,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #ecic  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,septemb] #ab1        
#bjbc,mr4 ,griffi? 7= himself & ,mr4    
,c>t] ( ,georgia7 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 ,,xviii ( ! ,social ,security ,act
 to ensure fair assessm5t ( ph>macy     
p]=mance & quality "u ,m$ic>e "p ,d1 & =
 o!r purposes4  #a4 ,ensur+ fair        
assessm5t ( ph>macy p]=mance & quality  
"u ,m$ic>e "p ,d  7a7 ,/&>diz$ ph>macy  
p]=mance measures ,section #ahfj;,d-#b (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciew-#ajb7 is am5d$ by add+ at ! end 
! foll[+ new subsection3  7f7           
,application ( /&>diz$ ph>macy p]=mance 
measures  7#a7 ,measures ,= plan ye>s   
beg9n+ on or aft] ,janu>y #a1 #bjbe1 a  

,,pdp sponsor (f]+ a prescription drug  
plan & an ,,ma organization (f]+ an     
,,ma-,,pd plan %all1 = purposes (       
inc5tive paym5ts1 price concessions1 or 
any fees or o!r remun]ation paid or *>g$
 to a ph>macy bas$ on p]=mance measures1
 only use measures t are-- 7,a7 e/abli%$
 or adopt$ by ! ,secret>y "u p>agraph   
7#b7 & includ$ on ! li/ describ$ 9      
subp>agraph 7,b7 ( su* p>agraph2 &  7,b7
 relevant to ! p]=mance ( su* ph>macy   
bas$ on ! type ( ph>macy 7includ+       
retail1 mail ord]1 specialty1 long-t]m  
c>e1 & home infusion or o!r types (     
ph>macies71 drugs disp5s$1 & ph>macy    
s]vices us$ to disp5se & manage drugs4  
7#b7 ,/&>diz$ ph>macy p]=mance measures 
7,a7 ,measures  7i7 ,9 g5]al ,not)/&+   
any o!r provision ( law1 ! ,secret>y    
%all e/abli% 7or adopt pursuant to      
clause 7iii77 /&>diz$ ph>macy p]=mance  
measures to be us$ by a ,,pdp sponsor   
(f]+ a prescription drug plan & an ,,ma 
organization (f]+ an ,,ma-,,pd plan = ! 
purpose ( det]m9+ inc5tive paym5ts1     

price concessions1 or fees describ$ 9   
p>agraph 7#a74  7ii7 ,requirem5ts ,!    
measures "u clause 7i7 %all focus on    
ph>macy p]=mance & quality ( c>e bas$ on
 ! type ( ph>macy1 z det]m9$ by !       
,secret>y4 ,su* measures %all be        
evid5ce-bas$1 feasible1 appropriate &   
reasonable4 ,! ,secret>y may rely on    
data & in=mation collect$ f relevant    
/akehold]s to make det]m9ations ab\t    
:e!r a measure satisfies ! requirem5ts (
 ?is clause4  7iii7 ,adoption ( measure 
,9 lieu ( e/abli%+ "s or all ( !        
measures "u ?is p>agraph1 ! ,secret>y   
may adopt measures & measure p]=mance   
crit]ia t are endors$ by #a or m        
multi-/akehold] cons5sus organizations  
7su* z ! ,ph>macy ,quality ,alliance71 t
 has p>ticipation f ph>macies 7includ+  
retail & specialty ph>macies n own$ or  
affiliat$ ) a plan1 ph>macy b5efit      
manag]1 or o!r ph>macy71 heal? plans1   
ph>macy b5efit manag]s1 & ! ,c5t]s =    
,m$ic>e  ,m$icaid ,s]vices4 ,any measure
 adopt$ "u ?is clause %all be deem$ to  

meet ! requirem5ts "u clause 7ii74  7,b7
 ,ma9t5ance ( li/  7i7 ,9 g5]al ,!      
,secret>y %all ma9ta91 & publi% on a    
publicly available int]net website1 a   
li/ ( measures e/abli%$ or adopt$ "u ?is
 p>agraph4 ,su* li/ %all initially be   
publi%$ no lat] ?an ,june #a1 #bjbd4    
7ii7 ,update ,! ,secret>y %all          
p]iodically evaluate measures1 measure  
crit]ia1 & h[ measures are appli$ by    
type ( ph>macy & update ! measures on ! 
li/ "u clause 7i7 to ensure su* measures
 meet ! requirem5ts "u subp>agraph      
7,a77ii74  7#c7 ,,oig reports on ph>macy
 p]=mance measures  7,a7 ,,oig /udy ,!  
,(fice ( ! ,inspector ,g5]al ( !        
,dep>tm5t ( ,heal? & ,human ,s]vices 79 
?is p>agraph ref]r$ to z ! ,inspector   
,g5]al7 %all conduct a /udy ( ! use (   
p]=mance measures & o!r quality-relat$  
me*anisms 9 network ph>macy agreem5ts & 
o!r relevant contract+ arrangem5ts among
 ,,pdp sponsors (f]+ a prescription drug
 plan1 ,,ma organizations (f]+ a        
,,ma-,,pd plan1 ph>macy b5efit manag]s  

act+ on behalf ( su* sponsors &         
organizations1 & network ph>macies4 ,su*
 /udy may include audits1 reviews (     
relevant en=cem5t actions1 consultation 
) relevant /akehold]s1 & o!r activities 
det]m9$ appropriate by ! ,inspector     
,g5]al1 consi/5t ) o!r provisions ( law4
 ,su* /udy %all1 to ! ext5t feasible1   
include analysis (-- 7i7 ov]sight &     
en=cem5t activities und]tak5 ) respect  
to curr5t /atutory & regulatory         
requirem5ts relat$ to network ph>macy   
agreem5ts1 includ+ "u sections          
#dbc4eje7;b77#ah7 & #dbc4eje7;i7 ( title
 #db ( ! ,code ( ,f$]al ,regulations 7or
 any successor regulation7 & "u section 
#ahfj;,d-#d7;b77#a77;,a72  7ii7 p5alties
 or o!r corrective actions impos$ )     
respect to ! requirem5ts describ$ 9     
clause 7i72  7iii7 ! preval5ce ( !      
application ( p]=mance measures 9       
network ph>macy agreem5ts1 & ! mann] 9  
:i* su* measures are appli$1 includ+    
v>iation bas$ on ! type ( ph>macy1 !    
type ( drug disp5s$1 & ! s]vices requir$

 to manage & disp5se su* drug2  7iv7 !  
ext5t to :i* ! p]=mance measures &      
relat$ crit]ia appli$ "u network        
agreem5ts v>y among simil> types (      
ph>macies )9 a s+le network1 & ! ext5t  
to :i* ! application ( su* measures or  
crit]ia diff] betwe5 ph>macies-- 7,i7   
affiliat$ ) a ph>macy b5efit manag]1 a  
,,pdp sponsor (f]+ a prescription drug  
plan1 or an ,,ma organization (f]+ a    
,,ma-,,pd plan2 &  7,,ii7 ^? n affiliat$
 ) an entity describ$ 9 subclause 7,i72 
7v7 patt]ns & tr5ds 9 ! p]=mance        
measures appli$ "u ph>macy network      
agreem5ts1 includ+ if ! measure is be+  
us$ 9 accordance ) publi%$ measure      
specifications :i* h be5 validat$ &     
te/$1 if ! measure is be+ us$ accord+ to
 lic5s+ agreem5ts ) measure /ew>ds1 & ! 
level ( attribution & attribution       
crit]ia2  7vi7 ! ext5t to :i* p]=mance  
measures result 9 inc5tive paym5ts1     
fees1 price concessions1 or o!r =ms (   
remun]ation betwe5 ph>macies & ,,pdp    
sponsors or ,,ma organizations 7or      

ph>macy b5efit manag]s act+ on _!       
behalf71 includ+ an analysis ( :i*      
measures mo/ (t5 result 9 inc5tive      
paym5ts to ph>macies 7& ! g5]al am\nt ( 
su* paym5ts7 & :i* measures mo/ (t5     
result 9 remun]ation paid by ph>macies  
to o!r entities 7& ! g5]al am\nt ( su*  
paym5ts72  7vii7 v>iation 9 ! type (    
remun]ation 7z describ$ 9 clause 7vi7   
result+ f ! application ( p]=mance      
measures1 includ+ betwe5 diff]5t types (
 ph>macies1 diff]5t types ( drugs       
disp5s$1 & affiliation /atus ( ph>macies
 7z describ$ 9 clause 7iv772  7viii7 :51
 9 :at mann]1 diff]5t types ( ph>macies 
receive notice ( ! application (        
p]=mance measures1 ! measures t w be    
utiliz$1 ! p]=mance crit]ia t w be      
appli$1 & ! data & me?odologies t w be  
us$ to evaluate p]=mance2 &  7ix7 !     
ext5t to :i* ! ,c5t]s = ,m$ic>e         
,m$icaid ,s]vices has implem5t$ !       
ph>macy p]=mance report+ requirem5ts (  
section #dbc4ead7;a77#e7 ( title #db1   
,code ( ,f$]al ,regulations1 ! ext5t to 

:i* ,,pdp sponsors or ,,ma organizations
 7or ph>macy b5efit manag]s act+ on _!  
behalf7 comply ) su* provision1 & !     
ext5t to :i* ! ,c5t]s = ,m$ic>e         
,m$icaid ,s]vices has s\ght en=cem5t4   
7,b7 ,,oig reports  7i7 ,report on      
initial f9d+s ,n lat] ?an ,decemb] #ca1 
#bjbd1 ! ,inspector ,g5]al %all submit a
 report to ,congress outl9+1 to ! ext5t 
practicable1 a /atus update on ! /udy "u
 subp>agraph 7,a71 toge!r ) initial     
f9d+s ) respect to ! issues includ$ "u  
su* /udy4 ,su* report may include an    
analysis ( b>ri]s to access+ any ( !    
in=mation requir$ "u su* /udy1 along )  
recomm5dations = address+ su* b>ri]s4   
,su* report may also include            
recomm5dations = ! effective            
implem5tation ( ! requirem5ts enact$ "u 
?is subsection z well z exi/+           
regulations1 includ+ section            
#dbc4ead7;a77#e7 ( title #db1 ,code (   
,f$]al ,regulations1 along ) o!r        
recomm5dations1 z det]m9$ appropriate by
 ! ,inspector ,g5]al4  7ii7 ,int]im     

report ,n lat] ?an ,july #ca1 #bjbe1 !  
,inspector ,g5]al %all submit to        
,congress an int]im report on ! /udy "u 
subp>agraph 7,a71 includ+ additional    
recomm5dations = ! implem5tation ( !    
requirem5ts enact$ "u ?is subsection z  
well z "u exi/+ regulations1 includ+    
section #dbc4ead7;a77#e7 ( title #db1   
,code ( ,f$]al ,regulations4  7iii7     
,f9al report ,n lat] ?an ,decemb] #ca1  
#bjbe1 ! ,inspector ,g5]al %all submit  
to ,congress a f9al report on ! /udy "u 
subp>agraph 7,a71 toge!r ) additional   
recomm5dations1 z det]m9$ appropriate by
 ! ,inspector ,g5]al4  7#d7             
,nonapplication ( pap]work r$uction act 
,*apt] #ce ( title #dd1 ,unit$ ,/ates   
,code1 %all n apply to any data         
collection und]tak5 by ! ,secret>y "u   
?is p>agraph4  4  7b7 ,fund+ ,9 addition
 to am\nts o!rwise available1 !re is    
appropriat$ to ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices ,program ,managem5t   
,acc\nt1 out ( any money 9 ! ,treasury n
 o!rwise appropriat$1 #d1jjj1jjj =      

fiscal ye> #bjbe1 to rema9 available    
until exp5d$1 to c>ry out ! am5dm5t made
 by subsection 7a74  #b4 ,promot+       
transp>5cy = ph>macies "u ,m$ic>e "p ,d 
7a7 ,transp>5cy = ph>macies ,section    
#ahfj;,d-#b7;f7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciew-#ajb7;f771 z 
add$ by section #c1 is am5d$ by add+ at 
! end ! foll[+ new p>agraph3  7#c7      
,transp>5cy = ph>macies  7,a7 ,9 g5]al  
,= plan ye>s beg9n+ on or aft] ,janu>y  
#a1 #bjbe1 a ,,pdp sponsor (f]+ a       
prescription drug plan & an ,,ma        
organization (f]+ an ,,ma-,,pd plan1 )  
respect to paym5t made by su* ,,pdp     
sponsor or su* ,,ma organization to a   
ph>macy = a cov]$ "p ,d drug disp5s$ by 
su* ph>macy dur+ a plan ye>1 %all       
promptly furni%1 ^u receiv+ a claim = a 
cov]$ ,"p ,d drug f a ph>macy1 to su*   
ph>macy in=mation relat$ to su* claim1  
su* z ! ,network ,reimbursem5t ,,id1    
fees1 ph>macy price concessions1        
disc\nts1 inc5tives1 or any o!r =ms (   
remun]ation t affect paym5t & pric+ ( ! 

claim4  7,b7 ,/&>diz$ =mat ,! ,,pdp     
sponsor & ! ,,ma organization %all      
furni% ! in=mation describ$ 9           
subp>agraph 7,a7 9 a /&>diz$ =mat 7z    
specifi$ by ! ,secret>y7 t includes all 
fields ne$$ to price ! claim = a cov]$  
"p ,d drug disp5s$ by su* ph>macy4  7,c7
 ,implem5tation ,! ,secret>y %all       
implem5t ?is p>agraph by program        
in/ruction or o!r =ms ( program         
guidance4  4  7b7 ,fund+ ,9 addition to 
am\nts o!rwise available1 !re is        
appropriat$ to ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices ,program ,managem5t   
,acc\nt1 out ( any money 9 ! ,treasury n
 o!rwise appropriat$1 #b1jjj1jjj =      
fiscal ye> #bjbe1 to rema9 available    
until exp5d$1 to c>ry out ! am5dm5t made
 by subsection 7a74