,,ii  #aah? ,,congress  #a/ ,session    
,s4 #bjeb  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #bj1 #bjbc ,mr4  
,te/] 7= himself1 ,mrs4 ,capito1 ,mr4   
,br[n1 & ,mr4 ,lank=d7 introduc$ !      
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to am5d title ,,xviii ( ! ,social      
,security ,act to en=ce any will+       
ph>macy requirem5ts & e/abli% safegu>ds 
to ensure pati5t access to ph>macies 9  
,m$ic>e "p ,d1 & = o!r purposes4  #a4   
,%ort title ,?is ,act may be cit$ z !   
,protect ,pati5t ,access to ,ph>macies  
,act4  #b4 ,e/abli%+ safegu>ds to ensure
 fair m>ket competition = ph>macies 9   
,m$ic>e "p ,d ,section                  
#ahfj;,d-#d7;b77#a77;,c7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajd7;b77#a77;,c77 is am5d$ by   
add+ at ! end ! foll[+ new clauses3  7v7
 ,en=c+ any will+ provid] requirem5ts to
 support pati5t *oice ( ph>macy ,n lat] 
?an ,septemb] #cj1 #bjbd1 ! ,secret>y   
%all require t total paym5t 7includ+    

disp5s+ fees7 by a ,,pdp sponsor (f]+ a 
prescription drug plan or ,,ma          
organization (f]+ an ,,ma-,,pd plan =   
ea* cov]$ "p ,d drug disp5s$ to an      
enrollee by a network ph>macy 7includ+  
specialty ph>macies 7z def9$ "u section 
#ahfj;,d-#b7;d77#d77;,e7771 net ( any & 
all price concessions1 disc\nts1 fees ( 
any type1 inc5tive paym5ts1 or any o!r  
=m ( remun]ation1 ensures t at a m9imum1
 su* paym5t cov]s su* ph>macy's co/s to 
acquire & to disp5se ea* cov]$ "p ,d    
drug s t su* ph>macy may h ! option to  
p>ticipate z a network provid]1 :i* %all
 include ! ability to acquire & disp5se 
cov]$ "p ,d drugs & provide ph>macy     
s]vices necess>y = disp5s+ su* drugs4 ,9
 c>ry+ out ?is clause1 ! ,secret>y      
%all-- 7,i7 utilize ph>macy acquisition 
co/ data on ea* type ( ph>macy = ea*    
cov]$ "p ,d drug 7exclud+ drugs pur*as$ 
"u section #cdj;,b ( ! ,public ,heal?   
,s]vice ,act7 & co/ to disp5se data f   
ea* type ( ph>macy 7includ+ ph>macies n 
o!rwise own$1 controll$1 or affiliat$ ) 

any o!r ph>macy1 plan1 or ph>macy b5efit
 manag]72  7,,ii7 e/abli% paym5t        
p>amet]s = ea* cov]$ "p ,d drug t       
consid]s h[ ! drug is disp5s$ & :at     
ph>macy s]vices are provid$ by ea* type 
( ph>macy to support drug managem5t ) ! 
individual = :om ! drug is disp5s$2 &   
7,,iii7 e/abli% an appeal process 9 :i* 
! ph>macy may appeal paym5t1 9 writ+ & )
 support+ docum5tation1 to ! ,m$ic>e    
,ph>maceutical & ,te*nology ,ombudsman  
)9 #fj days foll[+ notification ( !     
paym5t or any adju/m5t ( su* paym5t (   
su* a drug1 if a network ph>macy        
believes t ! am\nt a ,,pdp (f]+ a       
prescription drug plan or an ,,ma       
organization (f]+ an ,,ma-,,pd plan has 
paid = su* drug is bel[ ! ph>macy's l[e/
 actual acquisition & disp5s+ co/s ( su*
 drug4  7vi7 ,utilization ( ph>macy     
acquisition co/ data ,) respect to !    
requirem5t "u clause 7v77,i7 = !        
,secret>y to utilize ph>macy acquisition
 co/ data-- 7,i7 ! ,secret>y %all       
utilize ph>macy acquisition co/ data    

describ$ 9 section #aibg7;f71 relat+ to 
a survey ( retail prices2 &  7,,ii7 =   
ea* cov]$ "p ,d drug n includ$ 9 !      
survey describ$ 9 section #aibg7;f71 !  
,secret>y %all am5d ! survey or e/abli% 
a survey4  4  #c4 ,ensur+ fair assessm5t
 ( ph>macy p]=mance & quality ,section  
#ahfj;,d-#b7;d7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciew-#ajb7;d77 is 
am5d$--  7#a7 9 p>agraph 7#a77;,b71 by  
/rik+ ,= purposes & ins]t+ ,subject to  
p>agraph 7#d71 = purposes2 &  7#b7 by   
add+ at ! end ! foll[+ new p>agraph3    
7#d7 ,application ( ph>macy p]=mance    
measures  7,a7 ,evaluation ( ph>macy    
p]=mance measures ,n lat] ?an #f mon?s  
aft] ! date ( enactm5t ( ?is ,act1 &    
annually !reaft]1 ! ,secret>y %all      
complete an evaluation ( ! p]=mance     
measures us$ by ,,pdp sponsors (f]+     
prescription drug plans & ,,ma          
organizations (f]+ ,,ma-,,pd plans to   
assess ph>macy price concessions or any 
o!r fees bas$ on p]=mance1 z e/abli%$ 9 
network ph>macy agreem5ts4 ,ea* su*     

evaluation %all 7to ! ext5t practicable7
 include at lea/ #e ye>s ( retrospective
 in=mation to exam9e ! foll[+3 7i7 ,h[  
measures are be+ appli$ to ph>macies1   
includ+ :e!r su* measures are appli$    
bas$ on ! type ( ph>macy 7includ+       
specialty ph>macy71 drugs disp5s$1 &    
ph>macy s]vices us$ to disp5se & manage 
drugs4  7ii7 ,:e!r1 ) respect to ea* su*
 measure1 su* measure results 9 any?+ ( 
value includ+ any fees1 ph>macy price   
concessions1 disc\nts1 or inc5tives1    
transf]r$ to or receiv$ f a ph>macy by a
 ,,pdp sponsor (f]+ a prescription drug 
plan or ,,ma organization (f]+ an       
,,ma-,,pd plan aft] ! po9t-(-sale ( a   
drug1 brok5 d[n by type ( ph>macy & !   
drug disp5s$4  7iii7 ,! ext5t to :i* ea*
 measure is appli$ across prescription  
drug plans (f]$ by a ,,pdp sponsor &    
,,ma-,,pd plans (f]$ by an ,,ma         
organization & if su* application is    
uni=m4  7iv7 ,h[ measures are appli$ &  
if !y are uni=mly appli$ to all         
9-network types ( ph>macies or only     

c]ta9 ph>macies )9 a network4  7v7 ,h[ &
 :5 ph>macies are provid$ notice (      
measures1 z well z me?ods & actual data 
calculations us$ to evaluate p]=mance1 &
 evaluation outcomes by type ( ph>macy4 
7vi7 ,h[ ph>macy p]=mance is evaluat$   
us+ su* measures & ! ext5t to :i* !     
goals or t>gets are-- 7,i7 a*ievable at 
scale2  7,,ii7 /ructur$ to improve      
pati5t outcomes2 &  7,,iii7 reasonable 9
 ! context ( indu/ry data reg>d+ basel9e
 pati5t behavior1 su* z improv$ pati5t  
outcomes & measure p]=mance4  7,b7      
,application ( /&>diz$ ph>macy p]=mance 
measures ,= plan ye>s beg9n+ on or aft] 
,janu>y #a1 #bjbe1 a ,,pdp sponsor (f]+ 
a prescription drug plan or an ,,ma     
organization (f]+ an ,,ma-,,pd plan t   
makes inc5tive paym5ts to a ph>macy1 or 
receives price concessions or any o!r   
remun]ation paid by a ph>macy1 bas$ on  
measures ( ! p]=mance or quality ( "w ( 
! ph>macy1 %all1 = ! purposes ( su*     
inc5tive paym5ts & price concessions or 
fees ) respect to cov]$ "p ,d drugs     

disp5s$ by su* ph>macy1 only use        
measures-- 7i7 on ! mo/ rec5tly updat$  
li/ ma9ta9$ by ! ,secret>y "u           
subp>agraph 7,c71 z li/$ "u clause 7ii7 
( su* subp>agraph2 &  7ii7 t are        
relevant to ! p]=mance ( su* ph>macy    
bas$ on ! type ( ph>macy1 drugs disp5s$1
 & ph>macy s]vices us$ to disp5se &     
manage drugs4  7,c7 ,/&>diz$ ph>macy    
p]=mance measures  7i7 ,9 g5]al ,not)/&+
 any o!r provision ( law1 ! ,secret>y   
%all1 tak+ into acc\nt evaluations "u   
subp>agraph 7,a71 e/abli% or adopt f "o 
or m multi-/akehold]1 neutral1          
cons5sus-bas$ measure developm5t        
organizations repres5t+ all types (     
ph>macies 7includ+ ph>macies n o!rwise  
own$1 controll$1 or affiliat$ ) any o!r 
ph>macy1 plan1 or ph>macy b5efit manag]7
 /&>diz$ ph>macy quality measures &     
p]=mance crit]ia1 su* z cut po9ts1 or   
any type ( paym5t to be us$ by a ,,pdp  
sponsor (f]+ a prescription drug plan & 
an ,,ma organization (f]+ an ,,ma-,,pd  
plan = ! purposes ( det]m9+ inc5tive    

paym5ts & price concessions or fees     
describ$ 9 subp>agraph 7,b74 ,su*       
measures %all be evid5ce-bas$1 feasible1
 appropriate1 & a*ievable bas$ on       
indu/ry data1 & focus on ph>macy        
p]=mance & quality ( c>e1 z det]m9$ by !
 ,secret>y1 t ! ph>macy c impact bas$ on
 cov]$ "p ,d drugs ! ph>macy disp5ses & 
manages4  7ii7 ,ma9t5ance ( li/ ,!      
,secret>y %all ma9ta9 a s+le li/ (      
measures e/abli%$ or adopt$ "u ?is      
subp>agraph4 ,su* measures %all be      
evaluat$ & su* li/ updat$ on an ongo+   
basis ?r\gh /akehold] cons5sus          
organizations repres5t+ all types (     
ph>macies z ref]5c$ 9 clause 7i7 to     
ensure ! measures on su* li/ are        
evid5ce-bas$1 feasible1 appropriate1 &  
a*ievable4 ,su* li/ %all be publi%$ on a
 public website n lat] ?an ,janu>y #a1  
#bjbd1 & updat$ !reaft] z appropriate z 
det]m9$ by ! ,secret>y4  7,d7           
,transp>5cy to ph>macy ,= plan ye>s     
beg9n+ on or aft] ,janu>y #a1 #bjbe1 !  
,secret>y %all e/abli% a uni=m process  

"u :i* a ,,pdp sponsor (f]+ a           
prescription drug plan & an ,,ma        
organization (f]+ an ,,ma-,,pd plan %all
 promptly disclose1 ^u receiv+ a claim =
 a cov]$ "p ,d drug f a ph>macy1 to su* 
ph>macy all pric+ compon5ts relat$ to   
su* claim1 includ+ ! ,network           
,reimbursem5t ,,id us$ to price ! claim1
 any s]vice fees & o!r fees1 ph>macy    
price concessions1 disc\nts1 inc5tives  
or any?+ else ( value to or f ! ph>macy4
  7,e7 ,specialty ph>macy ,= purposes ( 
?is subp>agraph & section               
#ahfj;,d-#d7;b77#a77;,c71 n lat] ?an    
,decemb] #ca1 #bjbd1 ! ,secret>y %all   
def9e ! t]m specialty ph>macy 9         
consultation ) all relevant /akehold]s4 
7,f7 ,def9itions ,= purposes ( ?is      
subp>agraph3  7i7 ,affiliat$ ,! t]m     
affiliat$ means1 ) respect to a ph>macy1
 a ,,pdp sponsor (f]+ a prescription    
drug plan1 or an ,,ma organization (f]+ 
an ,,ma-,,pd plan1 t ! ph>macy1 ,,pdp   
sponsor1 or ,,ma organization-- 7,i7 is 
directly or indirectly ?r\gh "o or m    

int]m$i>ies :olly or p>tially own$ by1  
controll$ by1 or is "u common own]%ip ( 
su* ph>macy1 ,,pdp sponsor1 or ,,ma     
organization2 or  7,,ii7 has a f9ancial 
int]e/ 9 su* ph>macy1 ,,pdp sponsor1 or 
,,ma organization4  7ii7 ,type ( ph>macy
 ,! t]m type ( ph>macy means any type ( 
ph>macy lic5s$ by a ,/ate1 includ+ a    
retail ph>macy1 specialty ph>macy1 & any
 o!r type ( ph>macy specifi$ by !       
,secret>y4  4  #d4 ,enc\rag+ use (      
ph>macy p]=mance measures ?r\gh quality 
rat+s ,section #ahec7o77#d77;,a7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bc7o77#d77;,a77 is am5d$-- 7#a7 
by /rik+ det]m9ation4--,! quality &     
ins]t+ det]m9ation4--  7i7 ,9 g5]al     
,subject to clause 7ii71 ! quality  2 & 
7#b7 by add+ at ! end ! foll[+ new      
clause3  7ii7 ,enc\rag+ use ( ph>macy   
p]=mance measures  7,i7 ,9 g5]al ,9 !   
case ( a plan describ$ 9 subclause      
7,,ii71 ) respect to ! det]m9ation (    
quality rat+s on or aft] ,janu>y #a1    
#bjbd1 ! ,secret>y %all provide = an    

increase 9 ! quality rat+ o!rwise       
det]m9$ "u clause 7i7 9 a mann] det]m9$ 
appropriate by ! ,secret>y4  7,,ii7     
,plan describ$ ,= purposes ( subclause  
7,i71 a plan describ$ 9 ?is subclause is
 a prescription drug plan (f]$ by a     
,,pdp sponsor or an ,,ma-,,pd plan (f]$ 
by an ,,ma organization t makes inc5tive
 paym5ts to a ph>macy1 or receives price
 concessions or any o!r remun]ation paid
 by a ph>macy1 bas$ on measures ( !     
p]=mance or quality ( "w ( ! ph>macy4  4