I 

117TH CONGRESS 

1ST SESSION H. R. 2608 

To amend title XVIII of the Social Security Act to ensure equal access 

of Medicare beneficiaries to community pharmacies in underserved areas 

as network pharmacies under Medicare prescription drug coverage, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 15, 2021 

Mr. WELCH (for himself, Mr. GRIFFITH, Mr. VICENTE GONZALEZ of Texas, 

Mr. CRAWFORD, Mr. CARTER of Georgia, Mrs. AXNE, Mr. ALLEN, Mr. 

RUPPERSBERGER, and Mr. WESTERMAN) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, 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 title XVIII of the Social Security Act to ensure 

equal access of Medicare beneficiaries to community 

pharmacies in underserved areas as network pharmacies 

under Medicare prescription drug coverage, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Ensuring Seniors Ac5 cess to Local Pharmacies Act of 2021’’. 


kjohnson on DSK79L0C42PROD with BILLS
2 

•HR 2608 IH

1 SEC. 2. ALLOWING ANY STATE LICENSED PHARMACY SERV2 ING AN UNDERSERVED AREA TO BECOME A 

3 NETWORK PHARMACY UNDER MEDICARE 

4 PRESCRIPTION DRUG COVERAGE. 

5 (a) IN GENERAL.—Section 1860D–4(b)(1)(B) of the 

6 Social Security Act (42 U.S.C. 1395w–104(b)(1)(B)) is 

7 amended— 

8 (1) by striking ‘‘DISCOUNTS ALLOWED FOR

9 NETWORK PHARMACIES.—For’’ and inserting the 

10 following: ‘‘DISCOUNTS ALLOWED FOR NETWORK

11 PHARMACIES.— 

12 ‘‘(i) IN GENERAL.—For’’; and 

13 (2) by adding at the end the following new 

14 clause: 

15 ‘‘(ii) INCLUSION OF PHARMACIES LO16 CATED IN UNDERSERVED AREAS IN NET17 WORKS.—For plan years beginning on or 

18 after January 1, 2022, in the case of a 

19 prescription drug plan that has, in its net20 work of pharmacies, one or more phar21 macies located in a health professional 

22 shortage area (as defined in section 

23 332(a)(1)(A) of the Public Health Service 

24 Act), in a medically underserved area (ac25 cording to a designation under section 

26 330(b)(3)(A) of the Public Health Service 


kjohnson on DSK79L0C42PROD with BILLS
3 

•HR 2608 IH

1 Act), among a medically underserved popu2 lation (as defined in such section 

3 330(b)(3)(A) of such Act), or in a rural 

4 area (as defined by the Federal Office of 

5 Rural Health Policy), and that provides a 

6 reduction in coinsurance or copayments de7 scribed in clause (i) for covered part D 

8 drugs dispensed through such pharmacies, 

9 such plan shall extend to any pharmacy lo10 cated in such area or among such popu11 lation the option to be an in-network phar12 macy with respect to such plan under 

13 terms and conditions (including the reduc14 tions described in clause (i)) comparable to 

15 those the plan has agreed upon with other 

16 in-network pharmacies located in such area 

17 or among such population.’’. 

18 SEC. 3. REASONABLE REIMBURSEMENT REQUIREMENTS. 

19 Section 1860D–2(d)(1)(B) of the Social Security Act 

20 (42 U.S.C. 1395w–102(d)(1)(B)) is amended— 

21 (1) by striking ‘‘PRICES.—For purposes’’ and 

22 inserting ‘‘PRICES.— 

23 ‘‘(i) IN GENERAL.—For purposes’’; 

24 and 


kjohnson on DSK79L0C42PROD with BILLS
4 

•HR 2608 IH

1 (2) by adding at the end the following new 

2 clauses: 

3 ‘‘(ii) REASONABLE REIMBURSE4 MENT.—For plan years beginning on or 

5 after January 1, 2022, a PDP sponsor and 

6 a Medicare Advantage organization shall 

7 ensure that— 

8 ‘‘(I) each prescription drug plan 

9 or MA–PD plan offered by the spon10 sor or organization does not reimburse 

11 a pharmacy or pharmacist an amount 

12 less than the amount that the phar13 macy benefits manager reimburses a 

14 pharmacy benefits manager affiliate 

15 (as defined in clause (iv)); and 

16 ‘‘(II) in no case may the nego17 tiated price for a covered part D drug 

18 furnished by a pharmacy under a pre19 scription drug plan or MA–PD plan 

20 offered by the sponsor or organiza21 tion, be less than such pharmacy’s 

22 cost of purchasing and dispensing 

23 such drug and providing such other 

24 services associated with furnishing 


kjohnson on DSK79L0C42PROD with BILLS
5 

•HR 2608 IH

1 such drug as may be specified by the 

2 Secretary. 

3 ‘‘(iii) CLAIM REIMBURSEMENT DIS4 CLOSURE REQUIREMENTS.—With respect 

5 to payment made by a PDP sponsor or a 

6 Medicare Advantage organization to a 

7 pharmacy for a covered part D drug fur8 nished by such pharmacy during a plan 

9 year beginning on or after January 1, 

10 2022, such sponsor or organization shall 

11 promptly furnish all pricing components 

12 including the Network Reimbursement ID 

13 used to price the claim, any fees, pharmacy 

14 price concessions, discounts, subsidies, re15 bates, incentives, or any other forms of di16 rect or indirect remuneration that affect 

17 payment and pricing of the claim as part 

18 of the claim adjudication response at the 

19 point-of sale. All pricing components de20 scribed in the preceding sentence shall 

21 each be identified in a predetermined line 

22 item in the remittance advice that is stand23 ard across the industry. The PDP sponsor 

24 or Medicare Advantage organization shall 

25 include suitable claim-level detail on the 


kjohnson on DSK79L0C42PROD with BILLS
6 

•HR 2608 IH

1 electronic remittance advice that accom2 panies each payment. This claim-level de3 tail shall include, in an industry standard4 ized format, all fields needed to properly 

5 identify the claim, including the Claim Au6 thorization Number, date of service, date 

7 of payment remittance, ingredient cost re8 imbursed, dispensing fee reimbursed, pay9 ment amounts including the Network ID 

10 used to price the claim, the specific dollar 

11 amounts and the appropriate qualifier 

12 codes for each payment adjustment includ13 ing fees, pharmacy price concessions, or in14 centives. 

15 ‘‘(iv) PHARMACY BENEFITS MANAGER

16 AFFILIATE DEFINED.—For purposes of 

17 clause (ii), the term ‘pharmacy benefits 

18 manager affiliate’ means a pharmacy or 

19 pharmacist that directly or indirectly, 

20 through one or more intermediaries, owns 

21 or controls, is owned or controlled by, or is 

22 under common ownership or corporate con23 trol with a pharmacy benefits manager, 


kjohnson on DSK79L0C42PROD with BILLS
7 

•HR 2608 IH

1 PDP sponsor or a Medicare Advantage or2 ganization.’’. 

Æ 


kjohnson on DSK79L0C42PROD with BILLS