,,ii #aaith ,,congress #b;d ,session ,s4 #eehf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #bi1 #bjbf,mr4 ,warner 7for himself and ,mr4 ,cassidy7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to require the ,secretary of ,health and ,human ,services to conduct surveys of non-retail pharmacy drug prices1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,ensuring ,accurate ,payments to ,specialty ,pharmacies ,act4 #b4 ,ensuring accurate payments to pharmacies under ,medicaid 7a7 ,in general ,section #aibg7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;f77 is amended-- 7#a7 by redesignating paragraphs 7#b7 through 7#d7 as paragraphs 7#c71 7#d71 and 7#f71 respectively2 7#b7 by inserting after paragraph 7#a7 the following new paragraph3 7#b7 ,determining applicable non-retail pharmacy actual acquisition costs 7,a7 ,in general ,the ,secretary shall conduct a survey of applicable non-retail pharmacy drug prices to determine national average drug acquisition cost benchmarks4 ,in conducting such survey1 the ,secretary may contract services for-- 7i7 the determination of survey prices1 separate from the survey prices described in paragraph 7#a77;,a77i71 of the applicable non-retail national average drug acquisition cost for covered outpatient drugs that represent a nationwide average of consumer purchase prices for such drugs1 net of all discounts and rebates 7to the extent any information with respect to such discounts and rebates is available7 based on a monthly survey of applicable non-retail pharmacies2 and 7ii7 at the discretion of the ,secretary1 for each type of applicable non-retail pharmacy 7as identified pursuant to the type indicators established by the ,secretary under subsection 7k77#ab77;,b77ii771 the determination of survey prices1 separate from the survey prices described in paragraph 7#a77;,a77i7 or clause 7i7 of this subparagraph1 of the national average drug acquisition cost for such type of pharmacy for covered outpatient drugs that represent a nationwide average of consumer purchase prices for such drugs1 net of all discounts and rebates 7to the extent any information with respect to such discounts and rebates is available7 based on a monthly survey of such pharmacies4 7,b7 ,application of requirements ,subparagraphs 7,c71 7,d71 and 7,e7 of paragraph 7#a7 shall apply to surveys of non-retail pharmacy drug prices conducted under this paragraph in the same manner as such subparagraphs apply to surveys of retail pharmacy drug prices conducted under subparagraph 7#a74 7,c7 ,additional requirement ,in addition to the terms and conditions identified in paragraph 7#a77;,d71 and such other terms and conditions as the ,secretary shall specify1 a contract with a vendor under this paragraph shall require that the vendor must differentiate1 in collecting and reporting survey data1 the relevant pharmacy type indicator for all cost information collected1 including whether a pharmacy is owned by1 operated by1 or otherwise affiliated with a pharmacy benefit manager and whether a pharmacy is an applicable non-retail pharmacy1 and1 in the case of an applicable non-retail pharmacy1 which type of applicable non-retail pharmacy 7as identified pursuant to the type indicators established by the ,secretary under subsection 7k77#ab77;,b77ii77 it is4 7,d7 ,survey reporting ,in order to meet the requirement of section #aijb7;a77#ed71 a ,state shall require that any applicable non-retail pharmacy in the ,state that receives any payment1 reimbursement1 administrative fee1 discount1 or rebate related to the dispensing of covered outpatient drugs to individuals receiving benefits under this title1 regardless of whether such payment1 reimbursement1 administrative fee1 discount1 or rebate is received from the ,state or a managed care entity or other specified entity 7as such terms are defined in section #aijc7m77#i77;,d77 directly or from a pharmacy benefit manager or another entity that has a contract with the ,state or a managed care entity or other specified entity 7as so defined71 shall respond to surveys conducted under this paragraph4 7,e7 ,survey information ,information on national drug acquisition prices obtained under this paragraph shall be made publicly available and shall include at least the following3 7i7 ,the monthly response rate to the survey including a list of applicable non-retail pharmacies not in compliance with subparagraph 7,d74 7ii7 ,the sampling methodology and number of applicable non-retail pharmacies sampled monthly4 7iii7 ,information on price concessions to applicable non-retail pharmacies1 including discounts1 rebates1 and other price concessions1 to the extent that such information may be publicly released and has been collected by the ,secretary as part of the survey4 7,f7 ,penalties ,the ,secretary1 in consultation with the ,office of the ,inspector ,general of the ,department of ,health and ,human ,services1 shall enforce the provisions of this paragraph with respect to an applicable non-retail pharmacy through the establishment of appropriate civil monetary penalties1 which may be assessed with respect to each violation or survey non-response1 and with respect to each non-compliant applicable non-retail pharmacy 7including a pharmacy that is part of a chain71 until compliance with this paragraph has been completed4 ,the provisions of section #aabh;,a 7other than subsections 7a7 and 7b77 shall apply to a civil money penalty under the preceding sentence in the same manner as such provisions apply to a civil money penalty or proceeding under section #aabh;,a7a74 7,g7 ,limitation on use of applicable non-retail pharmacy pricing information ,no ,state shall use pricing information reported by applicable non-retail pharmacies under subparagraph 7,a7 to develop or inform reimbursement rates for retail community pharmacies4 2 7#c7 in paragraph 7#c71 as so redesignated-- 7,a7 in subparagraph 7,a71 by inserting 1 including payment rates under managed care entities or other specified entities 7as such terms are defined in section #aijc7m77#i77;,d771 after under this title2 and 7,b7 in subparagraph 7,b71 by inserting and the basis for such dispensing fees before the semicolon2 7#d7 by inserting after paragraph 7#d71 as so redesignated1 the following new paragraph3 7#e7 ,oversight 7,a7 ,in general ,the ,inspector ,general of the ,department of ,health and ,human ,services shall conduct periodic studies of the survey data reported under this subsection1 as appropriate1 including with respect to substantial variations in acquisition costs or other applicable costs1 as well as with respect to how internal transfer prices and related party transactions may influence the costs reported by pharmacies affiliated with pharmacy benefit managers1 wholesalers1 distributors1 and other entities that acquire covered outpatient drugs relative to costs reported by pharmacies not affiliated with such entities4 ,the ,inspector ,general shall provide periodic updates to ,congress on the results of such studies1 as appropriate1 in a manner that does not disclose trade secrets or other proprietary information4 7,b7 ,appropriation ,there is appropriated to the ,inspector ,general of the ,department of ,health and ,human ,services1 out of any money in the ,treasury not otherwise appropriated1 #e1jjj1jjj for fiscal year #bjbg1 to remain available until expended1 to carry out this paragraph4 2 and 7#e7 in paragraph 7#f71 as so redesignated1 by inserting 1 and #i1jjj1jjj for fiscal year #bjbg and each fiscal year thereafter1 after #bjaj4 7b7 ,definitions ,section #aibg7k7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7k77 is amended by adding the following-- 7#ab7 ,applicable non-retail pharmacy 7,a7 ,in general ,the term applicable non-retail pharmacy means a pharmacy that is licensed as a pharmacy by the ,state and that is not a retail community pharmacy1 including a pharmacy that dispenses prescription medications to patients primarily through mail and specialty pharmacies4 ,such term does not include nursing home pharmacies1 long-term care facility pharmacies1 hospital pharmacies1 clinics1 charitable or not-for-profit pharmacies1 government pharmacies1 or low dispensing pharmacies 7as defined by the ,secretary74 7,b7 ,identification of applicable non-retail pharmacies 7i7 ,in general ,for purposes of subsection 7f71 the ,secretary shall1 not later than ,january #a1 #bjbh1 in consultation with stakeholders as appropriate1 publish guidance specifying pharmacies that meet the definition of applicable non-retail pharmacies and that will be subject to the survey requirements under subsection 7f77#b74 7ii7 ,inclusion of pharmacy type indicators ,the guidance published under clause 7i7 shall include pharmacy type indicators to distinguish between different types of applicable non-retail pharmacies1 such as pharmacies that dispense prescriptions primarily through the mail and pharmacies that dispense prescriptions that require special handling or distribution4 ,an applicable non-retail pharmacy may be identified through multiple pharmacy type indicators4 7#ac7 ,pharmacy benefit manager ,the term pharmacy benefit manager means any person or entity that1 either directly or through an intermediary1 acts as a price negotiator or group purchaser on behalf of a ,state1 managed care entity 7as defined in section #aijc7m77#i77;,d771 or other specified entity 7as so defined71 or manages the prescription drug benefits provided by a ,state1 managed care entity1 or other specified entity1 including the processing and payment of claims for prescription drugs1 the performance of drug utilization review1 the processing of drug prior authorization requests1 the managing of appeals or grievances related to the prescription drug benefits1 contracting with pharmacies1 controlling the cost of covered outpatient drugs1 or the provision of services related thereto4 ,such term includes any person or entity acts as a price negotiator 7with regard to payment amounts to pharmacies and providers for a covered outpatient drug or the net cost of the drug7 or group purchaser on behalf of a ,state1 managed care entity1 or other specified entity or that carries out #a or more of the other activities described in the preceding sentence1 irrespective of whether such person or entity calls itself a pharmacy benefit manager4 4 7c7 ,effective date ,the amendments made by this section take effect on the first day of the first quarter that begins on or after the date that is #ah months after the date of enactment of this ,act4