,,ii  #aai? ,,congress  #a/ ,session    
,s4 #ibg  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #aa 7legislative  
day1 ,m>* #aj71 #bjbe,mr4 ,wel* 7=      
himself1 ,mr4 ,m>%all1 ,mr4 ,w>n]1 &    
,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 ensure accurate paym5ts to      
ph>macies "u ,m$icaid & to prev5t ! use 
( abusive spread pric+ practices "u     
,m$icaid4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,protect+ ,ph>macies 9     
,m$icaid ,act4  #b4 ,ensur+ accurate    
paym5ts to ph>macies "u ,m$icaid  7a7 ,9
 g5]al ,section #aibg7;f7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acifr-#h7;f77 is am5d$-- 7#a7 9        
p>agraph 7#a77;,a7-- 7,a7 by r$esignat+ 
clause 7ii7 z clause 7iii72 &  7,b7 by  
/rik+ & aft] ! semicolon at ! end (     
clause 7i7 & all t prec$es x ?r\gh 7#a7 
& ins]t+ ! foll[+3  7#a7 ,det]m9+       
ph>macy actual acquisition co/s ,!      

,secret>y %all conduct a survey ( retail
 community ph>macy drug prices &        
applicable non-retail ph>macy drug      
prices to det]m9e national av]age drug  
acquisition co/ b5*m>ks 7z su* t]m is   
def9$ by ! ,secret>y7 z foll[s3 7,a7    
,use ( v5dor ,! ,secret>y may contract  
s]vices =-- 7i7 ) respect to retail     
community ph>macies1 ! det]m9ation (    
retail survey prices ( ! national av]age
 drug acquisition co/ = cov]$ outpati5t 
drugs t repres5t a nationwide av]age (  
consum] pur*ase prices = su* drugs1 net 
( all disc\nts1 rebates1 & o!r price    
concessions 7to ! ext5t any in=mation ) 
respect to su* disc\nts1 rebates1 & o!r 
price concessions is available7 bas$ on 
a mon?ly survey ( su* ph>macies2 &  7ii7
 ) respect to applicable non-retail     
ph>macies-- 7,i7 ! det]m9ation ( survey 
prices1 sep>ate f ! survey prices       
describ$ 9 clause 7i71 ( ! 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\nts1 
rebates1 & o!r price concessions 7to !  
ext5t any in=mation ) respect to su*    
disc\nts1 rebates1 & o!r price          
concessions is available7 bas$ on a     
mon?ly survey ( su* ph>macies2 &  7,,ii7
 at ! discretion ( ! ,secret>y1 = ea*   
type ( applicable non-retail ph>macy1 ! 
det]m9ation ( survey prices1 sep>ate f !
 survey prices describ$ 9 clause 7i7 or 
subclause 7,i7 ( ?is clause1 ( !        
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\nts1 rebates1 & o!r price    
concessions 7to ! ext5t any in=mation ) 
respect to su* disc\nts1 rebates1 & o!r 
price concessions is available7 bas$ on 
a mon?ly survey ( su* ph>macies2 &  2   
7#b7 9 subp>agraph 7,b7 ( p>agraph 7#a71
 by /rik+ subp>agraph 7,a77ii7 & ins]t+ 
subp>agraph 7,a77iii72  7#c7 9          
subp>agraph 7,d7 ( p>agraph 7#a71 by    
/rik+ clauses 7ii7 & 7iii7 & ins]t+ !   

foll[+3  7ii7 ,! v5dor mu/ update !     
,secret>y no less (t5 ?an mon?ly on !   
survey prices = cov]$ outpati5t drugs4  
7iii7 ,! v5dor mu/ diff]5tiate1 9       
collect+ & report+ survey data1 = all   
co/ in=mation collect$1 :e!r a ph>macy  
is a retail community ph>macy or an     
applicable non-retail ph>macy1 includ+  
:e!r su* ph>macy is an affiliate 7z     
def9$ 9 subsection 7k77#ad771 &1 9 !    
case ( an applicable non-retail ph>macy1
 :i* type ( applicable non-retail       
ph>macy x is us+ ! relevant ph>macy type
 indicators includ$ 9 ! guidance requir$
 by subsection 7d77#b7 ( section #b ( ! 
,protect+ ,ph>macies 9 ,m$icaid ,act4  2
  7#d7 by add+ at ! end ( p>agraph 7#a7 
! foll[+3  7,f7 ,survey report+ ,9 ord] 
to meet ! requirem5t ( section          
#aijb7;a77#ed71 a ,/ate %all require t  
any retail community ph>macy or         
applicable non-retail ph>macy 9 ! ,/ate 
t receives any paym5t1 reimbursem5t1    
adm9i/rative fee1 disc\nt1 rebate1 or   
o!r price concession relat$ to ! disp5s+

 ( cov]$ outpati5t drugs to individuals 
receiv+ b5efits "u ?is title1 reg>dless 
( :e!r su* paym5t1 reimbursem5t1        
adm9i/rative fee1 disc\nt1 rebate1 or   
o!r price concession 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,g7 ,survey         
in=mation ,in=mation on national drug   
acquisition prices obta9$ "u ?is        
p>agraph %all be made publicly available
 9 a =m & mann] to be det]m9$ by !      
,secret>y & %all include at lea/ !      
foll[+3 7i7 ,! mon?ly response rate to !
 survey 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 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,h7 ,p5alties  7i7 ,9 g5]al ,subject 
to clauses 7ii71 7iii71 & 7iv71 !       
,secret>y %all en=ce ! provisions ( ?is 
p>agraph ) respect to a ph>macy ?r\gh ! 
e/abli%m5t ( civil money p5alties       
applicable to a retail community ph>macy
 or an applicable non-retail ph>macy4   
7ii7 ,basis = p5alties ,! ,secret>y %all
 impose a civil money p5alty e/abli%$ "u
 ?is subp>agraph on a retail community  
ph>macy or applicable non-retail ph>macy
 if-- 7,i7 ! retail ph>macy or          
applicable non-retail ph>macy refuses or
 o!rwise fails to respond to a reque/ = 
in=mation ab\t prices 9 connection ) a  
survey "u ?is subsection2  7,,ii7 kn[+ly
 provides false in=mation 9 response to 
su* a survey2 or  7,,iii7 o!rwise fails 
to comply ) ! requirem5ts e/abli%$ "u   
?is p>agraph4  7iii7 ,p>amet]s =        
p5alties  7,i7 ,9 g5]al ,a civil money  
p5alty e/abli%$ "u ?is subp>agraph may  

be assess$ ) respect to ea* violation1 &
 ) respect to ea* non-compliant retail  
community ph>macy 7includ+ a ph>macy t  
is "p ( a *a97 or non-compliant         
applicable non-retail ph>macy 7includ+ a
 ph>macy t is "p ( a *a971 9 an am\nt n 
to exce$ #ajj1jjj = ea* su* violation4  
7,,ii7 ,consid]ations ,9 det]m9+ ! am\nt
 ( a civil money p5alty impos$ "u ?is   
subp>agraph1 ! ,secret>y may consid] !  
size1 bus9ess /ructure1 & type ( ph>macy
 involv$1 z well z ! type ( violation & 
o!r relevant factors1 z det]m9$         
appropriate by ! ,secret>y4  7iv7 ,rule 
( application ,! provisions ( section   
#aabh;,a 7o!r ?an subsections 7a7 & 7b77
 %all apply to a civil money p5alty "u  
?is subp>agraph 9 ! same mann] z su*    
provisions apply to a civil money p5alty
 or proce$+ "u section #aabh;,a7a74     
7,i7 ,limitation on use ( applicable    
non-retail ph>macy pric+ in=mation ,no  
,/ate %all use pric+ in=mation report$  
by applicable non-retail ph>macies "u   
subp>agraph 7,a77ii7 to develop or in=m 

paym5t me?odologies = retail community  
ph>macies4  2  7#e7 9 p>agraph 7#b7--   
7,a7 9 subp>agraph 7,a71 by ins]t+ 1    
includ+ paym5t rates & me?odologies =   
det]m9+ +r$i5t co/ reimbursem5t "u      
manag$ 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#f7 by r$esignat+ p>agraph 
7#d7 z p>agraph 7#e72  7#g7 by ins]t+   
aft] p>agraph 7#c7 ! foll[+ new         
p>agraph3  7#d7 ,ov]sight  7,a7 ,9 g5]al
 ,! ,inspector ,g5]al ( ! ,dep>tm5t (   
,heal? & ,human ,s]vices %all conduct   
p]iodic /udies ( ! survey data report$  
"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 t are affiliates 7z def9$ 
9 subsection 7k77#ad77 or are own$ by1  

controll$ by1 or relat$ "u a common     
own]%ip /ructure ) a :olesal]1          
di/ributor1 or o!r entity t acquires    
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> #bjbf1 to rema9 
available until exp5d$1 to c>ry out ?is 
p>agraph4  2 &  7#h7 9 p>agraph 7#e71 z 
s r$esignat$-- 7,a7 by ins]t+ 1 &       
#i1jjj1jjj = fiscal ye> #bjbf & ea*     
fiscal ye> !reaft]1 aft] #bjaj2 &  7,b7 
by ins]t+ ,funds appropriat$ "u ?is     
p>agraph = fiscal ye> #bjbf & any       
subsequ5t fiscal ye> %all rema9         
available until exp5d$4 aft] ! p]iod4   
7b7 ,def9itions ,section #aibg7k7 ( !   

,social ,security ,act 7#db ,u4,s4,c4   
#acifr-#h7k77 is am5d$-- 7#a7 9 ! matt] 
prec$+ p>agraph 7#a71 by /rik+ ,9 !     
section & ins]t+ ,9 ?is section2 &  7#b7
 by add+ at ! end ! foll[+ new          
p>agraphs3  7#ab7 ,applicable non-retail
 ph>macy ,! 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#ac7 ,affiliate ,! t]m affiliate means 
any entity t is own$ by1 controll$ by1  
or relat$ "u a common own]%ip /ructure )
 a ph>macy b5efit manag] or a manag$ c>e
 entity or o!r specifi$ entity 7z su*   
t]ms are def9$ 9 section                
#aijc7m77#i77;,d774  4  7c7 ,effective  

date  7#a7 ,9 g5]al ,subject to p>agraph
 7#b71 ! am5dm5ts made by ?is section   
%all take effect on ! fir/ day ( ! fir/ 
qu>t] t beg9s on or aft] ! date t is #f 
mon?s aft] ! date ( enactm5t ( ?is ,act4
  7#b7 ,delay$ application to applicable
 non-retail ph>macies ,! ph>macy survey 
requirem5ts e/abli%$ by ! am5dm5ts to   
section #aibg7;f7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acifr-#h7;f77 made 
by ?is section %all apply to retail     
community ph>macies beg9n+ on !         
effective date describ$ 9 p>agraph 7#a71
 b %all n apply to applicable non-retail
 ph>macies until ! fir/ day ( ! fir/    
qu>t] t beg9s on or aft] ! date t is #ah
 mon?s aft] ! date ( enactm5t ( ?is     
,act4  7d7 ,id5tification ( applicable  
non-,retail ph>macies  7#a7 ,9 g5]al ,n 
lat] ?an ,janu>y #a1 #bjbg1 ! ,secret>y 
( ,heal? & ,human ,s]vices %all1 9      
consultation ) /akehold]s z appropriate1
 publi% guidance specify+ ph>macies t   
meet ! def9ition ( applicable non-retail
 ph>macies 7z su* t]m is def9$ 9        

subsection 7k77#ab7 ( section #aibg ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acifr-#h71 z add$ by subsection 7b771 &
 t w be subject to ! survey requirem5ts 
"u subsection 7f77#a7 ( su* section1 z  
am5d$ by subsection 7a74  7#b7          
,inclusion ( ph>macy type indicators ,! 
guidance publi%$ "u p>agraph 7#a7 %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  7e7 
,implem5tation  7#a7 ,9 g5]al ,not)/&+  
any o!r provision ( law1 ! ,secret>y (  
,heal? & ,human ,s]vices may implem5t ! 
am5dm5ts made by ?is section by program 
in/ruction or o!rwise4  7#b7            
,nonapplication ( ,adm9i/rative         
,proc$ure ,act ,implem5tation ( !       
am5dm5ts made by ?is section %all be    

exempt f ! requirem5ts ( section #eec ( 
title #e1 ,unit$ ,/ates ,code4  7f7     
,nonapplication ( pap]work r$uction act 
,*apt] #ce ( title #dd1 ,unit$ ,/ates   
,code1 %all n apply to any data         
collection und]tak5 by ! ,secret>y (    
,heal? & ,human ,s]vices "u section     
#aibg7;f7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acifr-#h7;f771 z am5d$  
by ?is section4  #c4 ,prev5t+ ! use (   
abusive spread pric+ 9 ,m$icaid  7a7 ,9 
g5]al ,section #aibg ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #acifr-#h7
 is am5d$-- 7#a7 9 subsection 7e71 by   
add+ at ! end ! foll[+ new p>agraph3    
7#f7 ,transp>5t prescription drug       
pass-?r\gh pric+ requir$  7,a7 ,9 g5]al 
,a contract betwe5 ! ,/ate & a ph>macy  
b5efit manag] 7ref]r$ to 9 ?is p>agraph 
z a ,,pbm71 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 t paym5t = su* drugs & relat$   
adm9i/rative s]vices 7z applicable71    
includ+ paym5ts made by a ,,pbm on      
behalf ( ! ,/ate or entity1 is bas$ on a
 transp>5t prescription drug pass-?r\gh 
pric+ model "u :i*-- 7i7 any paym5t made
 by ! entity or ! ,,pbm 7z applicable7 =
 su* a drug-- 7,i7 is limit$ to-- 7aa7  
+r$i5t co/2 &  7bb7 a pr(essional       
disp5s+ fee t is n less ?an !           
pr(essional disp5s+ fee t ! ,/ate w\ld  
pay if ! ,/ate 7 mak+ ! paym5t directly 
9 accordance ) ! ,/ate plan2  7,,ii7 is 
pass$ ?r\gh 9 its entirety 7except z    
r$uc$ "u ,f$]al or ,/ate laws &         
regulations 9 response to in/ances (    
wa/e1 fraud1 or abuse7 by ! entity or   
,,pbm to ! ph>macy or provid] t disp5ses
 ! drug2 &  7,,iii7 is made 9 a mann] t 
is consi/5t ) sections #ddg4ejb1        
#ddg4eab1 #ddg4ead1 & #ddg4eah ( title  
#db1 ,code ( ,f$]al ,regulations 7or any
 successor regulation7 z if su*         

requirem5ts appli$ directly to ! entity 
or ! ,,pbm1 except t any paym5t by !    
entity or ! ,,pbm = ! +r$i5t co/ ( su*  
drug pur*as$ by a cov]$ entity 7z def9$ 
9 subsection 7a77#e77;,b77 may exce$ !  
actual acquisition co/ 7z def9$ 9       
#ddg4ejb ( title #db1 ,code ( ,f$]al    
,regulations1 or any successor          
regulation7 = su* drug if-- 7aa7 su*    
drug 0 subject to an agreem5t "u section
 #cdj;,b ( ! ,public ,heal? ,s]vice     
,act2  7bb7 su* paym5t = ! +r$i5t co/ ( 
su* drug does n exce$ ! maximum paym5t t
 w\ld h be5 made by ! entity or ! ,,pbm 
= ! +r$i5t co/ ( su* drug if su* drug _h
 n be5 pur*as$ by su* cov]$ entity2 &   
7cc7 su* cov]$ entity reports to !      
,secret>y 79 a =m & mann] specifi$ by ! 
,secret>y71 on an annual basis & )      
respect to paym5ts = ! +r$i5t co/s ( su*
 drugs s pur*as$ by su* cov]$ entity t  
are 9 excess ( ! actual acquisition co/s
 = su* drugs1 ! aggregate am\nt ( su*   
excess2  7ii7 paym5t to ! entity or !   
,,pbm 7z applicable7 = adm9i/rative     

s]vices p]=m$ by ! entity or ,,pbm is   
limit$ to an adm9i/rative fee t reflects
 ! fair m>ket value 7z def9$ by !       
,secret>y7 ( su* s]vices2  7iii7 !      
entity or ! ,,pbm 7z applicable7 makes  
available to ! ,/ate1 & ! ,secret>y ^u  
reque/ 9 a =m & mann] specifi$ by !     
,secret>y1 all co/s & paym5ts relat$ to 
cov]$ outpati5t drugs & accompany+      
adm9i/rative s]vices 7z describ$ 9      
clause 7ii77 incurr$1 receiv$1 or made  
by ! entity or ! ,,pbm1 brok5 d[n 7z    
specifi$ by ! ,secret>y71 to ! ext5t su*
 co/s & paym5ts are attributable to an  
individual cov]$ outpati5t drug1 by ea* 
su* drug1 includ+ any +r$i5t co/s1      
pr(essional disp5s+ fees1 adm9i/rative  
fees 7z describ$ 9 clause 7ii771        
po/-sale & po/-invoice fees1 disc\nts1  
or relat$ adju/m5ts su* z direct &      
indirect remun]ation fees1 & any & all  
o!r remun]ation1 z def9$ by ! ,secret>y2
 &  7iv7 any =m ( spread pric+ :]eby any
 am\nt *>g$ or claim$ by ! entity or !  
,,pbm 7z applicable7 t exce$s ! am\nt   

paid to ! ph>macies or provid]s on      
behalf ( ! ,/ate or entity1 includ+ any 
po/-sale or po/-invoice fees1 disc\nts1 
or relat$ adju/m5ts su* z direct &      
indirect remun]ation fees or assessm5ts1
 z def9$ by ! ,secret>y1 7aft] all[+ =  
an adm9i/rative fee z describ$ 9 clause 
7ii77 is n all[able = purposes ( claim+ 
,f$]al mat*+ paym5ts "u ?is title4  7,b7
 ,publication ( in=mation ,! ,secret>y  
%all publi%1 n less frequ5tly ?an on an 
annual basis & 9 a mann] t does n       
disclose ! id5tity ( a p>ticul> cov]$   
entity or organization1 in=mation       
receiv$ by ! ,secret>y pursuant to      
subp>agraph 7,a77iii77,,iii7 t is brok5 
out by ,/ate & by ea* ( ! foll[+        
categories ( cov]$ entity )9 ea* su*    
,/ate3 7i7 ,cov]$ entities describ$ 9   
subp>agraph 7,a7 ( section              
#cdj;,b7a77#d7 ( ! ,public ,heal?       
,s]vice ,act4  7ii7 ,cov]$ entities     
describ$ 9 subp>agraphs 7,b7 ?r\gh 7,k7 
( su* section4  7iii7 ,cov]$ entities   
describ$ 9 subp>agraph 7,l7 ( su*       

section4  7iv7 ,cov]$ entities describ$ 
9 subp>agraph 7,m7 ( su* section4  7v7  
,cov]$ entities describ$ 9 subp>agraph  
7,n7 ( su* section4  7vi7 ,cov]$        
entities describ$ 9 subp>agraph 7,o7 (  
su* section4  2 &  7#b7 9 subsection    
7k71 z am5d$ by section #b7;b71 by add+ 
at ! end ! foll[+ new p>agraph3  7#ad7  
,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 7z def9$ 9 section               
#aijc7m77#i77;,d771 or o!r specifi$     
entity 7z s def9$71 or manages !        
prescription drug b5efits provid$ by a  
,/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 
acts z a price negotiator 7) reg>d to   
paym5t am\nts to ph>macies & provid]s = 
a cov]$ outpati5t drug or ! net co/ ( ! 
drug7 or gr\p pur*as] on behalf ( a     
,/ate1 manag$ c>e entity1 or o!r        
specifi$ entity or t c>ries out #a or m 
( ! o!r activities describ$ 9 ! prec$+  
s5t5ce1 irrespective ( :e!r su* p]son or
 entity calls itself a ph>macy b5efit   
manag]4  4  7b7 ,con=m+ am5dm5ts        
,section #aijc7m7 ( su* ,act 7#db       
,u4,s4,c4 #acif;b7m77 is am5d$-- 7#a7 9 
p>agraph 7#b77;,a77xiii7-- 7,a7 by /rik+
 & 7,,iii7 & ins]t+ 7,,iii72  7,b7 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 &  7,c7 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  7c7 ,effective date
 ,! am5dm5ts made by ?is section %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] !   
date t is #ah mon?s aft] ! date (       
enactm5t ( ?is ,act4  7d7 ,implem5tation
  7#a7 ,9 g5]al ,not)/&+ any o!r        
provision ( law1 ! ,secret>y ( ,heal? & 
,human ,s]vices may implem5t ! am5dm5ts 
made by ?is section by program          
in/ruction or o!rwise4  7#b7            
,nonapplication ( adm9i/rative proc$ure 
act ,implem5tation ( ! am5dm5ts made by 
?is section %all be exempt f !          
requirem5ts ( section #eec ( title #e1  

,unit$ ,/ates ,code4  7e7               
,nonapplication ( pap]work r$uction act 
,*apt] #ce ( title #dd1 ,unit$ ,/ates   
,code1 %all n apply to any data         
collection und]tak5 by ! ,secret>y (    
,heal? & ,human ,s]vices "u section     
#aibg7;e7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acifr-#h7;e771 z am5d$  
by ?is section4