,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #dhhc  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #be1 #bjbc ,mr4 
,murphy 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   
require ! disclosure ( c]ta9 own]%ip    
in=mation relat+ to heal? c>e provid] & 
ph>macy own]%ip1 & = o!r purposes4  #a4 
,%ort title ,?is ,act may be cit$ z !   
,m$ic>e ,common ,own]%ip ,transp>5cy    
,act ( #bjbc4  #b4 ,report on           
integration 9 ,m$ic>e  7a7 ,requir$ ,,ma
 & ,,pdp report+  7#a7 ,,ma plans       
,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> #bjbe & = e ?ird plan ye> !reaft]1  
ea* ,,ma organization (f]+ an ,,ma plan 
"u ?is "p dur+ su* plan ye> %all submit 
to ! ,secret>y1 at a "t & 9 a mann]     
specifi$ by ! ,secret>y-- 7i7 ! taxpay] 
id5tification numb] = ea* heal? c>e     
provid] t 0 a specifi$ heal? c>e provid]
 ) respect to su* organization dur+ su* 
ye>2  7ii7 ! total am\nt ( inc5tive-bas$
 paym5ts made to1 & ! total am\nt ( %>$ 
losses rec\pm5ts collect$ f1 su*        
specifi$ heal? c>e provid]s dur+ su*    
plan ye>2 &  7iii7 ! 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 7ii7 dur+ su* plan    
ye>4  7,b7 ,def9ition ,= purposes ( ?is 
p>agraph1 ! t]m specifi$ heal? c>e      
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$74  4  7#b7 ,prescription drug   
plans ,section #ahfj;,d-#ab7;b7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#aab7;b77 is am5d$ by add+ at !  
end ! foll[+ new p>agraph3  7#i7        
,provision ( in=mation relat+ to ph>macy
 own]%ip  7,a7 ,9 g5]al ,= plan ye>     
#bjbe & = e ?ird plan ye> !reaft]1 ea*  
,,pdp sponsor (f]+ a prescription drug  
plan "u ?is "p dur+ su* plan ye> %all   
submit to ! ,secret>y1 at a "t & 9 a    
mann] specifi$ by ! ,secret>y1 ! taxpay]
 id5tification numb] & ,national        
,provid] ,id5tifi] = ea* ph>macy t 0 a  
specifi$ ph>macy ) respect to su*       
sponsor dur+ su* ye>4  7,b7 ,def9ition  
,= purposes ( ?is p>agraph1 ! t]m       
specifi$ ph>macy means1 ) respect to an 
,,pdp sponsor (f]+ a prescription drug  
plan & a plan ye>1 a ph>macy ) respect  
to :i*--  7i7 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$72 or  7ii7 a ph>macy  
b5efit manag] (f]+ s]vices "u su* plan  
7or any p]son ) an own]%ip or control   
int]e/ 7z s def9$7 9 su* sponsor7 is a  
p]son ) an own]%ip or control int]e/ 7z 
s def9$74  4  7b7 ,med,p,a,c reports ,"p
 ,e ( title ,,xviii ( ! ,social         
,security ,act 7#db ,u4,s4,c4 #aciex et 
seq47 is am5d$ by add+ at ! end ! foll[+
 new section3  #ahii;,c4 ,reports on    
v]tical integration "u ,m$ic>e  7a7 ,9  
g5]al ,n lat] ?an ,june #ae1 #bjbi1 & e 
#c ye>s !reaft]1 ! ,m$ic>e ,paym5t      
,advisory ,commission %all submit to    
,congress a report on ! /ate ( v]tical  
integration 9 ! heal? c>e sector dur+ ! 
applicable ye> ) respect to entities    
p>ticipat+ 9 ! ,m$ic>e program1 includ+ 
heal? c>e provid]s1 ph>macies1          
prescription drug plan sponsors1 ,m$ic>e
 ,advantage organizations1 & ph>macy    
b5efit manag]s4 ,su* report %all        
include--  7#a7 ) respect to ,m$ic>e    
,advantage organizations1 ! evaluation  

describ$ 9 subsection 7b72  7#b7 )      
respect to prescription drug plans1     
ph>macy b5efit manag]s1 & ph>macies1 !  
comp>isons & evaluations describ$ 9     
subsection 7c72  7#c7 ) respect to      
,m$ic>e ,advantage plans "u :i* b5efits 
are available = physician-adm9i/]$      
drugs1 ! in=mation describ$ 9 subsection
 7d72 &  7#d7 ! id5tifications describ$ 
9 subsection 7e72 &  7#e7 an analysis ( 
! impact ( su* integration on heal? c>e 
access1 price1 quality1 & outcomes4  7b7
 ,m$ic>e ,advantage organizations ,=    
purposes ( subsection 7a77#a71 !        
evaluation describ$ 9 ?is subsection is1
 ) respect to ,m$ic>e ,advantage        
organizations & an applicable ye>1 an   
evaluation1 tak+ into acc\nt pati5t     
acuity & ! types ( areas s]vic$ by su*  
organization1 (--  7#a7 ! av]age numb] (
 qualify+ diagnoses made dur+ su* ye> ) 
respect to enrollees ( a ,m$ic>e        
,advantage plan (f]$ by su* organization
 :o1 dur+ su* ye>1 receiv$ a heal? risk 
assessm5t f a specifi$ heal? c>e        

provid]2  7#b7 ! av]age risk score = su*
 enrollees :o receiv$ su* an assessm5t  
dur+ su* ye>2  7#c7 any relation%ip     
betwe5 su* risk scores = su* enrollees  
receiv+ su* an assessm5t f su* a provid]
 dur+ su* ye> & inc5tive paym5ts made to
 su* provid]s2  7#d7 ! av]age risk score
 = enrollees ( su* plan :o receiv$ any  
item or s]vice f a specifi$ heal? c>e   
provid] dur+ su* ye>2  7#e7 any         
relation%ip betwe5 ! risk scores (      
enrollees "u su* plan & :e!r ! enrollees
 h receiv$ any item or s]vice f a       
specifi$ provid]2 &  7#f7 any           
relation%ip betwe5 ! risk scores (      
enrollees "u su* plan t h receiv$ any   
item or s]vice f a specifi$ provid] &   
inc5tive paym5ts made "u ! plan to      
specifi$ provid]s4  7c7 ,prescription   
drug plans ,= purposes ( subsection     
7a77#b71 ! comp>isons & evaluations     
describ$ 9 ?is subsection are1 ) respect
 to prescription drug plans & an        
applicable ye>1 ! foll[+3 7#a7 ,= ea*   
cov]$ "p ,d drug = :i* b5efits are      

available "u su* a plan1 a comp>ison ( !
 av]age negotiat$ rate 9 effect )       
specifi$ ph>macies ) su* rates 9 effect 
= 9-network ph>macies t are n specifi$  
ph>macies4  7#b7 ,comp>isons ( ! foll[+3
 7,a7 ,! total am\nt paid by ph>macy    
b5efit manag]s to specifi$ ph>macies =  
cov]$ "p ,d drugs & ! total am\nt s paid
 to ph>macies t are n specifi$ ph>macies
 = su* drugs4  7,b7 ,! total am\nt paid 
by su* sponsors to specifi$ ph>macy     
b5efit manag]s z reimbursem5t = cov]$ "p
 ,d drugs & ! total am\nt s paid to     
ph>macy b5efit manag]s t are n specifi$ 
ph>macy b5efit manag]s z su*            
reimbursem5t4  7,c7 ,fees paid "u by    
plan to specifi$ ph>macy b5efit manag]s 
comp>$ to su* fees paid to ph>macy      
b5efit manag]s t are n specifi$ ph>macy 
b5efit manag]s4  7#c7 ,an evaluation ( !
 total am\nt ( direct & indirect        
remun]ation = cov]$ "p ,d drugs pass$   
?r\gh to prescription drug plan sponsors
 & ! total am\nt reta9$ by ph>macy      
b5efit manag]s 7includ+ entities "u     

contract ) su* a manag]74  7#d7 ,to !   
ext5t t ! available data p]mits1 an     
evaluation ( fees *>g$ by rebate        
aggregators t are affiliat$ ) plan      
sponsors4  7d7 ,physician-,adm9i/]$     
drugs ,= purposes ( subsection 7a77#c71 
! in=mation describ$ 9 ?is subsection   
is1 ) respect to physician-adm9i/]$     
drugs = :i* b5efits are available "u a  
,m$ic>e ,advantage plan dur+ an         
applicable ye>1 ! foll[+3 7#a7 ,)       
respect to ea* su* plan1 an             
id5tification ( ea* drug = :i* b5efits 7
 available "u su* plan only :5 adm9i/]$ 
by a heal? c>e provid] t acquir$ su*    
drug f an affiliat$ ph>macy4  7#b7 ,an  
evaluation ( ! diff]5ce betwe5 ! total  
numb] ( drugs adm9i/]$ by a heal? c>e   
provid] t 7 acquir$ f affiliat$         
ph>macies comp>$ to ! numb] ( su* drugs 
s adm9i/]$ t 7 acquir$ f ph>macies o!r  
?an affiliat$ ph>macies1 & an evaluation
 ( ! diff]5ce 9 paym5ts = su* drugs s   
adm9i/]$ :5 acquir$ f a specifi$ ph>macy
 & :5 acquir$ f a ph>macy t is n a      

specifi$ ph>macy4  7#c7 ,an evaluation (
 ! doll> value ( all su* drugs t 7 n s  
adm9i/]$ because ( a delay attributable 
to an affiliat$ ph>macy comp>$ to !     
doll> value ( all su* drugs t 7 n s     
adm9i/]$ because ( a delay attributable 
to ph>macy t is n an affiliat$ ph>macy4 
7#d7 ,! numb] ( enrollees adm9i/]$ su* a
 drug t 0 acquir$ f an affiliat$        
ph>macy4  7#e7 ,! numb] ( enrollees     
furni%$ su* a drug t 0 acquir$ f a      
ph>macy t is n an affiliat$ ph>macy4    
7e7 ,id5tifications ,= purposes (       
subsection 7a77#d71 ! id5tifications    
describ$ 9 ?is subsection are1 ) respect
 to an applicable ye>1 id5tifications ( 
ea* heal? c>e entity p>ticipat+ "u !    
,m$ic>e program ) respect to :i* ano!r  
heal? c>e entity s p>ticipat+ is a p]son
 ) an own]%ip or control int]e/ 7z def9$
 9 section #aabd7;a77#c7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acbj;a-#c7;a77#c7774  7f7 ,def9itions  
,9 ?is section3  7#a7 ,affiliat$ ph>macy
 ,! t]m affiliat$ ph>macy means1 )      

respect to a ,m$ic>e ,advantage plan    
(f]$ by a ,m$ic>e ,advantage            
organization1 a ph>macy ) respect to :i*
 su* organization 7or any p]son ) an    
own]%ip or control int]e/ 7z def9$ 9    
section #aabd7;a77#c77 9 su*            
organization7 is a p]son ) an own]%ip or
 control int]e/ 7z s def9$74  7#b7      
,applicable ye> ,! t]m applicable ye>   
means1 ) respect to a report submitt$ "u
 subsection 7a71 ! fir/ cal5d> ye>      
beg9n+ at lea/ #d ye>s prior to ! date (
 ! submission ( su* report4  7#c7 ,cov]$
 "p ,d drug ,! t]m cov]$ "p ,d drug has 
! mean+ giv5 su* t]m 9 section          
#ahfj;,d-#b7;e74  7#d7 ,direct &        
indirect remun]ation ,! t]m direct &    
indirect remun]ation has ! mean+ giv5   
su* t]m 9 section #dbc4cjh ( title #db1 
,code ( ,f$]al ,regulations 7or any     
successor regulation74  7#e7 ,qualify+  
diagnosis ,! t]m qualify+ diagnosis     
means1 ) respect to an enrollee ( a     
,m$ic>e ,advantage plan1 a diagnosis t  
is tak5 into acc\nt 9 calculat+ a risk  

score = su* enrollee "u ! risk adju/m5t 
me?odology e/abli%$ by ! ,secret>y      
pursuant to section #ahec7;a77#c74  7#f7
 ,risk score ,! t]m risk score means1 ) 
respect to an enrollee ( a ,m$ic>e      
,advantage plan1 ! score calculat$ = su*
 individual us+ ! me?odology describ$ 9 
p>agraph 7#e74  7#g7 ,physician-adm9i/]$
 drug ,! t]m physician-adm9i/]$ drug    
means a drug furni%$ to an individual t1
 _h su* individual be5 enroll$ "u "p ,b 
& n enroll$ "u "p ,c1 w\ld h be5 payable
 "u section #ahdb7o74  7#h7 ,specifi$   
heal? c>e provid] ,! t]m specifi$ heal? 
c>e provid] means1 ) respect to a       
,m$ic>e ,advantage plan (f]$ by a       
,m$ic>e ,advantage organization1 a heal?
 c>e provid] ) respect to :i* su*       
organization 7or any p]son ) an own]%ip 
or control int]e/ 7z def9$ 9 section    
#aabd7;a77#c77 9 su* organization7 is a 
p]son ) an own]%ip or control int]e/ 7z 
s def9$74  7#i7 ,specifi$ ph>macy ,! t]m
 specifi$ ph>macy means1 ) respect to a 
prescription drug plan (f]$ by a        

prescription drug plan sponsor1 a       
ph>macy ) respect to :i*-- 7,a7 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$72 or  7,b7 a ph>macy b5efit manag]
 (f]+ s]vices "u su* plan 7or any p]son 
) an own]%ip or control int]e/ 7z s     
def9$7 9 su* sponsor7 is a p]son ) an   
own]%ip or control int]e/ 7z s def9$74  
7#aj7 ,specifi$ ph>macy b5efit manag] ,!
 t]m specifi$ ph>macy b5efit manag]     
means1 ) respect to a prescription drug 
plan (f]$ by a prescription drug plan   
sponsor1 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