 prescription drug plan = a plan ye>1 ! 
foll[+3 7i7 ,) respect to ! total am\nt 
( ph>macy & manufactur] rebates collect$
 by su* manag] 7or collect$ on behalf ( 
su* plan by any o!r entity ) a contract 
9 effect ) su* manag] = su* collection7 
= all cov]$ "p ,d drugs disp5s$ "u su*  
plan dur+ su* plan ye>-- 7,i7 ! total   
am\nt ( su* rebates pass$ ?r\gh to !    
,,pdp sponsor ( su* plan2 &  7,,ii7 !   
total am\nt ( su* rebates reta9$ by su* 
manag] or su* o!r entities4  7ii7 ,!    
total am\nt paid by su* manag] to       
ph>macies = drugs furni%$ "u su* plan   
dur+ su* plan ye>4  7iii7 ,! total am\nt
 ( paym5ts made by su* sponsor to su*   
manag] z reimbursem5t = su* manag]'s    
paym5ts describ$ 9 clause 7ii74  7iv7 ,!

 total am\nt ( paym5ts made by su*      
sponsor to su* manag] z fees = s]vices  
furni%$ by su* manag] ) respect to su*  
plan = su* plan ye> 7n includ+ paym5ts  
describ$ 9 clause 7iii774  7v7 ,! total 
am\nt ( adm9i/rative co/s incurr$ by su*
 manag] = furni%+ su* s]vices "u su*    
plan = su* plan ye>4  7vi7 ,a           
specification z to :e!r su* manag] is a 
specifi$ ph>macy b5efit manag] ) respect
 to ! ,,pdp sponsor ( su* plan4  7,c7   
,def9ition ,9 ?is p>agraph1 ! t]m       
specifi$ ph>macy b5efit manag] means1 ) 
respect to an ,,pdp sponsor & a plan    
ye>1 a ph>macy b5efit manag] ) respect  
to :i* su* sponsor 7or any p]son ) an   
own]%ip or control int]e/ 7z def9$ 9    
section #aabd7;a77#c77 9 su* sponsor7 is
 a p]son ) an own]%ip or control int]e/ 
7z s def9$74  4  7c7 ,publication ,n    
lat] ?an ,janu>y #a1 #bjbg1 ! ,secret>y 
( ,heal? & ,human ,s]vices %all e/abli% 
a process "u :i* in=mation submitt$ to !
 ,secret>y pursuant to ! am5dm5ts made  
by ?is section is publicly disclos$4    

,su* process %all ensure t any in=mation
 s disclos$ does n id5tify a specific   
drug manufactur]1 provid] ( s]vices or  
suppli]1 ph>macy1 ph>macy b5efit manag]1
 or any price *>g$ ) respect to a       
p>ticul> drug4