,,ii #aahth ,,congress #ast ,session ,s4 #bjeb ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #bj1 #bjbc ,mr4 ,tester 7for himself1 ,mrs4 ,capito1 ,mr4 ,brown1 and ,mr4 ,lankford7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to enforce any willing pharmacy requirements and establish safeguards to ensure patient access to pharmacies in ,medicare part ,d1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,protect ,patient ,access to ,pharmacies ,act4 #b4 ,establishing safeguards to ensure fair market competition for pharmacies in ,medicare part ,d ,section #ahfj;,d-#d7;b77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;b77#a77;,c77 is amended by adding at the end the following new clauses3 7v7 ,enforcing any willing provider requirements to support patient choice of pharmacy ,not later than ,september #cj1 #bjbd1 the ,secretary shall require that total payment 7including dispensing fees7 by a ,,pdp sponsor offering a prescription drug plan or ,,ma organization offering an ,,ma-,,pd plan for each covered part ,d drug dispensed to an enrollee by a network pharmacy 7including specialty pharmacies 7as defined under section #ahfj;,d-#b7;d77#d77;,e7771 net of any and all price concessions1 discounts1 fees of any type1 incentive payments1 or any other form of remuneration1 ensures that at a minimum1 such payment covers such pharmacy's costs to acquire and to dispense each covered part ,d drug so that such pharmacy may have the option to participate as a network provider1 which shall include the ability to acquire and dispense covered part ,d drugs and provide pharmacy services necessary for dispensing such drugs4 ,in carrying out this clause1 the ,secretary shall-- 7,i7 utilize pharmacy acquisition cost data on each type of pharmacy for each covered part ,d drug 7excluding drugs purchased under section #cdj;,b of the ,public ,health ,service ,act7 and cost to dispense data from each type of pharmacy 7including pharmacies not otherwise owned1 controlled1 or affiliated with any other pharmacy1 plan1 or pharmacy benefit manager72 7,,ii7 establish payment parameters for each covered part ,d drug that considers how the drug is dispensed and what pharmacy services are provided by each type of pharmacy to support drug management with the individual for whom the drug is dispensed2 and 7,,iii7 establish an appeal process in which the pharmacy may appeal payment1 in writing and with supporting documentation1 to the ,medicare ,pharmaceutical and ,technology ,ombudsman within #fj days following notification of the payment or any adjustment of such payment of such a drug1 if a network pharmacy believes that the amount a ,,pdp offering a prescription drug plan or an ,,ma organization offering an ,,ma-,,pd plan has paid for such drug is below the pharmacy's lowest actual acquisition and dispensing costs of such drug4 7vi7 ,utilization of pharmacy acquisition cost data ,with respect to the requirement under clause 7v77,i7 for the ,secretary to utilize pharmacy acquisition cost data-- 7,i7 the ,secretary shall utilize pharmacy acquisition cost data described in section #aibg7;f71 relating to a survey of retail prices2 and 7,,ii7 for each covered part ,d drug not included in the survey described in section #aibg7;f71 the ,secretary shall amend the survey or establish a survey4 4 #c4 ,ensuring fair assessment of pharmacy performance and quality ,section #ahfj;,d-#b7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;d77 is amended-- 7#a7 in paragraph 7#a77;,b71 by striking ,for purposes and inserting ,subject to paragraph 7#d71 for purposes2 and 7#b7 by adding at the end the following new paragraph3 7#d7 ,application of pharmacy performance measures 7,a7 ,evaluation of pharmacy performance measures ,not later than #f months after the date of enactment of this ,act1 and annually thereafter1 the ,secretary shall complete an evaluation of the performance measures used by ,,pdp sponsors offering prescription drug plans and ,,ma organizations offering ,,ma-,,pd plans to assess pharmacy price concessions or any other fees based on performance1 as established in network pharmacy agreements4 ,each such evaluation shall 7to the extent practicable7 include at least #e years of retrospective information to examine the following3 7i7 ,how measures are being applied to pharmacies1 including whether such measures are applied based on the type of pharmacy 7including specialty pharmacy71 drugs dispensed1 and pharmacy services used to dispense and manage drugs4 7ii7 ,whether1 with respect to each such measure1 such measure results in anything of value including any fees1 pharmacy price concessions1 discounts1 or incentives1 transferred to or received from a pharmacy by a ,,pdp sponsor offering a prescription drug plan or ,,ma organization offering an ,,ma-,,pd plan after the point-of-sale of a drug1 broken down by type of pharmacy and the drug dispensed4 7iii7 ,the extent to which each measure is applied across prescription drug plans offered by a ,,pdp sponsor and ,,ma-,,pd plans offered by an ,,ma organization and if such application is uniform4 7iv7 ,how measures are applied and if they are uniformly applied to all in-network types of pharmacies or only certain pharmacies within a network4 7v7 ,how and when pharmacies are provided notice of measures1 as well as methods and actual data calculations used to evaluate performance1 and evaluation outcomes by type of pharmacy4 7vi7 ,how pharmacy performance is evaluated using such measures and the extent to which the goals or targets are-- 7,i7 achievable at scale2 7,,ii7 structured to improve patient outcomes2 and 7,,iii7 reasonable in the context of industry data regarding baseline patient behavior1 such as improved patient outcomes and measure performance4 7,b7 ,application of standardized pharmacy performance measures ,for plan years beginning on or after ,january #a1 #bjbe1 a ,,pdp sponsor offering a prescription drug plan or an ,,ma organization offering an ,,ma-,,pd plan that makes incentive payments to a pharmacy1 or receives price concessions or any other remuneration paid by a pharmacy1 based on measures of the performance or quality of work of the pharmacy1 shall1 for the purposes of such incentive payments and price concessions or fees with respect to covered part ,d drugs dispensed by such pharmacy1 only use measures-- 7i7 on the most recently updated list maintained by the ,secretary under subparagraph 7,c71 as listed under clause 7ii7 of such subparagraph2 and 7ii7 that are relevant to the performance of such pharmacy based on the type of pharmacy1 drugs dispensed1 and pharmacy services used to dispense and manage drugs4 7,c7 ,standardized pharmacy performance measures 7i7 ,in general ,notwithstanding any other provision of law1 the ,secretary shall1 taking into account evaluations under subparagraph 7,a71 establish or adopt from one or more multi-stakeholder1 neutral1 consensus-based measure development organizations representing all types of pharmacies 7including pharmacies not otherwise owned1 controlled1 or affiliated with any other pharmacy1 plan1 or pharmacy benefit manager7 standardized pharmacy quality measures and performance criteria1 such as cut points1 or any type of payment to be used by a ,,pdp sponsor offering a prescription drug plan and an ,,ma organization offering an ,,ma-,,pd plan for the purposes of determining incentive payments and price concessions or fees described in subparagraph 7,b74 ,such measures shall be evidence-based1 feasible1 appropriate1 and achievable based on industry data1 and focus on pharmacy performance and quality of care1 as determined by the ,secretary1 that the pharmacy can impact based on covered part ,d drugs the pharmacy dispenses and manages4 7ii7 ,maintenance of list ,the ,secretary shall maintain a single list of measures established or adopted under this subparagraph4 ,such measures shall be evaluated and such list updated on an ongoing basis through stakeholder consensus organizations representing all types of pharmacies as referenced in clause 7i7 to ensure the measures on such list are evidence-based1 feasible1 appropriate1 and achievable4 ,such list shall be published on a public website not later than ,january #a1 #bjbd1 and updated thereafter as appropriate as determined by the ,secretary4 7,d7 ,transparency to pharmacy ,for plan years beginning on or after ,january #a1 #bjbe1 the ,secretary shall establish a uniform process under which a ,,pdp sponsor offering a prescription drug plan and an ,,ma organization offering an ,,ma-,,pd plan shall promptly disclose1 upon receiving a claim for a covered part ,d drug from a pharmacy1 to such pharmacy all pricing components related to such claim1 including the ,network ,reimbursement ,,id used to price the claim1 any service fees and other fees1 pharmacy price concessions1 discounts1 incentives or anything else of value to or from the pharmacy4 7,e7 ,specialty pharmacy ,for purposes of this subparagraph and section #ahfj;,d-#d7;b77#a77;,c71 not later than ,december #ca1 #bjbd1 the ,secretary shall define the term specialty pharmacy in consultation with all relevant stakeholders4 7,f7 ,definitions ,for purposes of this subparagraph3 7i7 ,affiliated ,the term affiliated means1 with respect to a pharmacy1 a ,,pdp sponsor offering a prescription drug plan1 or an ,,ma organization offering an ,,ma-,,pd plan1 that the pharmacy1 ,,pdp sponsor1 or ,,ma organization-- 7,i7 is directly or indirectly through one or more intermediaries wholly or partially owned by1 controlled by1 or is under common ownership of such pharmacy1 ,,pdp sponsor1 or ,,ma organization2 or 7,,ii7 has a financial interest in such pharmacy1 ,,pdp sponsor1 or ,,ma organization4 7ii7 ,type of pharmacy ,the term type of pharmacy means any type of pharmacy licensed by a ,state1 including a retail pharmacy1 specialty pharmacy1 and any other type of pharmacy specified by the ,secretary4 4 #d4 ,encouraging use of pharmacy performance measures through quality ratings ,section #ahec7o77#d77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7o77#d77;,a77 is amended-- 7#a7 by striking determination4--,the quality and inserting determination4-- 7i7 ,in general ,subject to clause 7ii71 the quality 2 and 7#b7 by adding at the end the following new clause3 7ii7 ,encouraging use of pharmacy performance measures 7,i7 ,in general ,in the case of a plan described in subclause 7,,ii71 with respect to the determination of quality ratings on or after ,january #a1 #bjbd1 the ,secretary shall provide for an increase in the quality rating otherwise determined under clause 7i7 in a manner determined appropriate by the ,secretary4 7,,ii7 ,plan described ,for purposes of subclause 7,i71 a plan described in this subclause is a prescription drug plan offered by a ,,pdp sponsor or an ,,ma-,,pd plan offered by an ,,ma organization that makes incentive payments to a pharmacy1 or receives price concessions or any other remuneration paid by a pharmacy1 based on measures of the performance or quality of work of the pharmacy4 4