[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1909 Introduced in Senate (IS)]
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117th CONGRESS
1st Session
S. 1909
To amend title XVIII of the Social Security Act to reform requirements
with respect to direct and indirect remuneration under Medicare part D,
and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 27, 2021
Mr. Tester (for himself, Mrs. Capito, Mr. Brown, and Mr. Lankford)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to reform requirements
with respect to direct and indirect remuneration under Medicare part D,
and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Pharmacy DIR Reform To Reduce Senior
Drug Costs Act''.
SEC. 2. REQUIRING PHARMACY-NEGOTIATED PRICE CONCESSIONS, PAYMENT, AND
FEES TO BE INCLUDED IN NEGOTIATED PRICES AT THE POINT-OF-
SALE UNDER PART D OF THE MEDICARE PROGRAM.
Section 1860D-2(d)(1)(B) of the Social Security Act (42 U.S.C.
1395w-102(d)(1)(B)) is amended--
(1) by striking ``prices.--For purposes'' and inserting
``prices.--
``(i) In general.--For purposes''; and
(2) by adding at the end the following new clause:
``(ii) Prices negotiated with pharmacy at
point-of-sale.--For plan years beginning on or
after January 1, 2022, a negotiated price for a
covered part D drug described in clause (i)
shall include price concessions, payments, and
fees negotiated with such pharmacy as defined
by the Secretary, but shall not include
incentive payments based on pharmacy
performance paid or to be paid to such
pharmacy. Such negotiated price shall be
provided at the point-of-sale of such drug.''.
SEC. 3. DISCLOSURE TO PHARMACY OF POST-POINT-OF-SALE PHARMACY PRICE
CONCESSIONS AND INCENTIVE PAYMENTS.
Section 1860D-2(d)(2) of the Social Security Act (42 U.S.C. 1395w-
102(d)(2)) is amended--
(1) by striking ``disclosure.--A PDP sponsor'' and
inserting ``disclosure.--
``(A) To the secretary.--A PDP sponsor''; and
(2) by adding at the end the following new subparagraph:
``(B) To pharmacies.--
``(i) In general.--For plan year 2022 and
subsequent plan years, a PDP sponsor offering a
prescription drug plan and an MA organization
offering an MA-PD plan shall report any
pharmacy price concession or incentive payment
that occurs with respect to a pharmacy after
payment for covered part D drugs at the point-
of-sale, including by an intermediary
organization with which a PDP sponsor or MA
organization has contracted, to the pharmacy.
``(ii) Timing.--The reporting of price
concessions and incentive payments to a
pharmacy under clause (i) shall be made on a
periodic basis (but in no case less frequently
than annually).
``(iii) Claim level.--The reporting of
price concessions and incentive payments to a
pharmacy under clause (i) shall be at the claim
level or approximated at the claim level if the
price concession or incentive payment was
applied at a level other than at the claim
level.''.
SEC. 4. ESTABLISHMENT OF PHARMACY PERFORMANCE MEASURES UNDER MEDICARE
PART D.
Section 1860D-4(c) of the Social Security Act (42 U.S.C. 1395w-
104(c)) is amended--
(1) by redesignating paragraph (6), as added by section
50354 of division E of the Bipartisan Budget Act of 2018
(Public Law 115-123), as paragraph (7); and
(2) by adding at the end the following new paragraph:
``(8) Application of standardized pharmacy performance
measures.--
``(A) In general.--A PDP sponsor and MA-PD plan
that makes incentive payments to a pharmacy or receives
price concessions paid by a pharmacy based on
performance measures shall, for the purposes of such
incentive payments and price concessions with respect
to covered part D drugs dispensed by such pharmacy,
only use measures--
``(i) established or adopted by the
Secretary under subparagraph (B), as listed
under clause (ii) of such subparagraph; and
``(ii) that are relevant to the performance
of such pharmacy with respect to areas that the
pharmacy can impact based on covered part D
drugs dispensed and managed.
``(B) Standardized pharmacy performance measures.--
``(i) In general.--Notwithstanding any
other provision of law, the Secretary shall
establish or adopt standardized pharmacy
performance measures from one or more multi-
stakeholder, consensus organizations
representing all pharmacy types (including
specialty pharmacies) to be used by a PDP
sponsor and MA-PD plan for the purposes of
determining incentive payments and price
concessions described in subparagraph (A). Such
measures shall be evidence-based and focus on
pharmacy performance on patient health outcomes
and other areas, as determined by the
Secretary, that the pharmacy can impact based
on covered part D drugs dispensed and managed.
``(ii) Maintenance of list.--The Secretary
shall maintain a single list of measures
established or adopted under this subparagraph
and measures shall be evaluated and updated on
an ongoing basis through stakeholder consensus
organizations to ensure they are transparent,
achievable, and clinically meaningful.
``(iii) Application to star ratings.--The
Secretary shall require the development of
measures to apply in the star rating system
under this part to assess the use of a standard
set of pharmacy performance measures by PDP
sponsors and MA-PD plans.
``(C) Specialty pharmacy.--For purposes of
subparagraph (B)(i), the Secretary shall, not later
than December 31, 2022, define the term `specialty
pharmacy' in consultation with relevant stakeholders.
``(D) Effective date.--The requirement under
subparagraph (A) shall take effect for plan years
beginning on January 1, 2022, or such earlier date
specified by the Secretary if the Secretary determines
there are sufficient measures established or adopted
under subparagraph (B) for the purposes of the
requirement under subparagraph (A).''.
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