I 

116TH CONGRESS 

1ST SESSION H. R. 4649 

To amend title XVIII of the Social Security Act to provide for a cap on 

beneficiary liability under part D of the Medicare program, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 11, 2019 

Mr. HORSFORD (for himself and Ms. KENDRA S. HORN of Oklahoma) 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 provide 

for a cap on beneficiary liability under part D of the 

Medicare program, 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 ‘‘Capping Drug Costs 

5 for Seniors Act of 2019’’. 


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1 SEC. 2. MEDICARE PART D BENEFIT REDESIGN. 

2 (a) BENEFIT STRUCTURE REDESIGN.—Section 

3 1860D–2(b) of the Social Security Act (42 U.S.C. 1395w– 

4 102(b)) is amended— 

5 (1) in paragraph (2)— 

6 (A) in subparagraph (A), in the matter 

7 preceding clause (i), by inserting ‘‘for a year 

8 preceding 2022 and for costs above the annual 

9 deductible specified in paragraph (1) and up to 

10 the annual out-of-pocket threshold specified in 

11 paragraph (4)(B) for 2022 and each subsequent 

12 year’’ after ‘‘paragraph (3)’’; 

13 (B) in subparagraph (C)— 

14 (i) in clause (i), in the matter pre15 ceding subclause (I), by inserting ‘‘for a 

16 year preceding 2022,’’ after ‘‘paragraph 

17 (4),’’; and 

18 (ii) in clause (ii)(III), by striking 

19 ‘‘and each subsequent year’’ and inserting 

20 ‘‘and 2021’’; and 

21 (C) in subparagraph (D)— 

22 (i) in clause (i)— 

23 (I) in the matter preceding sub24 clause (I), by inserting ‘‘for a year 

25 preceding 2022,’’ after ‘‘paragraph 

26 (4),’’; and 


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1 (II) in subclause (I)(bb), by 

2 striking ‘‘a year after 2018’’ and in3 serting ‘‘each of years 2018 through 

4 2021’’; and 

5 (ii) in clause (ii)(V), by striking 

6 ‘‘2019 and each subsequent year’’ and in7 serting ‘‘each of years 2019 through 

8 2021’’; 

9 (2) in paragraph (3)(A)— 

10 (A) in the matter preceding clause (i), by 

11 inserting ‘‘for a year preceding 2022,’’ after 

12 ‘‘and (4),’’; and 

13 (B) in clause (ii), by striking ‘‘for a subse14 quent year’’ and inserting ‘‘for each of years 

15 2007 through 2021’’; and 

16 (3) in paragraph (4)— 

17 (A) in subparagraph (A)— 

18 (i) in clause (i)— 

19 (I) by redesignating subclauses 

20 (I) and (II) as items (aa) and (bb), 

21 respectively, and moving the margin 

22 of each such redesignated item 2 ems 

23 to the right; 

24 (II) in the matter preceding item 

25 (aa), as redesignated by subclause (I), 


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1 by striking ‘‘is equal to the greater 

2 of—’’ and inserting ‘‘is equal to— 

3 ‘‘(I) for a year preceding 2022, 

4 the greater of—’’; 

5 (III) by striking the period at the 

6 end of item (bb), as redesignated by 

7 subclause (I), and inserting ‘‘; and’’; 

8 and 

9 (IV) by adding at the end the fol10 lowing: 

11 ‘‘(II) for 2022 and each suc12 ceeding year, $0.’’; and 

13 (ii) in clause (ii)— 

14 (I) by striking ‘‘clause (i)(I)’’ and 

15 inserting ‘‘clause (i)(I)(aa)’’; and 

16 (II) by adding at the end the fol17 lowing new sentence: ‘‘The Secretary 

18 shall continue to calculate the dollar 

19 amounts specified in clause (i)(I)(aa), 

20 including with the adjustment under 

21 this clause, after 2021 for purposes of 

22 section 1860D–14(a)(1)(D)(iii).’’; 

23 (B) in subparagraph (B)— 

24 (i) in clause (i)— 


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1 (I) in subclause (V), by striking 

2 ‘‘or’’ at the end; 

3 (II) in subclause (VI)— 

4 (aa) by striking ‘‘for a sub5 sequent year’’ and inserting ‘‘for 

6 2021’’; and 

7 (bb) by striking the period 

8 at the end and inserting a semi9 colon; and 

10 (III) by adding at the end the 

11 following new subclauses: 

12 ‘‘(VII) for 2022, is equal to 

13 $2,000; or 

14 ‘‘(VIII) for a subsequent year, is 

15 equal to the amount specified in this 

16 subparagraph for the previous year, 

17 increased by the annual percentage in18 crease described in paragraph (6) for 

19 the year involved.’’; and 

20 (ii) in clause (ii), by striking ‘‘clause 

21 (i)(II)’’ and inserting ‘‘clause (i)’’; 

22 (C) in subparagraph (C)(i), by striking 

23 ‘‘and for amounts’’ and inserting ‘‘and, for a 

24 year preceding 2022, for amounts’’; and 


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1 (D) in subparagraph (E), by striking ‘‘In 

2 applying’’ and inserting ‘‘For each of years 

3 2011 through 2021, in applying’’. 

4 (b) DECREASING REINSURANCE PAYMENT

5 AMOUNT.—Section 1860D–15(b)(1) of the Social Security 

6 Act (42 U.S.C. 1395w–115(b)(1)) is amended by inserting 

7 after ‘‘80 percent’’ the following: ‘‘(or, with respect to a 

8 coverage year after 2021, 20 percent)’’. 

9 (c) MANUFACTURER DISCOUNT PROGRAM.— 

10 (1) IN GENERAL.—Part D of title XVIII of the 

11 Social Security Act (42 U.S.C. 1395w–101 et seq.) 

12 is amended by inserting after section 1860D–14A 

13 the following new section: 

14 ‘‘SEC. 1860D–14B. MANUFACTURER DISCOUNT PROGRAM. 

15 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab16 lish a manufacturer discount program (in this section re17 ferred to as the ‘program’). Under the program, the Sec18 retary shall enter into agreements described in subsection 

19 (b) with manufacturers and provide for the performance 

20 of the duties described in subsection (c). The Secretary 

21 shall establish a model agreement for use under the pro22 gram by not later than January 1, 2021, in consultation 

23 with manufacturers, and allow for comment on such model 

24 agreement. 

25 ‘‘(b) TERMS OF AGREEMENT.— 


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1 ‘‘(1) IN GENERAL.— 

2 ‘‘(A) AGREEMENT.—An agreement under 

3 this section shall require the manufacturer to 

4 provide applicable beneficiaries access to dis5 counted prices for applicable drugs of the man6 ufacturer that are dispensed on or after Janu7 ary 1, 2022. 

8 ‘‘(B) PROVISION OF DISCOUNTED PRICES

9 AT THE POINT-OF-SALE.—The discounted prices 

10 described in subparagraph (A) shall be provided 

11 to the applicable beneficiary at the pharmacy or 

12 by the mail order service at the point-of-sale of 

13 an applicable drug. 

14 ‘‘(C) TIMING OF AGREEMENT.— 

15 ‘‘(i) SPECIAL RULE FOR 2022.—In 

16 order for an agreement with a manufac17 turer to be in effect under this section with 

18 respect to the period beginning on January 

19 1, 2022, and ending on December 31, 

20 2022, the manufacturer shall enter into 

21 such agreement not later than 30 days 

22 after the date of the establishment of a 

23 model agreement under subsection (a). 

24 ‘‘(ii) 2023 AND SUBSEQUENT

25 YEARS.—In order for an agreement with a 


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1 manufacturer to be in effect under this 

2 section with respect to plan year 2023 or 

3 a subsequent plan year, the manufacturer 

4 shall enter into such agreement (or such 

5 agreement shall be renewed under para6 graph (4)(A)) not later than January 30 of 

7 the preceding year. 

8 ‘‘(2) PROVISION OF APPROPRIATE DATA.—Each 

9 manufacturer with an agreement in effect under this 

10 section shall collect and have available appropriate 

11 data, as determined by the Secretary, to ensure that 

12 it can demonstrate to the Secretary compliance with 

13 the requirements under the program. 

14 ‘‘(3) COMPLIANCE WITH REQUIREMENTS FOR

15 ADMINISTRATION OF PROGRAM.—Each manufac16 turer with an agreement in effect under this section 

17 shall comply with requirements imposed by the Sec18 retary or a third party with a contract under sub19 section (d)(3), as applicable, for purposes of admin20 istering the program, including any determination 

21 under subparagraph (A) of subsection (c)(1) or pro22 cedures established under such subsection (c)(1). 

23 ‘‘(4) LENGTH OF AGREEMENT.— 

24 ‘‘(A) IN GENERAL.—An agreement under 

25 this section shall be effective for an initial peVerDate Sep 11 2014 23:59 Oct 11, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4649.IH H4649

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1 riod of not less than 12 months and shall be 

2 automatically renewed for a period of not less 

3 than 1 year unless terminated under subpara4 graph (B). 

5 ‘‘(B) TERMINATION.— 

6 ‘‘(i) BY THE SECRETARY.—The Sec7 retary may provide for termination of an 

8 agreement under this section for a knowing 

9 and willful violation of the requirements of 

10 the agreement or other good cause shown. 

11 Such termination shall not be effective ear12 lier than 30 days after the date of notice 

13 to the manufacturer of such termination. 

14 The Secretary shall provide, upon request, 

15 a manufacturer with a hearing concerning 

16 such a termination, and such hearing shall 

17 take place prior to the effective date of the 

18 termination with sufficient time for such 

19 effective date to be repealed if the Sec20 retary determines appropriate. 

21 ‘‘(ii) BY A MANUFACTURER.—A man22 ufacturer may terminate an agreement 

23 under this section for any reason. Any 

24 such termination shall be effective, with re25 spect to a plan year— 


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1 ‘‘(I) if the termination occurs be2 fore January 30 of a plan year, as of 

3 the day after the end of the plan year; 

4 and 

5 ‘‘(II) if the termination occurs on 

6 or after January 30 of a plan year, as 

7 of the day after the end of the suc8 ceeding plan year. 

9 ‘‘(iii) EFFECTIVENESS OF TERMI10 NATION.—Any termination under this sub11 paragraph shall not affect discounts for 

12 applicable drugs of the manufacturer that 

13 are due under the agreement before the ef14 fective date of its termination. 

15 ‘‘(iv) NOTICE TO THIRD PARTY.—The 

16 Secretary shall provide notice of such ter17 mination to a third party with a contract 

18 under subsection (d)(3) within not less 

19 than 30 days before the effective date of 

20 such termination. 

21 ‘‘(c) DUTIES DESCRIBED.—The duties described in 

22 this subsection are the following: 

23 ‘‘(1) ADMINISTRATION OF PROGRAM.—Admin24 istering the program, including— 


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1 ‘‘(A) the determination of the amount of 

2 the discounted price of an applicable drug of a 

3 manufacturer; 

4 ‘‘(B) the establishment of procedures 

5 under which discounted prices are provided to 

6 applicable beneficiaries at pharmacies or by 

7 mail order service at the point-of-sale of an ap8 plicable drug; 

9 ‘‘(C) the establishment of procedures to 

10 ensure that, not later than the applicable num11 ber of calendar days after the dispensing of an 

12 applicable drug by a pharmacy or mail order 

13 service, the pharmacy or mail order service is 

14 reimbursed for an amount equal to the dif15 ference between— 

16 ‘‘(i) the negotiated price of the appli17 cable drug; and 

18 ‘‘(ii) the discounted price of the appli19 cable drug; 

20 ‘‘(D) the establishment of procedures to 

21 ensure that the discounted price for an applica22 ble drug under this section is applied before any 

23 coverage or financial assistance under other 

24 health benefit plans or programs that provide 

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1 chase or provision of prescription drug coverage 

2 on behalf of applicable beneficiaries as the Sec3 retary may specify; and 

4 ‘‘(E) providing a reasonable dispute resolu5 tion mechanism to resolve disagreements be6 tween manufacturers, applicable beneficiaries, 

7 and the third party with a contract under sub8 section (d)(3). 

9 ‘‘(2) MONITORING COMPLIANCE.— 

10 ‘‘(A) IN GENERAL.—The Secretary shall 

11 monitor compliance by a manufacturer with the 

12 terms of an agreement under this section. 

13 ‘‘(B) NOTIFICATION.—If a third party 

14 with a contract under subsection (d)(3) deter15 mines that the manufacturer is not in compli16 ance with such agreement, the third party shall 

17 notify the Secretary of such noncompliance for 

18 appropriate enforcement under subsection (e). 

19 ‘‘(3) COLLECTION OF DATA FROM PRESCRIP20 TION DRUG PLANS AND MA–PD PLANS.—The Sec21 retary may collect appropriate data from prescrip22 tion drug plans and MA–PD plans in a timeframe 

23 that allows for discounted prices to be provided for 

24 applicable drugs under this section. 

25 ‘‘(d) ADMINISTRATION.— 


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1 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

2 the Secretary shall provide for the implementation of 

3 this section, including the performance of the duties 

4 described in subsection (c). 

5 ‘‘(2) LIMITATION.—In providing for the imple6 mentation of this section, the Secretary shall not re7 ceive or distribute any funds of a manufacturer 

8 under the program. 

9 ‘‘(3) CONTRACT WITH THIRD PARTIES.—The 

10 Secretary shall enter into a contract with one or 

11 more third parties to administer the requirements 

12 established by the Secretary in order to carry out 

13 this section. At a minimum, the contract with a 

14 third party under the preceding sentence shall re15 quire that the third party— 

16 ‘‘(A) receive and transmit information be17 tween the Secretary, manufacturers, and other 

18 individuals or entities the Secretary determines 

19 appropriate; 

20 ‘‘(B) receive, distribute, or facilitate the 

21 distribution of funds of manufacturers to ap22 propriate individuals or entities in order to 

23 meet the obligations of manufacturers under 

24 agreements under this section; 


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1 ‘‘(C) provide adequate and timely informa2 tion to manufacturers, consistent with the 

3 agreement with the manufacturer under this 

4 section, as necessary for the manufacturer to 

5 fulfill its obligations under this section; and 

6 ‘‘(D) permit manufacturers to conduct 

7 periodic audits, directly or through contracts, of 

8 the data and information used by the third 

9 party to determine discounts for applicable 

10 drugs of the manufacturer under the program. 

11 ‘‘(4) PERFORMANCE REQUIREMENTS.—The 

12 Secretary shall establish performance requirements 

13 for a third party with a contract under paragraph 

14 (3) and safeguards to protect the independence and 

15 integrity of the activities carried out by the third 

16 party under the program under this section. 

17 ‘‘(5) IMPLEMENTATION.—The Secretary may 

18 implement the program under this section by pro19 gram instruction or otherwise. 

20 ‘‘(6) ADMINISTRATION.—Chapter 35 of title 44, 

21 United States Code, shall not apply to the program 

22 under this section. 

23 ‘‘(e) ENFORCEMENT.— 


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1 ‘‘(1) AUDITS.—Each manufacturer with an 

2 agreement in effect under this section shall be sub3 ject to periodic audit by the Secretary. 

4 ‘‘(2) CIVIL MONEY PENALTY.— 

5 ‘‘(A) IN GENERAL.—The Secretary may 

6 impose a civil money penalty on a manufacturer 

7 that fails to provide applicable beneficiaries dis8 counts for applicable drugs of the manufacturer 

9 in accordance with such agreement for each 

10 such failure in an amount the Secretary deter11 mines is commensurate with the sum of— 

12 ‘‘(i) the amount that the manufac13 turer would have paid with respect to such 

14 discounts under the agreement, which will 

15 then be used to pay the discounts which 

16 the manufacturer had failed to provide; 

17 and 

18 ‘‘(ii) 25 percent of such amount. 

19 ‘‘(B) APPLICATION.—The provisions of 

20 section 1128A (other than subsections (a) and 

21 (b)) shall apply to a civil money penalty under 

22 this paragraph in the same manner as such 

23 provisions apply to a penalty or proceeding 

24 under section 1128A(a). 


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1 ‘‘(f) CLARIFICATION REGARDING AVAILABILITY OF

2 OTHER COVERED PART D DRUGS.—Nothing in this sec3 tion shall prevent an applicable beneficiary from pur4 chasing a covered part D drug that is not an applicable 

5 drug (including a generic drug or a drug that is not on 

6 the formulary of the prescription drug plan or MA–PD 

7 plan that the applicable beneficiary is enrolled in). 

8 ‘‘(g) DEFINITIONS.—In this section: 

9 ‘‘(1) APPLICABLE BENEFICIARY.—The term 

10 ‘applicable beneficiary’ means an individual who, on 

11 the date of dispensing a covered part D drug— 

12 ‘‘(A) is enrolled in a prescription drug plan 

13 or an MA–PD plan; 

14 ‘‘(B) is not enrolled in a qualified retiree 

15 prescription drug plan; and 

16 ‘‘(C) has incurred costs for covered part D 

17 drugs in the year that are equal to or exceed 

18 the annual deductible specified in section 

19 1860D–2(b)(1) for such year. 

20 ‘‘(2) APPLICABLE DRUG.—The term ‘applicable 

21 drug’, with respect to an applicable beneficiary 

22 means a covered part D drug— 

23 ‘‘(A) approved under a new drug applica24 tion under section 505(b) of the Federal Food, 

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1 logic product, licensed under section 351 of the 

2 Public Health Service Act; and 

3 ‘‘(B)(i) if the PDP sponsor of the prescrip4 tion drug plan or the MA organization offering 

5 the MA–PD plan uses a formulary, which is on 

6 the formulary of the prescription drug plan or 

7 MA–PD plan that the applicable beneficiary is 

8 enrolled in; 

9 ‘‘(ii) if the PDP sponsor of the prescrip10 tion drug plan or the MA organization offering 

11 the MA–PD plan does not use a formulary, for 

12 which benefits are available under the prescrip13 tion drug plan or MA–PD plan that the appli14 cable beneficiary is enrolled in; or 

15 ‘‘(iii) is provided through an exception or 

16 appeal. 

17 ‘‘(3) APPLICABLE NUMBER OF CALENDAR

18 DAYS.—The term ‘applicable number of calendar 

19 days’ means— 

20 ‘‘(A) with respect to claims for reimburse21 ment submitted electronically, 14 days; and 

22 ‘‘(B) with respect to claims for reimburse23 ment submitted otherwise, 30 days. 

24 ‘‘(4) DISCOUNTED PRICE.— 


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1 ‘‘(A) IN GENERAL.—The term ‘discounted 

2 price’ means, with respect to an applicable drug 

3 of a manufacturer furnished during a year to 

4 an applicable beneficiary— 

5 ‘‘(i) who has not incurred costs for 

6 covered part D drugs in the year that are 

7 equal to or exceed the annual out-of-pocket 

8 threshold specified in section 1860D– 

9 2(b)(4)(B)(i) for the year, 90 percent of 

10 the negotiated price of such drug; and 

11 ‘‘(ii) who has incurred such costs in 

12 the year that are equal to or exceed such 

13 threshold for the year, 70 percent of the 

14 negotiated price of such drug. 

15 ‘‘(B) CLARIFICATION.—Nothing in this 

16 section shall be construed as affecting the re17 sponsibility of an applicable beneficiary for pay18 ment of a dispensing fee for an applicable drug. 

19 ‘‘(C) SPECIAL CASE FOR CERTAIN

20 CLAIMS.— 

21 ‘‘(i) CLAIMS SPANNING DEDUCT22 IBLE.—In the case where the entire 

23 amount of the negotiated price of an indi24 vidual claim for an applicable drug with re25 spect to an applicable beneficiary does not 


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1 fall at or above the annual deductible spec2 ified in section 1860D–2(b)(1) for the 

3 year, the manufacturer of the applicable 

4 drug shall provide the discounted price 

5 under this section on only the portion of 

6 the negotiated price of the applicable drug 

7 that falls at or above such annual deduct8 ible. 

9 ‘‘(ii) CLAIMS SPANNING OUT-OF-POCK10 ET THRESHOLD.—In the case where the 

11 entire amount of the negotiated price of an 

12 individual claim for an applicable drug 

13 with respect to an applicable beneficiary 

14 does not fall entirely below or entirely 

15 above the annual out-of-pocket threshold 

16 specified in section 1860D–2(b)(4)(B)(i) 

17 for the year, the manufacturer of the ap18 plicable drug shall provide the discounted 

19 price— 

20 ‘‘(I) in accordance with subpara21 graph (A)(i) on the portion of the ne22 gotiated price of the applicable drug 

23 that falls below such threshold; and 

24 ‘‘(II) in accordance with subpara25 graph (A)(ii) on the portion of such 


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1 price of such drug that falls at or 

2 above such threshold. 

3 ‘‘(5) MANUFACTURER.—The term ‘manufac4 turer’ means any entity which is engaged in the pro5 duction, preparation, propagation, compounding, 

6 conversion, or processing of prescription drug prod7 ucts, either directly or indirectly by extraction from 

8 substances of natural origin, or independently by 

9 means of chemical synthesis, or by a combination of 

10 extraction and chemical synthesis. Such term does 

11 not include a wholesale distributor of drugs or a re12 tail pharmacy licensed under State law. 

13 ‘‘(6) NEGOTIATED PRICE.—The term ‘nego14 tiated price’ has the meaning given such term in sec15 tion 423.100 of title 42, Code of Federal Regula16 tions (as in effect on the date of enactment of sec17 tion 1860D–14A), except that such negotiated price 

18 shall not include any dispensing fee for the applica19 ble drug. 

20 ‘‘(7) QUALIFIED RETIREE PRESCRIPTION DRUG

21 PLAN.—The term ‘qualified retiree prescription drug 

22 plan’ has the meaning given such term in section 

23 1860D–22(a)(2).’’. 

24 (2) SUNSET OF MEDICARE COVERAGE GAP DIS25 COUNT PROGRAM.—Section 1860D–14A of the SoVerDate Sep 11 2014 23:59 Oct 11, 2019 Jkt 099200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H4649.IH H4649

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1 cial Security Act (42 U.S.C. 1395–114a) is amend2 ed— 

3 (A) in subsection (a), in the first sentence, 

4 by striking ‘‘The Secretary’’ and inserting 

5 ‘‘Subject to subsection (h), the Secretary’’; and 

6 (B) by adding at the end the following new 

7 subsection: 

8 ‘‘(h) SUNSET OF PROGRAM.— 

9 ‘‘(1) IN GENERAL.—The program shall not 

10 apply with respect to applicable drugs dispensed on 

11 or after January 1, 2022, and, subject to paragraph 

12 (2), agreements under this section shall be termi13 nated as of such date. 

14 ‘‘(2) CONTINUED APPLICATION FOR APPLICA15 BLE DRUGS DISPENSED PRIOR TO SUNSET.—The 

16 provisions of this section (including all responsibil17 ities and duties) shall continue to apply after Janu18 ary 1, 2022, with respect to applicable drugs dis19 pensed prior to such date.’’. 

20 (3) INCLUSION OF ACTUARIAL VALUE OF MANU21 FACTURER DISCOUNTS IN BIDS.—Section 1860D–11 

22 of the Social Security Act (42 U.S.C. 1395w–111) 

23 is amended— 

24 (A) in subsection (b)(2)(C)(iii)— 


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1 (i) by striking ‘‘assumptions regarding 

2 the reinsurance’’ an inserting ‘‘assump3 tions regarding— 

4 ‘‘(I) the reinsurance’’; and 

5 (ii) by adding at the end the fol6 lowing: 

7 ‘‘(II) for 2022 and each subse8 quent year, the manufacturer dis9 counts provided under section 1860D– 

10 14B subtracted from the actuarial 

11 value to produce such bid; and’’; and 

12 (B) in subsection (c)(1)(C)— 

13 (i) by striking ‘‘an actuarial valuation 

14 of the reinsurance’’ and inserting ‘‘an ac15 tuarial valuation of— 

16 ‘‘(i) the reinsurance’’; 

17 (ii) in clause (i), as inserted by clause 

18 (i) of this subparagraph, by adding ‘‘and’’ 

19 at the end; and 

20 (iii) by adding at the end the fol21 lowing: 

22 ‘‘(ii) for 2022 and each subsequent 

23 year, the manufacturer discounts provided 

24 under section 1860D–14B;’’. 

25 (d) CONFORMING AMENDMENTS.— 


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

2 (42 U.S.C. 1395w–102) is amended— 

3 (A) in subsection (a)(2)(A)(i)(I), by strik4 ing ‘‘, or an increase in the initial’’ and insert5 ing ‘‘or, for a year preceding 2022, an increase 

6 in the initial’’; 

7 (B) in subsection (c)(1)(C)— 

8 (i) in the subparagraph heading, by 

9 striking ‘‘AT INITIAL COVERAGE LIMIT’’; 

10 and 

11 (ii) by inserting ‘‘for a year preceding 

12 2022 or the annual out-of-pocket threshold 

13 specified in subsection (b)(4)(B) for the 

14 year for 2022 and each subsequent year’’ 

15 after ‘‘subsection (b)(3) for the year’’ each 

16 place it appears; and 

17 (C) in subsection (d)(1)(A), by striking ‘‘or 

18 an initial’’ and inserting ‘‘or, for a year pre19 ceding 2022, an initial’’. 

20 (2) Section 1860D–4(a)(4)(B)(i) of the Social 

21 Security Act (42 U.S.C. 1395w–104(a)(4)(B)) is 

22 amended by striking ‘‘the initial’’ and inserting ‘‘for 

23 a year preceding 2022, the initial’’. 

24 (3) Section 1860D–14(a) of the Social Security 

25 Act (42 U.S.C. 1395w–114(a)) is amended— 


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1 (A) in paragraph (1)— 

2 (i) in subparagraph (C), by striking 

3 ‘‘The continuation’’ and inserting ‘‘For a 

4 year preceding 2022, the continuation’’; 

5 (ii) in subparagraph (D)(iii), by strik6 ing ‘‘1860D–2(b)(4)(A)(i)(I)’’ and insert7 ing ‘‘1860D–2(b)(4)(A)(i)(I)(aa)’’; and 

8 (iii) in subparagraph (E), by striking 

9 ‘‘The elimination’’ and inserting ‘‘For a 

10 year preceding 2022, the elimination’’; and 

11 (B) in paragraph (2)— 

12 (i) in subparagraph (C), by striking 

13 ‘‘The continuation’’ and inserting ‘‘For a 

14 year preceding 2022, the continuation’’; 

15 and 

16 (ii) in subparagraph (E)— 

17 (I) by inserting ‘‘for a year pre18 ceding 2022,’’ after ‘‘subsection (c)’’; 

19 and 

20 (II) by striking ‘‘1860D– 

21 2(b)(4)(A)(i)(I)’’ and inserting 

22 ‘‘1860D–2(b)(4)(A)(i)(I)(aa)’’. 

23 (4) Section 1860D–21(d)(7) of the Social Secu24 rity Act (42 U.S.C. 1395w–131(d)(7)) is amended 


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•HR 4649 IH

1 by striking ‘‘section 1860D–2(b)(4)(B)(i)’’ and in2 serting ‘‘section 1860D–2(b)(4)(C)(i)’’. 

3 (5) Section 1860D–22(a)(2)(A) of the Social 

4 Security Act (42 U.S.C. 1395w–132(a)(2)(A)) is 

5 amended— 

6 (A) by striking ‘‘the value of any discount’’ 

7 and inserting the following: ‘‘the value of— 

8 ‘‘(i) for years prior to 2022, any dis9 count’’; 

10 (B) in clause (i), as inserted by subpara11 graph (A) of this paragraph, by striking the pe12 riod at the end and inserting ‘‘; and’’; and 

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

14 clause: 

15 ‘‘(ii) for 2022 and each subsequent 

16 year, any discount provided pursuant to 

17 section 1860D–14B.’’. 

18 (6) Section 1860D–41(a)(6) of the Social Secu19 rity Act (42 U.S.C. 1395w–151(a)(6)) is amended— 

20 (A) by inserting ‘‘for a year before 2022’’ 

21 after ‘‘1860D–2(b)(3)’’; and 

22 (B) by inserting ‘‘for such year’’ before the 

23 period. 


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•HR 4649 IH

1 (7) Paragraph (1) of section 1860D–43(a) of 

2 the Social Security Act (42 U.S.C. 1395w–153(a)) is 

3 amended to read as follows: 

4 ‘‘(1) participate in— 

5 ‘‘(A) for 2011 through 2021, the Medicare 

6 coverage gap discount program under section 

7 1860D–14A; and 

8 ‘‘(B) for 2022 and each subsequent year, 

9 the manufacturer discount program under sec10 tion 1860D–14B;’’. 

11 (e) EFFECTIVE DATE.—The amendments made by 

12 this section shall apply with respect to plan year 2022 and 

13 subsequent plan years. 

Æ 


kjohnson on DSK79L0C42 with BILLS