,,ii  #aah? ,,congress  #a/ ,session    
,s4 #cbde  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,novemb] #g1 #bjbc,mr4 
,w>n] 7= himself & ,mr4 ,cassidy7       
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title ,,xix
 ( ! ,social ,security ,act to require !
 ,secret>y ( ,heal? & ,human ,s]vices to
 conduct surveys ( non-retail ph>macy   
drug prices1 & = o!r purposes4  #a4     
,%ort title ,?is ,act may be cit$ z !   
,ensur+ ,accurate ,paym5ts to ,specialty
 ,ph>macies ,act4  #b4 ,ensur+ accurate 
paym5ts to ph>macies "u ,m$icaid  7a7 ,9
 g5]al ,section #aibg7;f7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acifr-#h7;f77 is am5d$-- 7#a7 by       
r$esignat+ p>agraphs 7#b7 ?r\gh 7#d7 z  
p>agraphs 7#c71 7#d71 & 7#f71           
respectively2  7#b7 by ins]t+ aft]      
p>agraph 7#a7 ! foll[+ new p>agraph3    
7#b7 ,det]m9+ applicable non-retail     
ph>macy actual acquisition co/s  7,a7 ,9
 g5]al ,! ,secret>y %all conduct a      

survey ( applicable non-retail ph>macy  
drug prices to det]m9e national av]age  
drug acquisition co/ b5*m>ks4 ,9        
conduct+ su* survey1 ! ,secret>y may    
contract s]vices =-- 7i7 ! det]m9ation (
 survey prices1 sep>ate f ! survey      
prices describ$ 9 p>agraph 7#a77;,a77i71
 ( ! applicable non-retail national     
av]age drug acquisition co/ = cov]$     
outpati5t drugs t repres5t a nationwide 
av]age ( consum] pur*ase prices = su*   
drugs1 net ( all disc\nts & rebates 7to 
! ext5t any in=mation ) respect to su*  
disc\nts & rebates is available7 bas$ on
 a mon?ly survey ( applicable non-retail
 ph>macies2 &  7ii7 at ! discretion ( ! 
,secret>y1 = ea* type ( applicable      
non-retail ph>macy 7z id5tifi$ pursuant 
to ! type indicators e/abli%$ by !      
,secret>y "u subsection                 
7k77#ab77;,b77ii771 ! det]m9ation (     
survey prices1 sep>ate f ! survey prices
 describ$ 9 p>agraph 7#a77;,a77i7 or    
clause 7i7 ( ?is subp>agraph1 ( !       
national av]age drug acquisition co/ =  

su* type ( ph>macy = cov]$ outpati5t    
drugs t repres5t a nationwide av]age (  
consum] pur*ase prices = su* drugs1 net 
( all disc\nts & rebates 7to ! ext5t any
 in=mation ) respect to su* disc\nts &  
rebates is available7 bas$ on a mon?ly  
survey ( su* ph>macies4  7,b7           
,application ( requirem5ts ,subp>agraphs
 7,c71 7,d71 & 7,e7 ( p>agraph 7#a7 %all
 apply to surveys ( non-retail ph>macy  
drug prices conduct$ "u ?is p>agraph 9 !
 same mann] z su* subp>agraphs apply to 
surveys ( retail ph>macy drug prices    
conduct$ "u subp>agraph 7#a74  7,c7     
,additional requirem5t ,9 addition to ! 
t]ms & conditions id5tifi$ 9 p>agraph   
7#a77;,d71 & su* o!r t]ms & conditions z
 ! ,secret>y %all specify1 a contract ) 
a v5dor "u ?is p>agraph %all require t !
 v5dor mu/ diff]5tiate1 9 collect+ &    
report+ survey data1 ! relevant ph>macy 
type indicator = all co/ in=mation      
collect$1 includ+ :e!r a ph>macy is own$
 by1 op]at$ by1 or o!rwise affiliat$ ) a
 ph>macy b5efit manag] & :e!r a ph>macy 

is an applicable non-retail ph>macy1 &1 
9 ! case ( an applicable non-retail     
ph>macy1 :i* type ( applicable          
non-retail ph>macy 7z id5tifi$ pursuant 
to ! type indicators e/abli%$ by !      
,secret>y "u subsection                 
7k77#ab77;,b77ii77 x is4  7,d7 ,survey  
report+ ,9 ord] to meet ! requirem5t (  
section #aijb7;a77#ed71 a ,/ate %all    
require t any applicable non-retail     
ph>macy 9 ! ,/ate t receives any paym5t1
 reimbursem5t1 adm9i/rative fee1        
disc\nt1 or rebate relat$ to ! disp5s+ (
 cov]$ outpati5t drugs to individuals   
receiv+ b5efits "u ?is title1 reg>dless 
( :e!r su* paym5t1 reimbursem5t1        
adm9i/rative fee1 disc\nt1 or rebate is 
receiv$ f ! ,/ate or a manag$ c>e entity
 or o!r specifi$ entity 7z su* t]ms are 
def9$ 9 section #aijc7m77#i77;,d77      
directly or f a ph>macy b5efit manag] or
 ano!r entity t has a contract ) ! ,/ate
 or a manag$ c>e entity or o!r specifi$ 
entity 7z s def9$71 %all respond to     
surveys conduct$ "u ?is p>agraph4  7,e7 

,survey in=mation ,in=mation on national
 drug acquisition prices obta9$ "u ?is  
p>agraph %all be made publicly available
 & %all include at lea/ ! foll[+3 7i7 ,!
 mon?ly response rate to ! survey       
includ+ a li/ ( applicable non-retail   
ph>macies n 9 compliance ) subp>agraph  
7,d74  7ii7 ,! sampl+ frame & numb] (   
applicable non-retail ph>macies sampl$  
mon?ly4  7iii7 ,in=mation on price      
concessions to applicable non-retail    
ph>macies1 includ+ disc\nts1 rebates1 & 
o!r price concessions1 to ! ext5t t su* 
in=mation may be publicly releas$ & has 
be5 collect$ by ! ,secret>y z "p ( !    
survey4  7,f7 ,p5alties ,! ,secret>y1 9 
consultation ) ! ,(fice ( ! ,inspector  
,g5]al ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices1 %all en=ce ! provisions ( ?is 
p>agraph ) respect to an applicable     
non-retail ph>macy ?r\gh ! e/abli%m5t ( 
appropriate civil monet>y p5alties1 :i* 
may be assess$ ) respect to ea*         
violation or survey non-response1 & )   
respect to ea* non-compliant applicable 

non-retail ph>macy 7includ+ a ph>macy t 
is "p ( a *a971 until compliance ) ?is  
p>agraph has be5 complet$4 ,! provisions
 ( section #aabh;,a 7o!r ?an subsections
 7a7 & 7b77 %all apply to a civil money 
p5alty "u ! prec$+ s5t5ce 9 ! same mann]
 z su* provisions apply to a civil money
 p5alty or proce$+ "u section           
#aabh;,a7a74  7,g7 ,limitation on use ( 
applicable non-retail ph>macy pric+     
in=mation ,no ,/ate %all use pric+      
in=mation report$ by applicable         
non-retail ph>macies "u subp>agraph 7,a7
 to develop or in=m reimbursem5t rates =
 retail community ph>macies4  2  7#c7 9 
p>agraph 7#c71 z s r$esignat$-- 7,a7 9  
subp>agraph 7,a71 by ins]t+ 1 includ+   
paym5t rates "u manag$ c>e entities or  
o!r specifi$ entities 7z su* t]ms are   
def9$ 9 section #aijc7m77#i77;,d771 aft]
 "u ?is title2 &  7,b7 9 subp>agraph    
7,b71 by ins]t+ & ! basis = su* disp5s+ 
fees be=e ! semicolon2  7#d7 by ins]t+  
aft] p>agraph 7#d71 z s r$esignat$1 !   
foll[+ new p>agraph3  7#e7 ,ov]sight    

7,a7 ,9 g5]al ,! ,inspector ,g5]al ( !  
,dep>tm5t ( ,heal? & ,human ,s]vices    
%all conduct p]iodic /udies ( ! survey  
data report$ "u ?is subsection1 z       
appropriate1 includ+ ) respect to       
sub/antial v>iations 9 acquisition co/s 
or o!r applicable co/s1 z well z )      
respect to h[ int]nal transf] prices &  
relat$ p>ty transactions may influ5ce ! 
co/s report$ by ph>macies affiliat$ )   
ph>macy b5efit manag]s1 :olesal]s1      
di/ributors1 & o!r entities t acquire   
cov]$ outpati5t drugs relative to co/s  
report$ by ph>macies n affiliat$ ) su*  
entities4 ,! ,inspector ,g5]al %all     
provide p]iodic updates to ,congress on 
! results ( su* /udies1 z appropriate1 9
 a mann] t does n disclose trade secrets
 or o!r propriet>y in=mation4  7,b7     
,appropriation ,!re is appropriat$ to ! 
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices1 out ( any money 9 ! 
,treasury n o!rwise appropriat$1        
#e1jjj1jjj = fiscal ye> #bjbd1 to rema9 
available until exp5d$1 to c>ry out ?is 

p>agraph4  2 &  7#e7 9 p>agraph 7#f71 z 
s r$esignat$1 by ins]t+ 1 & #i1jjj1jjj =
 fiscal ye> #bjbd & ea* fiscal ye>      
!reaft]1 aft] #bjaj4  7b7 ,def9itions   
,section #aibg7k7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acifr-#h7k77 is    
am5d$ by add+ ! foll[+--  7#ab7         
,applicable non-retail ph>macy  7,a7 ,9 
g5]al ,! t]m applicable non-retail      
ph>macy means a ph>macy t is lic5s$ z a 
ph>macy by ! ,/ate & t is n a retail    
community ph>macy1 includ+ a ph>macy t  
disp5ses prescription m$ications to     
pati5ts prim>ily ?r\gh mail & specialty 
ph>macies4 ,su* t]m does n include nurs+
 home ph>macies1 long-t]m c>e facility  
ph>macies1 hospital ph>macies1 cl9ics1  
*>itable or n-=-pr(it ph>macies1        
gov]nm5t ph>macies1 or l[ disp5s+       
ph>macies 7z def9$ by ! ,secret>y74     
7,b7 ,id5tification ( applicable        
non-retail ph>macies  7i7 ,9 g5]al ,=   
purposes ( subsection 7f71 ! ,secret>y  
%all1 n lat] ?an ,janu>y #a1 #bjbf1 9   
consultation ) /akehold]s z appropriate1

 issue guidance specify+ ph>macies t    
meet ! def9ition ( applicable non-retail
 ph>macies & t w1 beg9n+ ,janu>y #a1    
#bjbg1 be subject to ! survey           
requirem5ts "u subsection 7f77#b74  7ii7
 ,inclusion ( ph>macy type indicators ,!
 guidance promulgat$ "u clause 7i7 %all 
include ph>macy type indicators to      
di/+ui% betwe5 diff]5t types (          
applicable non-retail ph>macies1 su* z  
ph>macies t disp5se prescriptions       
prim>ily ?r\gh ! mail & ph>macies t     
disp5se prescriptions t require special 
h&l+ or di/ribution4 ,an applicable     
non-retail ph>macy may be id5tifi$ ?r\gh
 multiple ph>macy type indicators4      
7#ac7 ,ph>macy b5efit manag] ,! t]m     
ph>macy b5efit manag] means any p]son or
 entity t1 ei!r directly or ?r\gh an    
int]m$i>y1 acts z a price negotiator or 
gr\p pur*as] on behalf ( a ,/ate1 manag$
 c>e entity or o!r specifi$ entity 7z   
su* t]ms are def9$ 9 section            
#aijc7m77#i77;,d771 or manages !        
prescription drug b5efits provid$ by su*

 ,/ate1 manag$ c>e entity1 or o!r       
specifi$ entity1 includ+ ! process+ &   
paym5t ( claims = prescription drugs1 ! 
p]=mance ( drug utilization review1 !   
process+ ( drug prior au?orization      
reque/s1 ! manag+ ( appeals or          
grievances relat$ to ! prescription drug
 b5efits1 contract+ ) ph>macies1        
controll+ ! co/ ( cov]$ outpati5t drugs1
 or ! provision ( s]vices relat$ !reto4 
,su* t]m includes any p]son or entity t 
c>ries out #a or m ( ! activities       
describ$ 9 ! prec$+ s5t5ce1 irrespective
 ( :e!r su* p]son or entity calls itself
 a ph>macy b5efit manag]4  4  7c7       
,effective date ,! am5dm5ts made by ?is 
section take effect on ! fir/ day ( !   
fir/ qu>t] t beg9s on or aft] ! date t  
is #ah mon?s aft] ! date ( enactm5t (   
?is ,act4