[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6575 Introduced in House (IH)]

<DOC>






119th CONGRESS
  1st Session
                                H. R. 6575

  To amend the Internal Revenue Code of 1986 to extend and modify the 
   enhanced premium tax credit, to amend the Patient Protection and 
Affordable Care Act to make certain adjustments to the operation of the 
     Exchanges established under such Act, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           December 10, 2025

Mrs. Kiggans of Virginia (for herself, Mr. Gottheimer, Mr. Lawler, Mr. 
 Cuellar, Mr. Bresnahan, Mr. Suozzi, Mr. Mackenzie, Ms. Lee of Nevada, 
 Ms. Salazar, Mr. Landsman, Mr. Van Drew, Mr. Case, Mr. Ciscomani, Mr. 
 Costa, Mr. Valadao, Mr. Riley of New York, Mr. Hurd of Colorado, Ms. 
     Scholten, Mr. Bacon, Ms. Wilson of Florida, Mr. Gimenez, Ms. 
 Goodlander, Ms. De La Cruz, Mr. Soto, Mr. LaLota, Mr. Gray, Mr. Kiley 
 of California, Mr. Vicente Gonzalez of Texas, Mr. Kean, Mr. Figures, 
Mr. Fitzpatrick, Mr. Pappas, Mr. Liccardo, Mr. Davis of North Carolina, 
   Mr. Moskowitz, Mr. Panetta, Mr. Peters, and Mr. Golden of Maine) 
 introduced the following bill; which was referred to the Committee on 
  Energy and Commerce, and in addition to the Committees on Ways and 
  Means, and Rules, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend the Internal Revenue Code of 1986 to extend and modify the 
   enhanced premium tax credit, to amend the Patient Protection and 
Affordable Care Act to make certain adjustments to the operation of the 
     Exchanges established under such Act, 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 ``CommonGround for Affordable Health 
Care Act''.

SEC. 2. EXTENSION AND MODIFICATION OF ENHANCED PREMIUM TAX CREDIT.

    (a) Extension and Modification of Rules to Increase Premium 
Assistance Amounts.--Section 36B(b)(3)(A)(iii) of the Internal Revenue 
Code of 1986 is amended--
            (1) by redesignating subclauses (I) and (II) as items (aa) 
        and (bb), respectively, and adjusting the margins accordingly,
            (2) by striking ``Temporary percentages for 2021 through 
        2025.--In the case of'' and inserting ``Temporary percentages 
        for certain years.--
                                    ``(I) Before 2026.--In the case 
                                of'', and
            (3) by adding at the end the following:
                                    ``(II) 2026.--In the case of a 
                                taxable year beginning after December 
                                31, 2025, and before January 1, 2027--
                                            ``(aa) clause (ii) shall 
                                        not apply for purposes of 
                                        adjusting premium percentages 
                                        under this subparagraph, and
                                            ``(bb) the following table 
                                        shall be applied in lieu of the 
                                        table contained in clause (i):


----------------------------------------------------------------------------------------------------------------
                                                                                        The initial   The final
 ``In the case of household income (expressed as a percent of poverty line) within the    premium      premium
                                following income tier:                                   percentage   percentage
                                                                                            is-          is-
----------------------------------------------------------------------------------------------------------------
Up to 150%                                                                                     0.0%         0.0%
150% up to 200%                                                                                0.0%         2.0%
200% up to 250%                                                                                2.0%         4.0%
250% up to 300%                                                                                4.0%         6.0%
300% up to 400%                                                                                6.0%         8.5%
400% up to 600%                                                                                8.5%         8.5%
600% up to 900%                                                                                8.5%        9.25%
900% up to 1000%                                                                              9.25%     10.0%''.
----------------------------------------------------------------------------------------------------------------

    (b) Extension and Modification of Rule to Allow Credit to Taxpayers 
Whose Household Income Exceeds 400 Percent of Poverty Line.--Section 
36B(c)(1)(E) of such Code is amended--
            (1) by striking ``Temporary rule for 2021 through 2025.--In 
        the case of'' and inserting ``Temporary rule for certain 
        years.--
                            ``(i) Before 2026.--In the case of'', and
            (2) by adding at the end the following:
                            ``(ii) 2026.--In the case of a taxable year 
                        beginning after December 31, 2025, and before 
                        January 1, 2027, subparagraph (A) shall be 
                        applied by substituting `but does not exceed 
                        1000 percent' for `but does not exceed 400 
                        percent'.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2025.

SEC. 3. GUARDRAILS TO PREVENT FRAUD IN EXCHANGES.

    (a) Reduction of Fraudulent Enrollment in Qualified Health Plans.--
            (1) Penalties for agents and brokers.--Section 1411(h)(1) 
        of the Patient Protection and Affordable Care Act (42 U.S.C. 
        18081(h)(1)) is amended--
                    (A) in subparagraph (A)--
                            (i) by redesignating clause (ii) as clause 
                        (iv);
                            (ii) in clause (i)--
                                    (I) in the matter preceding 
                                subclause (I), by striking ``If--'' and 
                                all that follows through the ``such 
                                person'' in the matter following 
                                subclause (II) and inserting the 
                                following: ``If any person (other than 
                                an agent or broker) fails to provide 
                                correct information under subsection 
                                (b) and such failure is attributable to 
                                negligence or disregard of any rules or 
                                regulations of the Secretary, such 
                                person''; and
                                    (II) in the second sentence, by 
                                striking ``For purposes'' and inserting 
                                the following:
                            ``(iii) Definitions of negligence, 
                        disregard.--For purposes'';
                            (iii) by inserting after clause (i) the 
                        following:
                            ``(ii) Civil penalties for certain 
                        violations by agents or brokers.--If any agent 
                        or broker fails to provide correct information 
                        under subsection (b) or section 1311(c)(8) or 
                        other information, as specified by the 
                        Secretary, and such failure is attributable to 
                        negligence or disregard of any rules or 
                        regulations of the Secretary, such agent or 
                        broker shall be subject, in addition to any 
                        other penalties that may be prescribed by law, 
                        including subparagraph (C), to a civil penalty 
                        of not less than $10,000 and not more than 
                        $50,000 with respect to each individual who is 
                        the subject of an application for which such 
                        incorrect information is provided.''; and
                            (iv) in clause (iv) (as so redesignated), 
                        by inserting ``or (ii)'' after ``clause (i)'';
                    (B) in subparagraph (B)--
                            (i) by inserting ``including subparagraph 
                        (C),'' after ``law,'';
                            (ii) by striking ``Any person'' and 
                        inserting the following:
                            ``(i) In general.--Any person''; and
                            (iii) by adding at the end the following:
                            ``(ii) Civil penalties for knowing 
                        violations by agents or brokers.--
                                    ``(I) In general.--Any agent or 
                                broker who knowingly provides false or 
                                fraudulent information under subsection 
                                (b) or section 1311(c)(8), or other 
                                false or fraudulent information as part 
                                of an application for enrollment in a 
                                qualified health plan offered through 
                                an Exchange, as specified by the 
                                Secretary, shall be subject, in 
                                addition to any other penalties that 
                                may be prescribed by law, including 
                                subparagraph (C), to a civil penalty of 
                                not more than $200,000 with respect to 
                                each individual who is the subject of 
                                an application for which such false or 
                                fraudulent information is provided.
                                    ``(II) Procedure.--The provisions 
                                of section 1128A of the Social Security 
                                Act (other than subsections (a) and (b) 
                                of such section) shall apply to a civil 
                                monetary penalty under subclause (I) in 
                                the same manner as such provisions 
                                apply to a penalty or proceeding under 
                                section 1128A of the Social Security 
                                Act.''; and
                    (C) by adding at the end the following:
                    ``(C) Criminal penalties.--Any agent or broker who 
                knowingly and willfully provides false or fraudulent 
                information under subsection (b) or section 1311(c)(8), 
                or other false or fraudulent information as part of an 
                application for enrollment in a qualified health plan 
                offered through an Exchange, as specified by the 
                Secretary, shall be fined under title 18, United States 
                Code, imprisoned for not more than 10 years, or 
                both.''.
            (2) Consumer protections.--
                    (A) In general.--Section 1311(c) of the Patient 
                Protection and Affordable Care Act (42 U.S.C. 18031(c)) 
                is amended by adding at the end the following new 
                paragraph:
            ``(8) Agent- or broker-assisted enrollment in qualified 
        health plans in certain exchanges.--
                    ``(A) In general.--For plan years beginning on or 
                after such date specified by the Secretary, but not 
                later than January 1, 2029, in the case of an Exchange 
                that the Secretary operates pursuant to section 
                1321(c)(1), the Secretary shall establish a 
                verification process for new enrollments of individuals 
                in, and changes in coverage for individuals under, a 
                qualified health plan offered through such Exchange, 
                which are submitted by an agent or broker in accordance 
                with section 1312(e) and for which the agent or broker 
                is eligible to receive a commission.
                    ``(B) Requirements.--The enrollment verification 
                process under subparagraph (A) shall include--
                            ``(i) a requirement that the agent or 
                        broker provide with the new enrollment or 
                        coverage change such documentation or evidence 
                        (such as a standardized consent form) or other 
                        sources as the Secretary determines necessary 
                        to establish that the agent or broker has the 
                        consent of the individual for the new 
                        enrollment or coverage change;
                            ``(ii) a requirement that any commissions 
                        due to a broker or agent for such new 
                        enrollment or coverage change are paid after 
                        the enrollee has resolved all inconsistencies 
                        in accordance with paragraphs (3) and (4) of 
                        section 1411(e);
                            ``(iii) a requirement that the information 
                        required under clause (i) and, as applicable, 
                        the date on which inconsistencies are resolved 
                        as described in clause (ii), is accessible to 
                        the applicable qualified health plan through a 
                        database or other resource, as determined by 
                        the Secretary, so that any commissions due to a 
                        broker or agent for such enrollment can be 
                        effectuated at the appropriate time;
                            ``(iv) a requirement that individuals are 
                        notified of any changes to enrollment, 
                        coverage, the agent of record, or premium tax 
                        credits in a timely manner and that such notice 
                        provides plain language instructions on how 
                        individuals can cancel unauthorized activity;
                            ``(v) a requirement that individuals be 
                        able to access their account information on a 
                        website or other technology platform, as 
                        defined by the Secretary, when used to submit 
                        an enrollment or plan change, in lieu of the 
                        Exchange website described in subsection 
                        (d)(4)(C), including information on the agent 
                        of record, the qualified health plan, and when 
                        any changes are made to the agent of record or 
                        the qualified health plan, on a consumer-facing 
                        website or through a toll-free telephone 
                        hotline; and
                            ``(vi) a requirement that the agent or 
                        broker report to the Secretary any third-party 
                        marketing organization or field marketing 
                        organization (as such terms are defined in 
                        section 1312(e)) involved in the chain of 
                        enrollment (as so defined) with respect to such 
                        new enrollment or coverage change.
                    ``(C) Consumer protection.--The Secretary shall 
                ensure that the enrollment verification process under 
                subparagraph (A) prioritizes continuity of coverage and 
                care for individuals, including by not disenrolling 
                individuals from a qualified health plan without the 
                consent of the individual, regardless of whether the 
                broker, agent, or qualified health plan is in violation 
                of any requirement under this paragraph.''.
                    (B) Required reporting.--Section 1311(c)(1) of the 
                Patient Protection and Affordable Care Act (42 U.S.C. 
                18031(c)(1)) is amended--
                            (i) in subparagraph (H), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (I), by striking the 
                        period at the end and inserting ``; and''; and
                            (iii) by adding at the end the following:
                    ``(J) report to the Secretary the termination (as 
                defined in section 1312(e)(1)(C)) of an issuer.''.
            (3) Authority to regulate field marketing organizations and 
        third-party marketing organizations.--Section 1312(e) of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 18032(e)) 
        is amended--
                    (A) by redesignating paragraphs (1) and (2) as 
                subclauses (I) and (II), respectively, and adjusting 
                the margins accordingly;
                    (B) in subclause (II) (as so redesignated), by 
                striking the period at the end and inserting ``; and'';
                    (C) by striking the subsection designation and 
                heading and all that follows through ``brokers--'' and 
                inserting the following:
    ``(e) Regulation of Agents, Brokers, and Certain Marketing 
Organizations.--
            ``(1) Agents, brokers, and certain marketing 
        organizations.--
                    ``(A) In general.--The Secretary shall establish 
                procedures under which a State may allow--
                            ``(i) agents or brokers--''; and
                    (D) by adding at the end the following:
                            ``(ii) field marketing organizations and 
                        third-party marketing organizations to 
                        participate in the chain of enrollment for an 
                        individual with respect to qualified health 
                        plans offered through an Exchange.
                    ``(B) Criteria.--For plan years beginning on or 
                after such date specified by the Secretary, but not 
                later than January 1, 2029, the Secretary, by 
                regulation, shall establish criteria for States to use 
                in determining whether to allow agents and brokers to 
                enroll individuals and employers in qualified health 
                plans as described in subclause (I) of subparagraph 
                (A)(i) and to assist individuals as described in 
                subclause (II) of such subparagraph and field marketing 
                organizations and third-party marketing organizations 
                to participate in the chain of enrollment as described 
                in subparagraph (A)(ii). Such criteria shall, at a 
                minimum, require that--
                            ``(i) an agent or broker act in accordance 
                        with a standard of conduct that includes a duty 
                        of such agent or broker to act in the best 
                        interests of the enrollee;
                            ``(ii) a field marketing organization or 
                        third-party marketing organization agree to 
                        report the termination of an agent or broker to 
                        the applicable State and the Secretary, 
                        including the reason for termination; and
                            ``(iii) an agent, broker, field marketing 
                        organization, or third-party marketing 
                        organization--
                                    ``(I) meet such marketing 
                                requirements as are required by the 
                                Secretary;
                                    ``(II) meet marketing requirements 
                                in accordance with other applicable 
                                Federal or State law;
                                    ``(III) does not employ practices 
                                that are confusing or misleading, as 
                                determined by the Secretary;
                                    ``(IV) submit all marketing 
                                materials to the Secretary for, as 
                                determined appropriate by the 
                                Secretary, review and approval;
                                    ``(V) is a licensed agent or broker 
                                or meets other licensure requirements, 
                                as required by the State;
                                    ``(VI) register with the Secretary; 
                                and
                                    ``(VII) does not compensate any 
                                individual or organization for 
                                referrals or any other service relating 
                                to the sale of, marketing for, or 
                                enrollment in qualified health plans 
                                unless such individual or organization 
                                meets the criteria described in 
                                subclauses (I) through (VI).
                    ``(C) Definitions.--In this paragraph:
                            ``(i) Chain of enrollment.--The term `chain 
                        of enrollment', with respect to enrollment of 
                        an individual in a qualified health plan 
                        offered through an Exchange, means any steps 
                        taken from marketing to such individual, to 
                        such individual making an enrollment decision 
                        with respect to such a plan.
                            ``(ii) Field marketing organization.--The 
                        term `field marketing organization' means an 
                        organization or individual that directly 
                        employs or contracts with agents and brokers, 
                        or contracts with carriers, to provide 
                        functions relating to enrollment of individuals 
                        in qualified health plans offered through an 
                        Exchange as part of the chain of enrollment.
                            ``(iii) Marketing.--The term `marketing' 
                        means the use of marketing materials to provide 
                        information to current and prospective 
                        enrollees in a qualified health plan offered 
                        through an Exchange.
                            ``(iv) Marketing materials.--The term 
                        `marketing materials' means materials relating 
                        to a qualified health plan offered through an 
                        Exchange or benefits offered through an 
                        Exchange that--
                                    ``(I) are intended--
                                            ``(aa) to draw an 
                                        individual's attention to such 
                                        plan or the premium tax credits 
                                        or cost-sharing reductions for 
                                        such plan or plans offered 
                                        through an Exchange;
                                            ``(bb) to influence an 
                                        individual's decision-making 
                                        process when selecting a 
                                        qualified health plan in which 
                                        to enroll; or
                                            ``(cc) to influence an 
                                        enrollee's decision to stay 
                                        enrolled in such plan; and
                                    ``(II) include or address content 
                                regarding the benefits, benefit 
                                structure, premiums, or cost sharing of 
                                such plan.
                            ``(v) Termination.--The term `termination', 
                        with respect to a contract or business 
                        arrangement between an agent or broker and a 
                        field marketing organization, third-party 
                        marketing organization, or health insurance 
                        issuer, means--
                                    ``(I) the ending of such contract 
                                or business arrangement, either 
                                unilaterally by one of the parties or 
                                on mutual agreement; or
                                    ``(II) the expiration of such 
                                contract or business arrangement that 
                                is not replaced by a substantially 
                                similar agreement.
                            ``(vi) Third-party marketing 
                        organization.--The term `third-party marketing 
                        organization' means an organization or 
                        individual that is compensated to perform lead 
                        generation, marketing, or sales relating to 
                        enrollment of individuals in qualified health 
                        plans offered through an Exchange as part of 
                        the chain of enrollment.''.
            (4) Transparency.--Section 1312(e) of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18032(e)), as 
        amended by paragraph (3), is further amended by adding at the 
        end the following new paragraphs:
            ``(2) Audits.--
                    ``(A) In general.--For plan years beginning on or 
                after such date specified by the Secretary, but not 
                later than January 1, 2029, the Secretary, in 
                coordination with the States and in consultation with 
                the National Association of Insurance Commissioners, 
                shall implement a process for the oversight and 
                enforcement of agent and broker compliance with this 
                section and other applicable Federal and State law 
                (including regulations) that shall include--
                            ``(i) periodic audits of agents and brokers 
                        based on--
                                    ``(I) complaints filed with the 
                                Secretary by individuals enrolled by 
                                such an agent or broker in a qualified 
                                health plan offered through an 
                                Exchange;
                                    ``(II) an incident or enrollment 
                                pattern that suggests fraud; and
                                    ``(III) other factors determined by 
                                the Secretary; and
                            ``(ii) a process under which the Secretary 
                        shall share audit results and refer potential 
                        cases of fraud to the relevant State department 
                        of insurance.
                    ``(B) Effect.--Nothing in this paragraph limits or 
                restricts any referrals made under section 1311(i)(3) 
                or any enforcement actions under section 1411(h).
            ``(3) List.--The Secretary shall develop a process to 
        regularly provide to qualified health plans, Exchanges, and 
        States a list of suspended and terminated agents and 
        brokers.''.
    (b) Removal of Deceased Individuals From Exchange Plans.--Section 
1311(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 
18031(c)), as amended by subsection (a), is further amended by adding 
at the end the following new paragraph:
            ``(9) Removal of deceased individuals from exchange 
        plans.--
                    ``(A) In general.--Not later than 90 days after the 
                date of the enactment of this paragraph, and on a 
                quarterly basis thereafter, the Secretary shall conduct 
                a check of the Death Master File (as such term is 
                defined in section 203(d) of the Bipartisan Budget Act 
                of 2013) for purposes of identifying individuals 
                enrolled in a qualified health plan through an Exchange 
                who are deceased.
                    ``(B) Process.--The Secretary shall--
                            ``(i) establish a process to verify that an 
                        individual identified pursuant to a check 
                        described in subparagraph (A) is deceased; and
                            ``(ii) require an Exchange to terminate 
                        such individual's enrollment under a qualified 
                        health plan.''.
    (c) Standard of Proof for Terminating Agents and Brokers.--Section 
1312(e) of the Patient Protection and Affordable Care Act (42 U.S.C. 
18032(e)), as amended by subsection (a), is further amended by adding 
at the end the following new paragraph:
            ``(4) Standard for termination for certain exchanges.--In 
        the case of an agent or broker with an agreement in effect with 
        an Exchange operated by the Secretary pursuant to section 
        1321(c) to perform activities described in paragraph (1)(A)(i) 
        with respect to such Exchange, the Secretary may terminate such 
        agreement if the Secretary finds, based on a preponderance of 
        the evidence, that such agent or broker has violated such 
        agreement, otherwise applicable law, or any other requirement 
        applicable to such agent or broker.''.
    (d) Requirement for Exchange to Notify Individuals of Value of 
Premium Tax Credits.--Section 1412(c)(2) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18082(c)(2)) is amended by adding at the 
end the following new subparagraph:
                    ``(C) Exchange responsibilities.--Beginning January 
                1, 2027, if an Exchange is notified under paragraph (1) 
                of an advance determination under section 1411 with 
                respect to the eligibility of an individual for a 
                premium tax credit under section 36B of the Internal 
                Revenue Code of 1986, the Exchange shall, prior to 
                enrolling such individual in a qualified health plan, 
                clearly notify such individual of the amount of such 
                tax credit.''.

SEC. 4. EXTENDING ANNUAL OPEN ENROLLMENT PERIOD FOR EXCHANGES FOR PLAN 
              YEAR 2026.

    (a) In General.--The Secretary of Health and Human Services shall 
revise section 155.410(e) of title 45, Code of Federal Regulations (or 
any successor regulation) to provide that the annual open enrollment 
period determined for plan year 2026 pursuant to section 1311(c)(6) of 
the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)) 
shall begin on November 1, 2025, and end on March 19, 2026.
    (b) Notification of Open Enrollment Extension.--The Secretary of 
Health and Human Services shall perform such outreach activities as are 
necessary to inform qualified individuals (as defined in section 
1312(f)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 
18032(f)(1))) of the extended open enrollment period provided for under 
subsection (a).

SEC. 5. MODERNIZING AND ENSURING PBM ACCOUNTABILITY.

    (a) In General.--
            (1) Prescription drug plans.--Section 1860D-12 of the 
        Social Security Act (42 U.S.C. 1395w-112) is amended by adding 
        at the end the following new subsection:
    ``(h) Requirements Relating to Pharmacy Benefit Managers.--For plan 
years beginning on or after January 1, 2029:
            ``(1) Agreements with pharmacy benefit managers.--Each 
        contract entered into with a PDP sponsor under this part with 
        respect to a prescription drug plan offered by such sponsor 
        shall provide that any pharmacy benefit manager acting on 
        behalf of such sponsor has a written agreement with the PDP 
        sponsor under which the pharmacy benefit manager, and any 
        affiliates of such pharmacy benefit manager, as applicable, 
        agree to meet the following requirements:
                    ``(A) No income other than bona fide service 
                fees.--
                            ``(i) In general.--The pharmacy benefit 
                        manager and any affiliate of such pharmacy 
                        benefit manager shall not derive any 
                        remuneration with respect to any services 
                        provided on behalf of any entity or individual, 
                        in connection with the utilization of covered 
                        part D drugs, from any such entity or 
                        individual other than bona fide service fees, 
                        subject to clauses (ii) and (iii).
                            ``(ii) Incentive payments.--For the 
                        purposes of this subsection, an incentive 
                        payment (as determined by the Secretary) paid 
                        by a PDP sponsor to a pharmacy benefit manager 
                        that is performing services on behalf of such 
                        sponsor shall be deemed a `bona fide service 
                        fee' (even if such payment does not otherwise 
                        meet the definition of such term under 
                        paragraph (7)(B)) if such payment is a flat 
                        dollar amount, is consistent with fair market 
                        value (as specified by the Secretary), is 
                        related to services actually performed by the 
                        pharmacy benefit manager or affiliate of such 
                        pharmacy benefit manager, on behalf of the PDP 
                        sponsor making such payment, in connection with 
                        the utilization of covered part D drugs, and 
                        meets additional requirements, if any, as 
                        determined appropriate by the Secretary.
                            ``(iii) Clarification on rebates and 
                        discounts used to lower costs for covered part 
                        d drugs.--Rebates, discounts, and other price 
                        concessions received by a pharmacy benefit 
                        manager or an affiliate of a pharmacy benefit 
                        manager from manufacturers, even if such price 
                        concessions are calculated as a percentage of a 
                        drug's price, shall not be considered a 
                        violation of the requirements of clause (i) if 
                        they are fully passed through to a PDP sponsor 
                        and are compliant with all regulatory and 
                        subregulatory requirements related to direct 
                        and indirect remuneration for manufacturer 
                        rebates under this part, including in cases 
                        where a PDP sponsor is acting as a pharmacy 
                        benefit manager on behalf of a prescription 
                        drug plan offered by such PDP sponsor.
                            ``(iv) Evaluation of remuneration 
                        arrangements.--Components of subsets of 
                        remuneration arrangements (such as fees or 
                        other forms of compensation paid to or retained 
                        by the pharmacy benefit manager or affiliate of 
                        such pharmacy benefit manager), as determined 
                        appropriate by the Secretary, between pharmacy 
                        benefit managers or affiliates of such pharmacy 
                        benefit managers, as applicable, and other 
                        entities involved in the dispensing or 
                        utilization of covered part D drugs (including 
                        PDP sponsors, manufacturers, pharmacies, and 
                        other entities as determined appropriate by the 
                        Secretary) shall be subject to review by the 
                        Secretary, in consultation with the Office of 
                        the Inspector General of the Department of 
                        Health and Human Services, as determined 
                        appropriate by the Secretary. The Secretary, in 
                        consultation with the Office of the Inspector 
                        General, shall review whether remuneration 
                        under such arrangements is consistent with fair 
                        market value (as specified by the Secretary) 
                        through reviews and assessments of such 
                        remuneration, as determined appropriate.
                            ``(v) Disgorgement.--The pharmacy benefit 
                        manager shall disgorge any remuneration paid to 
                        such pharmacy benefit manager or an affiliate 
                        of such pharmacy benefit manager in violation 
                        of this subparagraph to the PDP sponsor.
                            ``(vi) Additional requirements.--The 
                        pharmacy benefit manager shall--
                                    ``(I) enter into a written 
                                agreement with any affiliate of such 
                                pharmacy benefit manager, under which 
                                the affiliate shall identify and 
                                disgorge any remuneration described in 
                                clause (v) to the pharmacy benefit 
                                manager; and
                                    ``(II) attest, subject to any 
                                requirements determined appropriate by 
                                the Secretary, that the pharmacy 
                                benefit manager has entered into a 
                                written agreement described in 
                                subclause (I) with any relevant 
                                affiliate of the pharmacy benefit 
                                manager.
                    ``(B) Transparency regarding guarantees and cost 
                performance evaluations.--The pharmacy benefit manager 
                shall--
                            ``(i) define, interpret, and apply, in a 
                        fully transparent and consistent manner for 
                        purposes of calculating or otherwise evaluating 
                        pharmacy benefit manager performance against 
                        pricing guarantees or similar cost performance 
                        measurements related to rebates, discounts, 
                        price concessions, or net costs, terms such 
                        as--
                                    ``(I) `generic drug', in a manner 
                                consistent with the definition of the 
                                term under section 423.4 of title 42, 
                                Code of Federal Regulations, or a 
                                successor regulation;
                                    ``(II) `brand name drug', in a 
                                manner consistent with the definition 
                                of the term under section 423.4 of 
                                title 42, Code of Federal Regulations, 
                                or a successor regulation;
                                    ``(III) `specialty drug';
                                    ``(IV) `rebate'; and
                                    ``(V) `discount';
                            ``(ii) identify any drugs, claims, or price 
                        concessions excluded from any pricing guarantee 
                        or other cost performance measure in a clear 
                        and consistent manner; and
                            ``(iii) where a pricing guarantee or other 
                        cost performance measure is based on a pricing 
                        benchmark other than the wholesale acquisition 
                        cost (as defined in section 1847A(c)(6)(B)) of 
                        a drug, calculate and provide a wholesale 
                        acquisition cost-based equivalent to the 
                        pricing guarantee or other cost performance 
                        measure.
                    ``(C) Provision of information.--
                            ``(i) In general.--Not later than July 1 of 
                        each year, beginning in 2029, the pharmacy 
                        benefit manager shall submit to the PDP 
                        sponsor, and to the Secretary, a report, in 
                        accordance with this subparagraph, and shall 
                        make such report available to such sponsor at 
                        no cost to such sponsor in a format specified 
                        by the Secretary under paragraph (5). Each such 
                        report shall include, with respect to such PDP 
                        sponsor and each plan offered by such sponsor, 
                        the following information with respect to the 
                        previous plan year:
                                    ``(I) A list of all drugs covered 
                                by the plan that were dispensed 
                                including, with respect to each such 
                                drug--
                                            ``(aa) the brand name, 
                                        generic or non-proprietary 
                                        name, and National Drug Code;
                                            ``(bb) the number of plan 
                                        enrollees for whom the drug was 
                                        dispensed, the total number of 
                                        prescription claims for the 
                                        drug (including original 
                                        prescriptions and refills, 
                                        counted as separate claims), 
                                        and the total number of dosage 
                                        units of the drug dispensed;
                                            ``(cc) the number of 
                                        prescription claims described 
                                        in item (bb) by each type of 
                                        dispensing channel through 
                                        which the drug was dispensed, 
                                        including retail, mail order, 
                                        specialty pharmacy, long term 
                                        care pharmacy, home infusion 
                                        pharmacy, or other types of 
                                        pharmacies or providers;
                                            ``(dd) the average 
                                        wholesale acquisition cost, 
                                        listed as cost per day's 
                                        supply, cost per dosage unit, 
                                        and cost per typical course of 
                                        treatment (as applicable);
                                            ``(ee) the average 
                                        wholesale price for the drug, 
                                        listed as price per day's 
                                        supply, price per dosage unit, 
                                        and price per typical course of 
                                        treatment (as applicable);
                                            ``(ff) the total out-of-
                                        pocket spending by plan 
                                        enrollees on such drug after 
                                        application of any benefits 
                                        under the plan, including plan 
                                        enrollee spending through 
                                        copayments, coinsurance, and 
                                        deductibles;
                                            ``(gg) total rebates paid 
                                        by the manufacturer on the drug 
                                        as reported under the Detailed 
                                        DIR Report (or any successor 
                                        report) submitted by such 
                                        sponsor to the Centers for 
                                        Medicare & Medicaid Services;
                                            ``(hh) all other direct or 
                                        indirect remuneration on the 
                                        drug as reported under the 
                                        Detailed DIR Report (or any 
                                        successor report) submitted by 
                                        such sponsor to the Centers for 
                                        Medicare & Medicaid Services;
                                            ``(ii) the average pharmacy 
                                        reimbursement amount paid by 
                                        the plan for the drug in the 
                                        aggregate and disaggregated by 
                                        dispensing channel identified 
                                        in item (cc);
                                            ``(jj) the average National 
                                        Average Drug Acquisition Cost 
                                        (NADAC); and
                                            ``(kk) total manufacturer-
                                        derived revenue, inclusive of 
                                        bona fide service fees, 
                                        attributable to the drug and 
                                        retained by the pharmacy 
                                        benefit manager and any 
                                        affiliate of such pharmacy 
                                        benefit manager.
                                    ``(II) In the case of a pharmacy 
                                benefit manager that has an affiliate 
                                that is a retail, mail order, or 
                                specialty pharmacy, with respect to 
                                drugs covered by such plan that were 
                                dispensed, the following information:
                                            ``(aa) The percentage of 
                                        total prescriptions that were 
                                        dispensed by pharmacies that 
                                        are an affiliate of the 
                                        pharmacy benefit manager for 
                                        each drug.
                                            ``(bb) The interquartile 
                                        range of the total combined 
                                        costs paid by the plan and plan 
                                        enrollees, per dosage unit, per 
                                        course of treatment, per 30-day 
                                        supply, and per 90-day supply 
                                        for each drug dispensed by 
                                        pharmacies that are not an 
                                        affiliate of the pharmacy 
                                        benefit manager and that are 
                                        included in the pharmacy 
                                        network of such plan.
                                            ``(cc) The interquartile 
                                        range of the total combined 
                                        costs paid by the plan and plan 
                                        enrollees, per dosage unit, per 
                                        course of treatment, per 30-day 
                                        supply, and per 90-day supply 
                                        for each drug dispensed by 
                                        pharmacies that are an 
                                        affiliate of the pharmacy 
                                        benefit manager and that are 
                                        included in the pharmacy 
                                        network of such plan.
                                            ``(dd) The lowest total 
                                        combined cost paid by the plan 
                                        and plan enrollees, per dosage 
                                        unit, per course of treatment, 
                                        per 30-day supply, and per 90-
                                        day supply, for each drug that 
                                        is available from any pharmacy 
                                        included in the pharmacy 
                                        network of such plan.
                                            ``(ee) The difference 
                                        between the average acquisition 
                                        cost of the affiliate, such as 
                                        a pharmacy or other entity that 
                                        acquires prescription drugs, 
                                        that initially acquires the 
                                        drug and the amount reported 
                                        under subclause (I)(jj) for 
                                        each drug.
                                            ``(ff) A list inclusive of 
                                        the brand name, generic or non-
                                        proprietary name, and National 
                                        Drug Code of covered part D 
                                        drugs subject to an agreement 
                                        with a covered entity under 
                                        section 340B of the Public 
                                        Health Service Act for which 
                                        the pharmacy benefit manager or 
                                        an affiliate of the pharmacy 
                                        benefit manager had a contract 
                                        or other arrangement with such 
                                        a covered entity in the service 
                                        area of such plan.
                                    ``(III) Where a drug approved under 
                                section 505(c) of the Federal Food, 
                                Drug, and Cosmetic Act (referred to in 
                                this subclause as the `listed drug') is 
                                covered by the plan, the following 
                                information:
                                            ``(aa) A list of currently 
                                        marketed generic drugs approved 
                                        under section 505(j) of the 
                                        Federal Food, Drug, and 
                                        Cosmetic Act pursuant to an 
                                        application that references 
                                        such listed drug that are not 
                                        covered by the plan, are 
                                        covered on the same formulary 
                                        tier or a formulary tier 
                                        typically associated with 
                                        higher cost-sharing than the 
                                        listed drug, or are subject to 
                                        utilization management that the 
                                        listed drug is not subject to.
                                            ``(bb) The estimated 
                                        average beneficiary cost-
                                        sharing under the plan for a 
                                        30-day supply of the listed 
                                        drug.
                                            ``(cc) Where a generic drug 
                                        listed under item (aa) is on a 
                                        formulary tier typically 
                                        associated with higher cost-
                                        sharing than the listed drug, 
                                        the estimated average cost-
                                        sharing that a beneficiary 
                                        would have paid for a 30-day 
                                        supply of each of the generic 
                                        drugs described in item (aa), 
                                        had the plan provided coverage 
                                        for such drugs on the same 
                                        formulary tier as the listed 
                                        drug.
                                            ``(dd) A written 
                                        justification for providing 
                                        more favorable coverage of the 
                                        listed drug than the generic 
                                        drugs described in item (aa).
                                            ``(ee) The number of 
                                        currently marketed generic 
                                        drugs approved under section 
                                        505(j) of the Federal Food, 
                                        Drug, and Cosmetic Act pursuant 
                                        to an application that 
                                        references such listed drug.
                                    ``(IV) Where a reference product 
                                (as defined in section 351(i) of the 
                                Public Health Service Act) is covered 
                                by the plan, the following information:
                                            ``(aa) A list of currently 
                                        marketed biosimilar biological 
                                        products licensed under section 
                                        351(k) of the Public Health 
                                        Service Act pursuant to an 
                                        application that refers to such 
                                        reference product that are not 
                                        covered by the plan, are 
                                        covered on the same formulary 
                                        tier or a formulary tier 
                                        typically associated with 
                                        higher cost-sharing than the 
                                        reference product, or are 
                                        subject to utilization 
                                        management that the reference 
                                        product is not subject to.
                                            ``(bb) The estimated 
                                        average beneficiary cost-
                                        sharing under the plan for a 
                                        30-day supply of the reference 
                                        product.
                                            ``(cc) Where a biosimilar 
                                        biological product listed under 
                                        item (aa) is on a formulary 
                                        tier typically associated with 
                                        higher cost-sharing than the 
                                        reference product, the 
                                        estimated average cost-sharing 
                                        that a beneficiary would have 
                                        paid for a 30-day supply of 
                                        each of the biosimilar 
                                        biological products described 
                                        in item (aa), had the plan 
                                        provided coverage for such 
                                        products on the same formulary 
                                        tier as the reference product.
                                            ``(dd) A written 
                                        justification for providing 
                                        more favorable coverage of the 
                                        reference product than the 
                                        biosimilar biological product 
                                        described in item (aa).
                                            ``(ee) The number of 
                                        currently marketed biosimilar 
                                        biological products licensed 
                                        under section 351(k) of the 
                                        Public Health Service Act, 
                                        pursuant to an application that 
                                        refers to such reference 
                                        product.
                                    ``(V) Total gross spending on 
                                covered part D drugs by the plan, not 
                                net of rebates, fees, discounts, or 
                                other direct or indirect remuneration.
                                    ``(VI) The total amount retained by 
                                the pharmacy benefit manager or an 
                                affiliate of such pharmacy benefit 
                                manager in revenue related to 
                                utilization of covered part D drugs 
                                under that plan, inclusive of bona fide 
                                service fees.
                                    ``(VII) The total spending on 
                                covered part D drugs net of rebates, 
                                fees, discounts, or other direct and 
                                indirect remuneration by the plan.
                                    ``(VIII) An explanation of any 
                                benefit design parameters under such 
                                plan that encourage plan enrollees to 
                                fill prescriptions at pharmacies that 
                                are an affiliate of such pharmacy 
                                benefit manager, such as mail and 
                                specialty home delivery programs, and 
                                retail and mail auto-refill programs.
                                    ``(IX) The following information:
                                            ``(aa) A list of all 
                                        brokers, consultants, advisors, 
                                        and auditors that receive 
                                        compensation from the pharmacy 
                                        benefit manager or an affiliate 
                                        of such pharmacy benefit 
                                        manager for referrals, 
                                        consulting, auditing, or other 
                                        services offered to PDP 
                                        sponsors related to pharmacy 
                                        benefit management services.
                                            ``(bb) The amount of 
                                        compensation provided by such 
                                        pharmacy benefit manager or 
                                        affiliate to each such broker, 
                                        consultant, advisor, and 
                                        auditor.
                                            ``(cc) The methodology for 
                                        calculating the amount of 
                                        compensation provided by such 
                                        pharmacy benefit manager or 
                                        affiliate, for each such 
                                        broker, consultant, advisor, 
                                        and auditor.
                                    ``(X) A list of all affiliates of 
                                the pharmacy benefit manager.
                                    ``(XI) A summary document submitted 
                                in a standardized template developed by 
                                the Secretary that includes such 
                                information described in subclauses (I) 
                                through (X).
                            ``(ii) Written explanation of contracts or 
                        agreements with drug manufacturers.--
                                    ``(I) In general.--The pharmacy 
                                benefit manager shall, not later than 
                                30 days after the finalization of any 
                                contract or agreement between such 
                                pharmacy benefit manager or an 
                                affiliate of such pharmacy benefit 
                                manager and a drug manufacturer (or 
                                subsidiary, agent, or entity affiliated 
                                with such drug manufacturer) that makes 
                                rebates, discounts, payments, or other 
                                financial incentives related to one or 
                                more covered part D drugs or other 
                                prescription drugs, as applicable, of 
                                the manufacturer directly or indirectly 
                                contingent upon coverage, formulary 
                                placement, or utilization management 
                                conditions on any other covered part D 
                                drugs or other prescription drugs, as 
                                applicable, submit to the PDP sponsor a 
                                written explanation of such contract or 
                                agreement.
                                    ``(II) Requirements.--A written 
                                explanation under subclause (I) shall--
                                            ``(aa) include the 
                                        manufacturer subject to the 
                                        contract or agreement, all 
                                        covered part D drugs and other 
                                        prescription drugs, as 
                                        applicable, subject to the 
                                        contract or agreement and the 
                                        manufacturers of such drugs, 
                                        and a high-level description of 
                                        the terms of such contract or 
                                        agreement and how such terms 
                                        apply to such drugs; and
                                            ``(bb) be certified by the 
                                        Chief Executive Officer, Chief 
                                        Financial Officer, or General 
                                        Counsel of such pharmacy 
                                        benefit manager, or affiliate 
                                        of such pharmacy benefit 
                                        manager, as applicable, or an 
                                        individual delegated with the 
                                        authority to sign on behalf of 
                                        one of these officers, who 
                                        reports directly to the 
                                        officer.
                                    ``(III) Definition of other 
                                prescription drugs.--For purposes of 
                                this clause, the term `other 
                                prescription drugs' means prescription 
                                drugs covered as supplemental benefits 
                                under this part or prescription drugs 
                                paid outside of this part.
                    ``(D) Audit rights.--
                            ``(i) In general.--Not less than once a 
                        year, at the request of the PDP sponsor, the 
                        pharmacy benefit manager shall allow for an 
                        audit of the pharmacy benefit manager to ensure 
                        compliance with all terms and conditions under 
                        the written agreement described in this 
                        paragraph and the accuracy of information 
                        reported under subparagraph (C).
                            ``(ii) Auditor.--The PDP sponsor shall have 
                        the right to select an auditor. The pharmacy 
                        benefit manager shall not impose any 
                        limitations on the selection of such auditor.
                            ``(iii) Provision of information.--The 
                        pharmacy benefit manager shall make available 
                        to such auditor all records, data, contracts, 
                        and other information necessary to confirm the 
                        accuracy of information provided under 
                        subparagraph (C), subject to reasonable 
                        restrictions on how such information must be 
                        reported to prevent redisclosure of such 
                        information.
                            ``(iv) Timing.--The pharmacy benefit 
                        manager must provide information under clause 
                        (iii) and other information, data, and records 
                        relevant to the audit to such auditor within 6 
                        months of the initiation of the audit and 
                        respond to requests for additional information 
                        from such auditor within 30 days after the 
                        request for additional information.
                            ``(v) Information from affiliates.--The 
                        pharmacy benefit manager shall be responsible 
                        for providing to such auditor information 
                        required to be reported under subparagraph (C) 
                        or under clause (iii) of this subparagraph that 
                        is owned or held by an affiliate of such 
                        pharmacy benefit manager.
            ``(2) Enforcement.--
                    ``(A) In general.--Each PDP sponsor shall--
                            ``(i) disgorge to the Secretary any amounts 
                        disgorged to the PDP sponsor by a pharmacy 
                        benefit manager under paragraph (1)(A)(v);
                            ``(ii) require, in a written agreement with 
                        any pharmacy benefit manager acting on behalf 
                        of such sponsor or affiliate of such pharmacy 
                        benefit manager, that such pharmacy benefit 
                        manager or affiliate reimburse the PDP sponsor 
                        for any civil money penalty imposed on the PDP 
                        sponsor as a result of the failure of the 
                        pharmacy benefit manager or affiliate to meet 
                        the requirements of paragraph (1) that are 
                        applicable to the pharmacy benefit manager or 
                        affiliate under the agreement; and
                            ``(iii) require, in a written agreement 
                        with any such pharmacy benefit manager acting 
                        on behalf of such sponsor or affiliate of such 
                        pharmacy benefit manager, that such pharmacy 
                        benefit manager or affiliate be subject to 
                        punitive remedies for breach of contract for 
                        failure to comply with the requirements 
                        applicable under paragraph (1).
                    ``(B) Reporting of alleged violations.--The 
                Secretary shall make available and maintain a mechanism 
                for manufacturers, PDP sponsors, pharmacies, and other 
                entities that have contractual relationships with 
                pharmacy benefit managers or affiliates of such 
                pharmacy benefit managers to report, on a confidential 
                basis, alleged violations of paragraph (1)(A) or 
                subparagraph (C).
                    ``(C) Anti-retaliation and anti-coercion.--
                Consistent with applicable Federal or State law, a PDP 
                sponsor shall not--
                            ``(i) retaliate against an individual or 
                        entity for reporting an alleged violation under 
                        subparagraph (B); or
                            ``(ii) coerce, intimidate, threaten, or 
                        interfere with the ability of an individual or 
                        entity to report any such alleged violations.
            ``(3) Certification of compliance.--
                    ``(A) In general.--Each PDP sponsor shall furnish 
                to the Secretary (at a time and in a manner specified 
                by the Secretary) an annual certification of compliance 
                with this subsection, as well as such information as 
                the Secretary determines necessary to carry out this 
                subsection.
                    ``(B) Implementation.--Notwithstanding any other 
                provision of law, the Secretary may implement this 
                paragraph by program instruction or otherwise.
            ``(4) Rule of construction.--Nothing in this subsection 
        shall be construed as--
                    ``(A) prohibiting flat dispensing fees or 
                reimbursement or payment for ingredient costs 
                (including customary, industry-standard discounts 
                directly related to drug acquisition that are retained 
                by pharmacies or wholesalers) to entities that acquire 
                or dispense prescription drugs; or
                    ``(B) modifying regulatory requirements or sub-
                regulatory program instruction or guidance related to 
                pharmacy payment, reimbursement, or dispensing fees.
            ``(5) Standard formats.--
                    ``(A) In general.--Not later than June 1, 2028, the 
                Secretary shall specify standard, machine-readable 
                formats for pharmacy benefit managers to submit annual 
                reports required under paragraph (1)(C)(i).
                    ``(B) Implementation.--Notwithstanding any other 
                provision of law, the Secretary may implement this 
                paragraph by program instruction or otherwise.
            ``(6) Confidentiality.--
                    ``(A) In general.--Information disclosed by a 
                pharmacy benefit manager, an affiliate of a pharmacy 
                benefit manager, a PDP sponsor, or a pharmacy under 
                this subsection that is not otherwise publicly 
                available or available for purchase shall not be 
                disclosed by the Secretary or a PDP sponsor receiving 
                the information, except that the Secretary may disclose 
                the information for the following purposes:
                            ``(i) As the Secretary determines necessary 
                        to carry out this part.
                            ``(ii) To permit the Comptroller General to 
                        review the information provided.
                            ``(iii) To permit the Director of the 
                        Congressional Budget Office to review the 
                        information provided.
                            ``(iv) To permit the Executive Director of 
                        the Medicare Payment Advisory Commission to 
                        review the information provided.
                            ``(v) To the Attorney General for the 
                        purposes of conducting oversight and 
                        enforcement under this title.
                            ``(vi) To the Inspector General of the 
                        Department of Health and Human Services in 
                        accordance with its authorities under the 
                        Inspector General Act of 1978 (section 406 of 
                        title 5, United States Code), and other 
                        applicable statutes.
                    ``(B) Restriction on use of information.--The 
                Secretary, the Comptroller General, the Director of the 
                Congressional Budget Office, and the Executive Director 
                of the Medicare Payment Advisory Commission shall not 
                report on or disclose information disclosed pursuant to 
                subparagraph (A) to the public in a manner that would 
                identify--
                            ``(i) a specific pharmacy benefit manager, 
                        affiliate, pharmacy, manufacturer, wholesaler, 
                        PDP sponsor, or plan; or
                            ``(ii) contract prices, rebates, discounts, 
                        or other remuneration for specific drugs in a 
                        manner that may allow the identification of 
                        specific contracting parties or of such 
                        specific drugs.
            ``(7) Definitions.--For purposes of this subsection:
                    ``(A) Affiliate.--The term `affiliate' means, with 
                respect to any pharmacy benefit manager or PDP sponsor, 
                any entity that, directly or indirectly--
                            ``(i) owns or is owned by, controls or is 
                        controlled by, or is otherwise related in any 
                        ownership structure to such pharmacy benefit 
                        manager or PDP sponsor; or
                            ``(ii) acts as a contractor, principal, or 
                        agent to such pharmacy benefit manager or PDP 
                        sponsor, insofar as such contractor, principal, 
                        or agent performs any of the functions 
                        described under subparagraph (C).
                    ``(B) Bona fide service fee.--The term `bona fide 
                service fee' means a fee that is reflective of the fair 
                market value (as specified by the Secretary, through 
                notice and comment rulemaking) for a bona fide, 
                itemized service actually performed on behalf of an 
                entity, that the entity would otherwise perform (or 
                contract for) in the absence of the service arrangement 
                and that is not passed on in whole or in part to a 
                client or customer, whether or not the entity takes 
                title to the drug. Such fee must be a flat dollar 
                amount and shall not be directly or indirectly based 
                on, or contingent upon--
                            ``(i) drug price, such as wholesale 
                        acquisition cost or drug benchmark price (such 
                        as average wholesale price);
                            ``(ii) the amount of discounts, rebates, 
                        fees, or other direct or indirect remuneration 
                        with respect to covered part D drugs dispensed 
                        to enrollees in a prescription drug plan, 
                        except as permitted pursuant to paragraph 
                        (1)(A)(ii);
                            ``(iii) coverage or formulary placement 
                        decisions or the volume or value of any 
                        referrals or business generated between the 
                        parties to the arrangement; or
                            ``(iv) any other amounts or methodologies 
                        prohibited by the Secretary.
                    ``(C) Pharmacy benefit manager.--The term `pharmacy 
                benefit manager' means any person or entity that, 
                either directly or through an intermediary, acts as a 
                price negotiator or group purchaser on behalf of a PDP 
                sponsor or prescription drug plan, or manages the 
                prescription drug benefits provided by such sponsor or 
                plan, including the processing and payment of claims 
                for prescription drugs, the performance of drug 
                utilization review, the processing of drug prior 
                authorization requests, the adjudication of appeals or 
                grievances related to the prescription drug benefit, 
                contracting with network pharmacies, controlling the 
                cost of covered part D drugs, or the provision of 
                related services. Such term includes any person or 
                entity that carries out one or more of the activities 
                described in the preceding sentence, irrespective of 
                whether such person or entity calls itself a `pharmacy 
                benefit manager'.''.
            (2) MA-PD plans.--Section 1857(f)(3) of the Social Security 
        Act (42 U.S.C. 1395w-27(f)(3)) is amended by adding at the end 
        the following new subparagraph:
                    ``(F) Requirements relating to pharmacy benefit 
                managers.--For plan years beginning on or after January 
                1, 2029, section 1860D-12(h).''.
            (3) Nonapplication of paperwork reduction act.--Chapter 35 
        of title 44, United States Code, shall not apply to the 
        implementation of this subsection.
            (4) Funding.--
                    (A) Secretary.--In addition to amounts otherwise 
                available, there is appropriated to the Centers for 
                Medicare & Medicaid Services Program Management 
                Account, out of any money in the Treasury not otherwise 
                appropriated, $113,000,000 for fiscal year 2026, to 
                remain available until expended, to carry out this 
                subsection.
                    (B) OIG.--In addition to amounts otherwise 
                available, there is appropriated to the Inspector 
                General of the Department of Health and Human Services, 
                out of any money in the Treasury not otherwise 
                appropriated, $20,000,000 for fiscal year 2026, to 
                remain available until expended, to carry out this 
                subsection.
    (b) GAO Study and Report on Price-Related Compensation Across the 
Supply Chain.--
            (1) Study.--The Comptroller General of the United States 
        (in this subsection referred to as the ``Comptroller General'') 
        shall conduct a study describing the use of compensation and 
        payment structures related to a prescription drug's price 
        within the retail prescription drug supply chain in part D of 
        title XVIII of the Social Security Act (42 U.S.C. 1395w-101 et 
        seq.). Such study shall summarize information from Federal 
        agencies and industry experts, to the extent available, with 
        respect to the following:
                    (A) The type, magnitude, other features (such as 
                the pricing benchmarks used), and prevalence of 
                compensation and payment structures related to a 
                prescription drug's price, such as calculating fee 
                amounts as a percentage of a prescription drug's price, 
                between intermediaries in the prescription drug supply 
                chain, including--
                            (i) pharmacy benefit managers;
                            (ii) PDP sponsors offering prescription 
                        drug plans and Medicare Advantage organizations 
                        offering MA-PD plans;
                            (iii) drug wholesalers;
                            (iv) pharmacies;
                            (v) manufacturers;
                            (vi) pharmacy services administrative 
                        organizations;
                            (vii) brokers, auditors, consultants, and 
                        other entities that--
                                    (I) advise PDP sponsors offering 
                                prescription drug plans and Medicare 
                                Advantage organizations offering MA-PD 
                                plans regarding pharmacy benefits; or
                                    (II) review PDP sponsor and 
                                Medicare Advantage organization 
                                contracts with pharmacy benefit 
                                managers; and
                            (viii) other service providers that 
                        contract with any of the entities described in 
                        clauses (i) through (vii) that may use price-
                        related compensation and payment structures, 
                        such as rebate aggregators (or other entities 
                        that negotiate or process price concessions on 
                        behalf of pharmacy benefit managers, plan 
                        sponsors, or pharmacies).
                    (B) The primary business models and compensation 
                structures for each category of intermediary described 
                in subparagraph (A).
                    (C) Variation in price-related compensation 
                structures between affiliated entities (such as 
                entities with common ownership, either full or partial, 
                and subsidiary relationships) and unaffiliated 
                entities.
                    (D) Potential conflicts of interest among 
                contracting entities related to the use of prescription 
                drug price-related compensation structures, such as the 
                potential for fees or other payments set as a 
                percentage of a prescription drug's price to advantage 
                formulary selection, distribution, or purchasing of 
                prescription drugs with higher prices.
                    (E) Notable differences, if any, in the use and 
                level of price-based compensation structures over time 
                and between different market segments, such as under 
                part D of title XVIII of the Social Security Act (42 
                U.S.C. 1395w-101 et seq.) and the Medicaid program 
                under title XIX of such Act (42 U.S.C. 1396 et seq.).
                    (F) The effects of drug price-related compensation 
                structures and alternative compensation structures on 
                Federal health care programs and program beneficiaries, 
                including with respect to cost-sharing, premiums, 
                Federal outlays, biosimilar and generic drug adoption 
                and utilization, drug shortage risks, and the potential 
                for fees set as a percentage of a drug's price to 
                advantage the formulary selection, distribution, or 
                purchasing of drugs with higher prices.
                    (G) Other issues determined to be relevant and 
                appropriate by the Comptroller General.
            (2) Report.--Not later than 2 years after the date of 
        enactment of this section, the Comptroller General shall submit 
        to Congress a report containing the results of the study 
        conducted under paragraph (1), together with recommendations 
        for such legislation and administrative action as the 
        Comptroller General determines appropriate.
    (c) MedPAC Reports on Agreements With Pharmacy Benefit Managers 
With Respect to Prescription Drug Plans and MA-PD Plans.--
            (1) In general.--The Medicare Payment Advisory Commission 
        shall submit to Congress the following reports:
                    (A) Initial report.--Not later than the first March 
                15 occurring after the date that is 2 years after the 
                date on which the Secretary makes the data available to 
                the Commission, a report regarding agreements with 
                pharmacy benefit managers with respect to prescription 
                drug plans and MA-PD plans. Such report shall include, 
                to the extent practicable--
                            (i) a description of trends and patterns, 
                        including relevant averages, totals, and other 
                        figures for the types of information submitted;
                            (ii) an analysis of any differences in 
                        agreements and their effects on plan enrollee 
                        out-of-pocket spending and average pharmacy 
                        reimbursement, and other impacts; and
                            (iii) any recommendations the Commission 
                        determines appropriate.
                    (B) Final report.--Not later than 2 years after the 
                date on which the Commission submits the initial report 
                under subparagraph (A), a report describing any changes 
                with respect to the information described in 
                subparagraph (A) over time, together with any 
                recommendations the Commission determines appropriate.
            (2) Funding.--In addition to amounts otherwise available, 
        there is appropriated to the Medicare Payment Advisory 
        Commission, out of any money in the Treasury not otherwise 
        appropriated, $1,000,000 for fiscal year 2026, to remain 
        available until expended, to carry out this subsection.

SEC. 6. EXPEDITED CONSIDERATION OF ENHANCED PREMIUM TAX CREDIT REFORM 
              BILL.

    (a) Qualifying Legislation.--
            (1) In general.--Only an enhanced premium tax credit reform 
        bill shall be entitled to expedited consideration under this 
        section.
            (2) Definition.--In this section, the term ``enhanced 
        premium tax credit reform bill'' means a bill or joint 
        resolution which consists solely of legislative language with 
        respect to continued health insurance premium savings, 
        including more significant reforms, that has accumulated at 
        least 10 cosponsors from each of the majority party and the 
        minority party at the time it is offered.
    (b) Consideration in the House of Representatives.--
            (1) Referral and reporting.--Any committee of the House of 
        Representatives to which an enhanced premium tax credit reform 
        bill is referred shall report the enhanced premium tax credit 
        reform bill to the House of Representatives without amendment 
        not later than 5 legislative days after the date on which the 
        enhanced premium tax credit reform bill was so referred. If a 
        committee of the House of Representatives fails to report an 
        enhanced premium tax credit reform bill within that period, 
        that committee shall be automatically discharged from 
        consideration of the enhanced premium tax credit reform bill, 
        and the enhanced premium tax credit reform bill shall be placed 
        on the appropriate calendar.
            (2) Proceeding to consideration.--After the last committee 
        authorized to consider an enhanced premium tax credit reform 
        bill reports it to the House of Representatives or has been 
        discharged from its consideration, it shall be in order to move 
        to proceed to consider the enhanced premium tax credit reform 
        bill in the House of Representatives. Such a motion shall not 
        be in order after the House of Representatives has disposed of 
        a motion to proceed with respect to the enhanced premium tax 
        credit reform bill. The previous question shall be considered 
        as ordered on the motion to its adoption without intervening 
        motion. The motion shall not be debatable. A motion to 
        reconsider the vote by which the motion is disposed of shall 
        not be in order.
            (3) Vote on passage.--The vote on passage of the enhanced 
        premium tax credit reform bill shall occur not later than 3 
        legislative days after the date on which the last committee 
        authorized to consider the enhanced premium tax credit reform 
        bill reports it to the House of Representatives or is 
        discharged.
    (c) Expedited Procedure in the Senate.--
            (1) Committee consideration.--An enhanced premium tax 
        credit reform bill introduced in the Senate shall be jointly 
        referred to the committee or committees of jurisdiction, which 
        committees shall report the enhanced premium tax credit reform 
        bill without any revision and with a favorable recommendation, 
        an unfavorable recommendation, or without recommendation, not 
        later than 5 session days after the date on which the enhanced 
        premium tax credit reform bill was so referred. If any 
        committee to which an enhanced premium tax credit reform bill 
        is referred fails to report the enhanced premium tax credit 
        reform bill within that period, that committee shall be 
        automatically discharged from consideration of the enhanced 
        premium tax credit reform bill, and the enhanced premium tax 
        credit reform bill shall be placed on the appropriate calendar.
            (2) Proceeding.--Notwithstanding rule XXII of the Standing 
        Rules of the Senate, it is in order, not later than 2 days of 
        session after the date on which an enhanced premium tax credit 
        reform bill is reported or discharged from all committees to 
        which the enhanced premium tax credit reform bill was referred, 
        for the majority leader of the Senate or the designee of the 
        majority leader to move to proceed to the consideration of the 
        enhanced premium tax credit reform bill. It shall also be in 
        order for any Member of the Senate to move to proceed to the 
        consideration of the enhanced premium tax credit reform bill at 
        any time after the conclusion of such 2-day period. A motion to 
        proceed is in order even though a previous motion to the same 
        effect has been disagreed to. All points of order against the 
        motion to proceed to the enhanced premium tax credit reform 
        bill are waived. The motion to proceed is not debatable. The 
        motion is not subject to a motion to postpone. A motion to 
        reconsider the vote by which the motion is agreed to or 
        disagreed to shall not be in order. If a motion to proceed to 
        the consideration of the enhanced premium tax credit reform 
        bill is agreed to, the enhanced premium tax credit reform bill 
        shall remain the unfinished business until disposed of. All 
        points of order against an enhanced premium tax credit reform 
        bill and against consideration of the enhanced premium tax 
        credit reform bill are waived.
    (d) Consideration by the Other House.--
            (1) In general.--If, before passing an enhanced premium tax 
        credit reform bill, a House receives from the other House an 
        enhanced premium tax credit reform bill of the other House--
                    (A) the enhanced premium tax credit reform bill of 
                the other House shall not be referred to a committee; 
                and
                    (B) the procedure in the receiving House shall be 
                the same as if no enhanced premium tax credit reform 
                bill had been received from the other House until the 
                vote on passage, when the enhanced premium tax credit 
                reform bill received from the other House shall 
                supplant the enhanced premium tax credit reform bill of 
                the receiving House.
            (2) Revenue measures.--This subsection shall not apply to 
        the House of Representatives if an enhanced premium tax credit 
        reform bill received from the Senate is a revenue measure.
    (e) Rules to Coordinate Action With Other House.--
            (1) Treatment of enhanced premium tax credit reform bill of 
        other house.--If an enhanced premium tax credit reform bill is 
        not introduced in the Senate or the Senate fails to consider an 
        enhanced premium tax credit reform bill under this section, the 
        enhanced premium tax credit reform bill of the House of 
        Representatives shall be entitled to expedited floor procedures 
        under this section.
            (2) Treatment of companion measures in the senate.--If, 
        following passage of an enhanced premium tax credit reform bill 
        in the Senate, the Senate then receives from the House of 
        Representatives an enhanced premium tax credit reform bill, the 
        House-passed enhanced premium tax credit reform bill shall not 
        be debatable. The vote on passage of the enhanced premium tax 
        credit reform bill in the Senate shall be considered to be the 
        vote on passage of the enhanced premium tax credit reform bill 
        received from the House of Representatives.
            (3) Vetoes.--If the President vetoes an enhanced premium 
        tax credit reform bill, consideration of a veto message in the 
        Senate under this paragraph shall be 10 hours equally divided 
        between the majority and minority leaders of the Senate or the 
        designees of the majority and minority leaders of the Senate.
    (f) Vote on Passage.--The vote on final passage in the House of 
Representatives and the Senate of the enhanced premium tax credit 
reform bill shall occur not later than July 1, 2026.
    (g) Exercise of Rulemaking Power.--This section is enacted by 
Congress--
            (1) as an exercise of the rulemaking power of the Senate 
        and House of Representatives, respectively, and as such it is 
        deemed a part of the rules of each House, respectively, but 
        applicable only with respect to the procedure to be followed in 
        that House in the case of an enhanced premium tax credit reform 
        bill, and it supersedes other rules only to the extent that it 
        is inconsistent with such rules; and
            (2) with full recognition of the constitutional right of 
        either House to change the rules (so far as relating to the 
        procedure of that House) at any time, in the same manner, and 
        to the same extent as in the case of any other rule of that 
        House.
                                 <all>