,,ii  #aaith ,,congress  #ast ,session  
,s4 #caei  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,november #g1  
#bjbe ,mr4 ,lankford 7for himself and   
,mr4 ,mullin7 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 temporarily provide  
for long-term care pharmacy supply fees 
in connection with the dispensing of    
certain drugs4  #a4  ,short title  ,this
 ,act may be cited as the ,preserving   
,patient ,access to ,long-,term ,care   
,pharmacies ,act4  #b4  ,long term care 
pharmacy supply fee  7a7  ,in general   
,section #ahfj;,d-#d7;b77#a7 of the     
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ajd7;b77#a77 is amended by      
adding at the end the following new     
subparagraph3  7,f7  ,long-term care    
pharmacy supply fees  7i7  ,plan        
reimbursement to pharmacy  7,i7  ,in    
general  ,for plan years #bjbf and      
#bjbg1 for each specified prescription  

dispensed by a long-term care pharmacy  
to an enrollee during such plan year1   
each ,,pdp sponsor of a prescription    
drug plan and each ,,ma organization    
offering an ,,ma-,,pd plan shall pay    
such pharmacy a supply fee in an amount 
equal to--  7aa7 for plan year #bjbf1   
#cj2 and  7bb7 for plan year #bjbg1 the 
amount of the supply fee for the prior  
plan year1 increased by the annual      
percentage increase described in section
 #ahfj;,d-#b7;b77#f74  7,,ii7           
,clarification  ,the supply fee under   
this subparagraph shall be paid at the  
same time and in addition to any other  
pharmacy reimbursements1 including      
ingredient costs1 dispensing fees1 or   
other payments negotiated between the   
,,pdp sponsor or ,,ma organization and  
the long-term care pharmacy1 and shall  
not result in a reduction to such other 
reimbursements4  7ii7  ,enforcement     
7,i7  ,civil money penalty  ,the        
,secretary shall impose a civil money   
penalty on each ,,pdp sponsor of a      

prescription drug plan and ,,ma         
organization offering an ,,ma-,,pd plan 
that fails to pay a supply fee for a    
specified prescription dispensed to an  
enrollee in accordance with this        
subparagraph for each such failure in an
 amount of not less than #aj1jjj4       
7,,ii7  ,application  ,the provisions of
 section #aabh;,a 7other than           
subsections 7a7 and 7b77 shall apply to 
a civil money penalty under this clause 
in the same manner as such provisions   
apply to a penalty or proceeding under  
section #aabh;,a7a74  7iii7             
,definitions  ,in this subparagraph3    
7,i7 ,applicable maximum fair price     
eligible individual ,the term applicable
 maximum fair price eligible individual 
means1 with respect to a specified      
prescription1 a maximum fair price      
eligible individual who1 with respect to
 such prescription1 is described in     
section #aaia7;c77#b77;,a74  7,,ii7     
,long-term care pharmacy  ,the term     
long-term care pharmacy means a pharmacy

 with a national provider identifier    
associated with taxonomy code           
#cccf,l#jjjc,x 7or a successor code71 as
 maintained by the ,national ,uniform   
,claim ,committee4  7,,iii7  ,maximum   
fair price  ,the term maximum fair price
 has the meaning given such term in     
section #aaia7;c77#c74  7,,iv7  ,maximum
 fair price eligible individual  ,the   
term maximum fair price eligible        
individual has the meaning given such   
term in section #aaia7;c77#b74  7,v7    
,specified prescription  ,the term      
specified prescription means a covered  
part ,d drug dispensed by a long-term   
care pharmacy to an applicable maximum  
fair price eligible individual at the   
maximum fair price pursuant to section  
#aaic7;a77#c77;,a74  4  7b7  ,repayment 
of long-,term pharmacy supply fees      
,section #ahfj;,d-#ae of the ,social    
,security ,act 7#db ,u4,s4,c4           
#aciew-#aae7 is amended by adding at the
 end the following new subsection3  7i7 
,repayment of long-,term pharmacy supply

 fees  7#a7  ,in general  ,in addition  
to amounts otherwise payable under this 
section to a ,,pdp sponsor of a         
prescription drug plan or an ,,ma       
organization offering an ,,ma-,,pd plan1
 for plan years #bjbf and #bjbg1 the    
,secretary shall provide the ,,pdp      
sponsor or ,,ma organization offering   
the plan subsidies in an amount equal to
 the aggregate amount of supply fees    
paid by such sponsor or organization to 
long-term care pharmacies pursuant to   
section #ahfj;,d-#d7;b77#a77;,f7 during 
the plan year4  7#b7  ,timing  ,the     
,secretary shall provide a subsidy under
 paragraph 7#a71 as applicable1 not     
later than #ah months following the end 
of the applicable plan year4  4  7c7    
,,gao study and report  7#a7  ,in       
general  ,not later than #ab months     
after the date of enactment of this     
section1 the ,comptroller ,general of   
the ,united ,states shall complete a    
study and submit to ,congress a report  
on the economic sustainability of the   

participation of long-term care         
pharmacies in the ,medicare prescription
 drug program4 ,such report shall       
include--  7,a7 an analysis of-- 7i7    
payment to long-term care pharmacies    
under the ,medicare prescription drug   
program with respect to--  7,i7         
ingredient costs-- 7aa7 for brand-name  
drugs2 and  7bb7 for generic drugs2 and 
7,,ii7 dispensing fees2  7ii7 the costs 
to long-term care pharmacies of         
compliance with the performance and     
service criteria for network long-term  
care pharmacies1 as described in the    
,medicare ,prescription ,drug ,benefit  
,manual2 and  7iii7 changes to payment  
to long-term care pharmacies under the  
,medicare prescription drug program     
during the #e-year period preceding the 
date of enactment of this section2 and  
7,b7 recommendations on steps that      
,congress and the ,secretary of ,health 
and ,human ,services should consider for
 purposes of creating a sustainable     
payment system under the ,medicare      

prescription drug program for long-term 
care pharmacies that would ensure that  
,medicare beneficiaries with long-term  
care needs have uninterrupted access to 
long-term care pharmacy services in all 
markets1 particularly rural markets4    
7#b7  ,definitions  ,in this subsection3
 7,a7 ,long-term care pharmacy ,the term
 long-term care pharmacy has the meaning
 given such term in subparagraph        
7,f77iii77,,ii7 of section              
#ahfj;,d-#d7;b77#a7 of the ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajd7;b77#a771 as added by       
subsection 7a74  7,b7  ,medicare        
beneficiary  ,the term ,medicare        
beneficiary means an individual who is  
entitled to benefits under part ,a of   
title ,,xviii of the ,social ,security  
,act 7#db ,u4,s4,c4 #acie;c et seq47 or 
enrolled under part ,b of such title    
7#db ,u4,s4,c4 #acie;j et seq474  7,c7  
,medicare prescription drug program     
,the term ,medicare prescription drug   
program means the program under part ,d 

of title ,,xviii of the ,social         
,security ,act 7#db ,u4,s4,c4           
#aciew-#aja et seq474