,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #ffji  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #aa1         
#bjbe,mr4 ,au*9closs 7= himself1 ,mrs4  
,h>%b>g]1 ,mr4 ,com]1 ,mr4 ,c>t] (      
,georgia1 ,mr4 ,ciscomani1 ,mr4 ,m\lton1
 ,mr4 ,deluzio1 ,mr4 ,pet]s1 ,ms4       
,tlaib1 ,ms4 ,budz9ski1 ,mr4            
,kri%namoor?i1 ,mr4 ,khanna1 ,mr4 ,lyn*1
 ,mr4 ,goldman ( ,texas1 ,mr4 ,coh51    
,ms4 ,pressley1 ,mr4 ,vic5te ,gonzalez (
 ,texas1 ,mr4 ,moore ( ,alabama1 ,mr4   
,subramanyam1 ,mr4 ,pocan1 ,mr4 ,bi%op1 
& ,ms4 ,mc,collum7 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  
titles ,,xi1 ,,xviii1 & ,,xix ( !       
,social ,security ,act to e/abli% c]ta9 
requirem5ts "u ,m$ic>e & ,m$icaid )     
respect to prescription drug b5efits &  

ph>macy b5efit manag]s4  #a4 ,%ort title
 ,?is ,act may be cit$ z ! ,ph>maci/s   
,fight ,back 9 ,m$ic>e & ,m$icaid ,act4 
#b4 ,e/abli%+ c]ta9 requirem5ts )       
respect to ,p,b,ms  7a7 ,m$ic>e  7#a7   
,prescription drug plans ,section       
#ahfj;,d-#ab ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciew-#aab7 is am5d$ by 
add+ at ! end ! foll[+ new subsection3  
7h7 ,requirem5ts relat+ to ph>macy      
b5efit manag]s ,= plan ye>s beg9n+ on or
 aft] ,janu>y #a1 #bjbg3 7#a7 ,9 g5]al  
,ea* contract ent]$ into ) a ,,pdp      
sponsor "u ?is "p ) respect to a        
prescription drug plan (f]$ by su*      
sponsor %all provide-- 7,a7 t ! sponsor 
7& any ph>macy b5efit manag] act+ on    
behalf ( su* sponsor1 includ+ any       
affiliate ( su* ,,pbm1 z applicable7--  
7i7 %all comply ) ! ph>macy paym5t      
requirem5ts describ$ 9 p>agraph 7#b72   
7ii7 %all comply ) ! rebate pass-?r\gh  
requirem5ts describ$ 9 p>agraph 7#c72   
7iii7 %all comply ) ! report+ requirem5t
 describ$ 9 p>agraph 7#d72 &  7iv7 may n

 engage 9 /e]+2 &  7,b7 t any ph>macy   
b5efit manag] act+ on behalf ( su*      
sponsor has a writt5 agreem5t ) ! ,,pdp 
sponsor "u :i* ! ,,pbm1 & any affiliate 
( su* ,,pbm1 z applicable1 agrees to    
meet ! requirem5ts describ$ 9           
subp>agraph 7,a74  7#b7 ,ph>macy paym5t 
requirem5ts ,= purposes ( p>agraph      
7#a77;,a77i71 ! ph>macy paym5t          
requirem5ts describ$ 9 ?is p>agraph are1
 ) respect to a ,,pdp sponsor 7& a ,,pbm
 act+ on behalf ( su* sponsor1 includ+  
any affiliate ( su* ,,pbm1 z applicable7
 ! foll[+3 7,a7 ,! sponsor1 ,,pbm1 or   
affiliate reimburses an 9-network       
ph>macy = ! +r$i5t co/ ( a cov]$ "p ,d  
drug 9 an am\nt equal to ! sum (-- 7i7 !
 national av]age drug acquisition co/ = 
! drug z ( ! day t ! ph>macy submits a  
claim = paym5t = su* drug 7z det]m9$    
bas$ ^u ! retail survey prices obta9$ "u
 section #aibg7;f77#a771 or1 9 ! case ( 
a drug = :i* no su* national av]age drug
 acquisition co/ is available1 !        
:olesale acquisition co/ = su* drug z ( 

su* day2 &  7ii7 an am\nt equal to #d   
p]c5t ( ! am\nt describ$ 9 clause 7i71  
or #ej1 :i*ev] is less4  7,b7 ,) respect
 to ea* cov]$ "p ,d drug obta9$ f an    
9-network ph>macy by an individual      
enroll$ 9 ! prescription drug plan1 !   
sponsor1 ,,pbm1 or affiliate-- 7i7 pays 
su* ph>macy a disp5s+ fee t is equal to 
! disp5s+ fee paid = su* drug "u ! ,/ate
 plan "u title ,,xix 9 ! ,/ate 9 :i* su*
 ph>macy is locat$1 z report$ by ! ,/ate
 "u section #aibg7;f77#b72 &  7ii7 does 
n require su* individual to reimburse   
su* disp5s+ fee or o!rwise increase !   
am\nt ow$ by su* individual ) respect to
 su* drug to acc\nt = su* disp5s+ fee4  
7,c7 ,! sponsor1 ,,pbm1 or affiliate    
does n impose any fee or o!r paym5t     
requirem5t ^u an 9-network ph>macy t    
w\ld h ! effect ( r$uc+ ! am\nt receiv$ 
by ! ph>macy "u ! o!r provisions ( ?is  
p>agraph4  7#c7 ,rebate pass-?r\gh      
requirem5ts ,= purposes ( p>agraph      
7#a77;,a77ii71 ! rebate pass-?r\gh      
requirem5ts describ$ 9 ?is p>agraph are1

 ) respect to a ,,pdp sponsor 7& a ,,pbm
 act+ on behalf ( su* sponsor1 includ+  
any affiliate ( su* ,,pbm1 z            
applicable71 t1 9 ! case t su* sponsor1 
,,pbm1 or affiliate receives a          
manufactur] rebate 9 connection ) a     
cov]$ "p ,d drug-- 7,a7 9 ! case t su*  
drug is obta9$ f an 9-network ph>macy by
 an individual enroll$ 9 ! prescription 
drug plan1 ! ,,pdp sponsor1 ,,pbm1 or   
affiliate applies1 at ! po9t ( sale (   
su* drug1 a r$uction to ! am\nt ( any   
co9surance or copaym5t ow$ by su*       
individual ) respect to su* drug1 su* t 
! am\nt ( co9surance or copaym5t s ow$  
is calculat$ bas$ on an am\nt equal to !
 reimbursem5t am\nt = su* drug det]m9$  
"u p>agraph 7#b77;,a71 less ! am\nt (   
su* rebate 7or1 9 ! case ( a rebate     
describ$ 9 p>agraph 7#e77;,b77ii71 !    
am\nt ( su* rebate t is attributable to 
su* drug & su* individual72 &  7,b7 9 ! 
case t ! entity receiv+ ! manufactur]   
rebate 9 connection ) su* drug is a     
,,pbm 7or any affiliate ( su* ,,pbm71 ! 

,,pbm 7or affiliate7 remits to ! ,,pdp  
sponsor an am\nt 79 ?is subp>agraph     
ref]r$ to z ! rebate remittance paym5t7 
equal to ! am\nt ( su* rebate 7or1 9 !  
case ( a rebate describ$ 9 p>agraph     
7#e77;,b77ii71 ! am\nt ( su* rebate t is
 attributable to su* drug & su*         
individual71 less ! am\nt by :i* !      
co9surance or copaym5t ow$ by an        
individual enroll$ 9 ! prescription drug
 plan ) respect to su* drug 0 r$uc$     
pursuant to subp>agraph 7,a72 &  7,c7 9 
! case t su* drug is obta9$ f an        
9-network ph>macy by an individual      
enroll$ 9 ! prescription drug plan :o is
 a subsidy eligible individual 7z def9$ 
9 section #ahfj;,d-#ad7;a77#c771 ! ,,pdp
 sponsor remits to ! ,secret>y1 at su*  
"t & 9 su* mann] z ! ,secret>y may      
specify-- 7i7 9 ! case t ! entity       
receiv+ ! manufactur] rebate 9          
connection ) su* drug is a ,,pbm 7or any
 affiliate ( su* ,,pbm71 ! am\nt receiv$
 by ! sponsor "u subp>agraph 7,b7 )     
respect to su* drug & su* individual2 & 

7ii7 9 ! case t ! entity receiv+ !      
manufactur] rebate 9 connection ) su*   
drug is ! ,,pdp sponsor1 an am\nt equal 
to ! am\nt ( su* rebate 7or1 9 ! case ( 
a rebate describ$ 9 p>agraph            
7#e77;,b77ii71 ! am\nt ( su* rebate t is
 attributable to su* drug & su*         
individual71 less ! am\nt by :i* !      
co9surance or copaym5t ow$ by su*       
individual ) respect to su* drug 0 r$uc$
 pursuant to subp>agraph 7,a74  7#d7    
,report+ requirem5t ,= purposes (       
p>agraph 7#a77;,a77iii71 ! report+      
requirem5t describ$ 9 ?is p>agraph is1 )
 respect to a ,,pbm & any affiliate (   
su* ,,pbm1 t1 n lat] ?an ,july #a1      
#bjbh1 & n less frequ5tly ?an annually  
!reaft]1 ! ,,pbm 7or affiliate7 submits 
to ! ,,pdp sponsor & to ! ,secret>y a   
report conta9+ a c]tification t1 dur+ ! 
prec$+ ye>1 su* ,,pbm 7or affiliate7--  
7,a7 compli$ ) ! requirem5ts "u         
p>agraphs 7#b7 & 7#c72 &  7,b7 did n    
engage 9 /e]+4  7#e7 ,def9itions ,=     
purposes ( ?is subsection3 7,a7         

,affiliate ,! t]m affiliate means1 )    
respect to a ,,pbm or ,,pdp sponsor1 an 
entity t1 directly or indirectly-- 7i7  
owns1 controls1 or has an inve/m5t      
int]e/ 9 su* ,,pbm or ,,pdp sponsor2    
7ii7 is own$ by su* ,,pbm or ,,pdp      
sponsor or controll$ by su* ,,pbm or    
,,pdp sponsor2  7iii7 t su* ,,pbm or    
,,pdp sponsor has an inve/m5t int]e/ 92 
or  7iv7 is "u common own]%ip or        
corporate control ( su* ,,pbm or ,,pdp  
sponsor4  7,b7 ,manufactur] rebate ,!   
t]m manufactur] rebate-- 7i7 means any  
price concession 7includ+ any paym5t1   
disc\nt1 adm9i/ration fee1 cr$it1       
inc5tive1 or p5alty7 provid$ by !       
manufactur] ( a cov]$ "p ,d drug 7or any
 affiliate1 subsidi>y1 ?ird p>ty1 or    
int]m$i>y ( su* manufactur]7 to a ,,pdp 
sponsor 7or any ,,pbm act+ on behalf (  
su* sponsor1 includ+ any affiliate ( su*
 ,,pbm1 z applicable71 9 connection ) ! 
furni%+ ( su* cov]$ "p ,d drug to an    
individual enroll$ 9 a prescription drug
 plan (f]$ by su* sponsor2 &  7ii7      

includes any su* price concession t is  
det]m9$ bas$ ^u-- 7,i7 ! aggregate      
volume ( su* cov]$ "p ,d drug 7or a gr\p
 ( cov]$ "p ,d drugs t includes su* "p  
,d drug7 furni%$ to individuals enroll$ 
9 a prescription drug plan (f]$ by su*  
sponsor2 or  7,,ii7 ! furni%+ ( any     
s]vice provid$ to ! manufactur] by su*  
sponsor 7or any ,,pbm act+ on behalf (  
su* sponsor1 or any affiliate ( su*     
,,pbm 7includ+ an (f-%ore entity or gr\p
 pur*as+ organization71 z applicable7 9 
connection ) ! furni%+ ( su* cov]$ "p ,d
 drug 7or a gr\p ( cov]$ "p ,d drugs t  
includes su* "p ,d drug74  7,c7 ,ph>macy
 b5efit manag]2 ,,pbm ,! t]ms ph>macy   
b5efit manag] & ,,pbm mean a p]son1     
bus9ess entity1 affiliate1 or o!r entity
 t p]=ms ph>macy b5efits managem5t      
s]vices4  7,d7 ,ph>macy b5efits         
managem5t s]vices ,! t]m ph>macy b5efits
 managem5t s]vices-- 7i7 means ! manag+ 
or adm9i/ration ( a plan or program t   
pays =1 reimburses1 & cov]s ! co/ (     
prescription drugs & m$ical devices2 &  

7ii7 includes ! process+ & paym5t (     
claims = prescription drugs & !         
adjudication ( appeals or grievances    
relat$ to qualifi$ prescription drug    
cov]age "u ?is "p4  7,e7 ,/e]+ ,! t]m   
/e]+ means1 ) respect to a ,,pdp sponsor
 7& any ,,pbm act+ on behalf ( su*      
sponsor1 includ+ any affiliate ( su*    
,,pbm1 z applicable7-- 7i7 direct+1     
ord]+1 or requir+ an enrollee 9 a       
prescription drug plan to use a specific
 ph>macy1 includ+ an affiliate ph>macy1 
= ! purpose ( fill+ a prescription = a  
cov]$ "p ,d drug or receiv+ s]vices f a 
ph>maci/2  7ii7 (f]+ or implem5t+ a     
prescription drug plan design t-- 7,i7  
requires an enrollee 9 a prescription   
drug plan to utilize a ph>macy1 includ+ 
an affiliate ph>macy2 or  7,,ii7        
increases co/s to ! ,,pdp sponsor or an 
enrollee1 includ+ by requir+ an enrollee
 to pay ! full co/ = a cov]$ "p ,d drug 
:5 su* enrollee *ooses n to use an      
affiliate ph>macy2  7iii7 adv]tis+1     
m>ket+1 or promot+ a ph>macy1 includ+ an

 affiliate ph>macy1 9 a mann] t         
enc\rages enrollees to *oose su* ph>macy
 ov] ano!r 9-network ph>macy2  7iv7     
creat+ m ?an "o network ( ph>macies )   
respect to a prescription drug plan su* 
t an 9-network ph>macy belong+ to a     
specific network 7su* z a pref]r$       
ph>macy network1 n>r[ ph>macy network1  
or specialty ph>macy network7 receives  
pref]5tial treatm5t1 or engag+ 9 any    
practice 7includ+ accr$itation or       
cr$5tial+ /&>ds1 day supply limitations1
 or deliv]y me?od limitations7 t has !  
effect ( exclud+ an 9-network ph>macy f 
p>ticipation 9 ! network ( ! ,,pdp      
sponsor or re/rict+ an 9-network ph>macy
 f fill+ a prescription = a cov]$ "p ,d 
drug2 or  7v7 engag+ 9 any practice t   
attempts to influ5ce or induce a        
manufactur] ( a cov]$ "p ,d drug to     
limit ! di/ribution ( su* drug to a     
small numb] ( ph>macies or c]ta9 types (
 ph>macies1 or to re/rict di/ribution ( 
su* drug to non-affiliate ph>macies4  4 
7#b7 ,requirem5t to d$uct expect$ rebate

 am\nts f plan bids ,section            
#ahfj;,d-#aa7;b77#b77;,c7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#aciew-#aaa7;b77#b77;,c77 is am5d$--    
7,a7 9 clause 7iii71 by /rik+ & at !    
end2  7,b7 by r$esignat+ clause 7iv7 z  
clause 7v72 &  7,c7 by ins]t+ aft]      
clause 7iii7 ! foll[+ new clause3  7iv7 
) respect to bids beg9n+ ) plan ye>     
#bjbg1 assumptions reg>d+ any rebate    
remittance paym5ts provid$ "u section   
#ahfj;,d-#ab7;h77#c77;,b71 subtract$ f !
 actu>ial value to produce su* bid2 &  4
  7#c7 ,,ma-,,pd plans ,section         
#aheg7;f77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#bg7;f77#c77 is  
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,f7 ,requirem5ts relat+  
to ph>macy b5efit manag]s ,= plan ye>s  
beg9n+ on or aft] ,janu>y #a1 #bjbg1    
section #ahfj;,d-#ab7;h74  4  7b7       
,m$icaid  7#a7 ,9 g5]al ,section #aibg (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acifr-#h7 is am5d$-- 7,a7 9 subsection
 7e71 by add+ at ! end ! foll[+ new     

p>agraph3  7#f7 ,requirem5ts relat$ to  
ph>macy b5efit manag]s ,a contract      
betwe5 ! ,/ate & a ph>macy b5efit       
manag]1 or a contract betwe5 ! ,/ate & a
 manag$ c>e entity or o!r specifi$      
entity 7z su* t]ms are def9$ 9 section  
#aijc7m77#i77;,d7 & collectively ref]r$ 
to 9 ?is p>agraph z ! entity7 t includes
 provisions mak+ ! entity responsible = 
cov]age ( cov]$ outpati5t drugs disp5s$ 
to individuals enroll$ ) ! entity1 %all 
require-- 7,a7 t ! entity or ,,pbm 7z   
applicable7 does n engage 9 /e]+2  7,b7 
t any paym5t made by ! entity or ! ,,pbm
 7z applicable7 = su* a drug & relat$   
adm9i/rative s]vices 7z applicable71    
includ+ paym5ts made by a ,,pbm on      
behalf ( ! ,/ate or entity1 is equal    
to-- 7i7 ! +r$i5t co/ ( su* drug1 :i*   
%all be 9 an am\nt equal to ! sum (--   
7,i7 ! national av]age drug acquisition 
co/ = ! drug z ( ! day t ! ph>macy      
submits a claim = paym5t = su* drug 7z  
det]m9$ bas$ ^u ! retail survey prices  
obta9$ "u subsection 7f77#a771 or1 9 !  

case ( a drug = :i* no su* national     
av]age drug acquisition co/ is          
available1 ! :olesale acquisition co/ = 
su* drug z ( su* day2 &  7,,ii7 an am\nt
 equal to #d p]c5t ( ! am\nt describ$ 9 
item 7aa71 or #ej1 :i*ev] is less2 &    
7ii7 a disp5s+ fee t is equal to !      
disp5s+ fee paid = su* drug "u ! ,/ate  
plan "u ?is title 9 ! ,/ate 9 :i* su*   
ph>macy is locat$1 z report$ by ! ,/ate 
"u subsection 7f77#b72 &  7,c7 t1 9 !   
case t ! entity or ,,pbm 7z applicable7 
receives f a manufactur] ( a cov]$      
outpati5t drug a rebate or disc\nt 9    
connection ) ! furni%+ ( su* drug to an 
individual enroll$ "u ! ,/ate plan 7or  
waiv] ( su* plan71 ! entity or ,,pbm    
remits to ! ,/ate an am\nt equal to !   
am\nt ( su* rebate4  2 &  7,b7 9        
subsection 7k71 by add+ at ! end !      
foll[+ new p>agraphs3  7#ac7 ,ph>macy   
b5efit manag]2 ,,pbm ,! t]ms ph>macy    
b5efit manag] & ,,pbm h ! mean+ giv5 su*
 t]ms 9 section #ahfj;,d-#ab7;h77,c74   
7#ad7 ,/e]+ ,! t]m /e]+ has ! mean+ giv5

 su* t]m 9 section #ahfj;,d-#ab7;h77,e71
 except t any ref]5ce 9 su* section to !
 ,,pdp sponsor is deem$ a ref]5ce to a  
manag$ c>e entity or o!r specifi$ entity
 7z su* t]ms are def9$ 9 section        
#aijc7m77#i77;,d77 t is responsible =   
cov]age ( cov]$ outpati5t drugs1 & any  
ref]5ce to a cov]$ "p ,d drug is deem$ a
 ref]5ce to a cov]$ outpati5t drug4  4  
7#b7 ,con=m+ am5dm5ts ,section #aijc7m7 
( su* ,act 7#db ,u4,s4,c4 #acif;b7m77 is
 am5d$-- 7,a7 9 p>agraph                
7#b77;,a77xiii7-- 7i7 by /rik+ & 7,,iii7
 & ins]t+ 7,,iii72  7ii7 by ins]t+ be=e 
! p]iod at ! end ! foll[+3 1 & 7,,iv7 if
 ! contract includes provisions mak+ !  
entity responsible = cov]age ( cov]$    
outpati5t drugs1 ! entity %all comply ) 
! requirem5ts ( section #aibg7;e77#f72 &
  7iii7 by mov+ ! m>g9 #b ems to ! left2
 &  7,b7 by add+ at ! end ! foll[+ new  
p>agraph3  7#aj7 ,no paym5t %all be made
 "u ?is title to a ,/ate ) respect to   
exp5ditures incurr$ by ! ,/ate = paym5t 
= s]vices provid$ by an o!r specifi$    

entity 7z def9$ 9 p>agraph              
7#i77;,d77iii77 unless su* s]vices are  
provid$ 9 accordance ) a contract betwe5
 ! ,/ate & su* entity :i* satisfies !   
requirem5ts ( p>agraph 7#b77;,a77xiii74 
4  7#c7 ,effective date ,! am5dm5ts made
 by ?is subsection %all apply to        
contracts betwe5 ,/ates & manag$ c>e    
entities1 o!r specifi$ entities1 or     
ph>macy b5efit manag]s t h an effective 
date beg9n+ on or aft] ,janu>y #a1      
#bjbg4  7c7 ,p5alties = noncompliant    
,p,b,ms  7#a7 ,crim9al p5alties ,section
 #aabh;,b ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acbj;a-#g;b7 is am5d$ by
 add+ at ! end ! foll[+ new subsection3 
7i7 ,:oev] provides ph>macy b5efits     
managem5t s]vices on behalf ( a         
prescription drug plan sponsor "u "p ,d 
( title ,,xviii or a m$icaid manag$ c>e 
organization "u title ,,xix &-- 7#a7    
kn[+ly & willfully fails to comply ) !  
ph>macy paym5t requirem5ts "u section   
#ahfj;,d-#ab7;h77#b7 or section         
#aibg7;e77#f77;,a71 z applicable2  7#b7 

kn[+ly & willfully engages 9 /e]+ 7z    
def9$ 9 section #ahfj;,d-#ab7;h772 or   
7#c7 kn[+ly & willfully fails to comply 
) ! rebate pass-?r\gh requirem5ts "u    
section #ahfj;,d-#ab7;h77#c7 or section 
#aibg7;e77#f77;,c71 z applicable1  %all 
be guilty ( a felony & ^u conviction    
!re( %all be f9$ n m ?an #a1jjj1jjj1 or 
imprison$ = n m ?an #aj ye>s1 or bo?4  4
  7#b7 ,civil monet>y p5alties ,section 
#aabh;,a7a7 ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acbj;a-#g;a7a77 is      
am5d$-- 7,a7 9 p>agraph 7#aj71 by add+  
or at ! end2  7,b7 by ins]t+ aft]       
p>agraph 7#aj7 ! foll[+ new p>agraph3   
7#aa7 commits an act describ$ 9 section 
#aabh;,b7i72  2 &  7,c7 9 ! fir/        
s5t5ce-- 7i7 by /rik+ or 9 cases "u     
p>agraph 7#i7 & ins]t+ 9 cases "u       
p>agraph 7#i72 &  7ii7 by /rik+ fact7 & 
ins]t+ fact1 or 9 cases "u p>agraph     
7#aa71 #a1jjj1jjj = ea* su* act74  7#c7 
,effective date ,! am5dm5ts made by ?is 
subsection %all apply beg9n+ on ,janu>y 
#a1 #bjbg4  #c4 ,improv+ prescription   

drug transp>5cy "u ! ,m$icaid program   
,section #aibg7;f7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifr-#h7;f77 is  
am5d$-- 7#a7 9 ! subsection head+1 by   
/rik+ retail & ins]t+ cov]$ outpati5t   
drug2 &  7#b7 9 p>agraph 7#a7-- 7,a7 9 !
 p>agraph head+1 by /rik+ retail &      
ins]t+ cov]$ outpati5t drug2  7,b7 9    
subp>agraph 7,a77i71 by /rik+ retail    
community ph>macy & ins]t+ ph>macy t    
disp5ses cov]$ outpati5t drugs1 includ+ 
a retail community ph>macy1 mail-ord]   
ph>macy1 specialty ph>macy1 nurs+ home  
ph>macy1 long-t]m c>e facility ph>macy1 
hospital ph>macy1 or cl9ic ph>macy 7b n 
includ+ a *>itable ph>macy or a         
n-=-pr(it ph>macy72  7,c7 9 subp>agraph 
7,c7-- 7i7 9 clause 7i7-- 7,i7 by /rik+ 
retail2 &  7,,ii7 by /rik+ prescription 
& ins]t+ cov]$ outpati5t2 &  7ii7 9     
clause 7ii71 by /rik+ retail community2 
7,d7 9 subp>agraph 7,d77ii71 by /rik+   
retail2  7,e7 9 subp>agraph 7,e71 by    
/rik+ ! t]m retail ea* place x appe>s2 &
  7,f7 by add+ at ! end ! foll[+ new    

subp>agraphs3  7,f7 ,survey report+ ,9  
ord] to meet ! requirem5t ( section     
#aijb7;a77#ed71 a ,/ate %all require t  
any ph>macy 9 ! ,/ate t receives any    
paym5t1 reimbursem5t1 adm9i/rative fee1 
disc\nt1 rebate1 or o!r price concession
 relat$ to ! disp5s+ ( a cov]$ outpati5t
 drug to an individual receiv+ b5efits  
"u ?is title1 reg>dless ( :e!r su*      
paym5t1 reimbursem5t1 fee1 disc\nt1     
rebate1 or o!r price concession is      
receiv$ directly f ! ,/ate or a manag$  
c>e entity or o!r specifi$ entity 7z su*
 t]ms are def9$ 9 section               
#aijc7m77#i77;,d771 or is receiv$       
indirectly f a ph>macy b5efits manag] or
 ano!r entity t has a contract ) ! ,/ate
 or a manag$ c>e entity or o!r specifi$ 
entity 7z s def9$7-- 7i7 %all respond to
 surveys conduct$ "u ?is p>agraph2 &    
7ii7 %all include 9 ea* su* response !  
ph>macy's acquisition price = ea* su*   
drug1 net ( all su* paym5ts1            
reimbursem5ts1 adm9i/rative fees1       
disc\nts1 rebates1 & o!r price          

concessions 7or1 9 ! case t ! ph>macy is
 unable to det]m9e ! net acquisition co/
 = su* a drug at ! "t t ! survey is     
receiv$1 ! ph>macy's negotiat$ price =  
su* drug74  7,g7 ,survey in=mation ,!   
,secret>y %all make in=mation on        
national drug acquisition prices obta9$ 
"u ?is p>agraph publicly available4 ,su*
 in=mation %all include at lea/ !       
foll[+3 7i7 ,! mon?ly response rate to !
 survey1 includ+ a li/ ( ph>macies n 9  
compliance ) subp>agraph 7,f74  7ii7 ,! 
sampl+ me?odology & numb] ( ph>macies   
sampl$ mon?ly4  7iii7 ,in=mation on     
price concessions to ea* ph>macy1       
includ+ disc\nts1 rebates1 & o!r price  
concessions1 to ! ext5t t su* in=mation 
is available dur+ ! survey p]iod4  7,h7 
,limitation on use ( applicable         
non-retail ph>macy pric+ in=mation ,no  
,/ate %all use pric+ in=mation report$  
by a ph>macy t is n a retail ph>macy to 
develop or in=m reimbursem5t rates =    
retail community ph>macies4  4