I 

118TH CONGRESS 

1ST SESSION H. R. 4883 

To amend title XVIII of the Social Security Act to require the disclosure 

of certain ownership information relating to health care provider and 

pharmacy ownership, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 25, 2023 

Mr. MURPHY introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy 

and Commerce, 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 require 

the disclosure of certain ownership information relating 

to health care provider and pharmacy ownership, 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 ‘‘Medicare Common 

5 Ownership Transparency Act of 2023’’. 

6 SEC. 2. REPORT ON INTEGRATION IN MEDICARE. 

7 (a) REQUIRED MA AND PDP REPORTING.— 


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1 (1) MA PLANS.—Section 1857(e) of the Social 

2 Security Act (42 U.S.C. 1395w–27(e)) is amended 

3 by adding at the end the following new paragraph: 

4 ‘‘(6) REQUIRED DISCLOSURE OF CERTAIN IN5 FORMATION RELATING TO HEALTH CARE PROVIDER

6 OWNERSHIP.— 

7 ‘‘(A) IN GENERAL.—For plan year 2025 

8 and for every third plan year thereafter, each 

9 MA organization offering an MA plan under 

10 this part during such plan year shall submit to 

11 the Secretary, at a time and in a manner speci12 fied by the Secretary— 

13 ‘‘(i) the taxpayer identification num14 ber for each health care provider that was 

15 a specified health care provider with re16 spect to such organization during such 

17 year; 

18 ‘‘(ii) the total amount of incentive19 based payments made to, and the total 

20 amount of shared losses recoupments col21 lected from, such specified health care pro22 viders during such plan year; and 

23 ‘‘(iii) the total amount of incentive24 based payments made to, and the total 

25 amount of shared losses recoupments colVerDate Sep 11 2014 00:48 Aug 17, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4883.IH H4883

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1 lected from, providers of services and sup2 pliers not described in clause (ii) during 

3 such plan year. 

4 ‘‘(B) DEFINITION.—For purposes of this 

5 paragraph, the term ‘specified health care pro6 vider’ means, with respect to an MA organiza7 tion and a plan year, a provider of services or 

8 supplier with respect to which such organization 

9 (or any person with an ownership or control in10 terest (as defined in section 1124(a)(3)) in such 

11 organization) is a person with an ownership or 

12 control interest (as so defined).’’. 

13 (2) PRESCRIPTION DRUG PLANS.—Section 

14 1860D–12(b) of the Social Security Act (42 U.S.C. 

15 1395w–112(b)) is amended by adding at the end the 

16 following new paragraph: 

17 ‘‘(9) PROVISION OF INFORMATION RELATING TO

18 PHARMACY OWNERSHIP.— 

19 ‘‘(A) IN GENERAL.—For plan year 2025 

20 and for every third plan year thereafter, each 

21 PDP sponsor offering a prescription drug plan 

22 under this part during such plan year shall sub23 mit to the Secretary, at a time and in a manner 

24 specified by the Secretary, the taxpayer identi25 fication number and National Provider IdentiVerDate Sep 11 2014 00:48 Aug 17, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4883.IH H4883

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1 fier for each pharmacy that was a specified 

2 pharmacy with respect to such sponsor during 

3 such year. 

4 ‘‘(B) DEFINITION.—For purposes of this 

5 paragraph, the term ‘specified pharmacy’ 

6 means, with respect to an PDP sponsor offering 

7 a prescription drug plan and a plan year, a 

8 pharmacy with respect to which— 

9 ‘‘(i) such sponsor (or any person with 

10 an ownership or control interest (as de11 fined in section 1124(a)(3)) in such spon12 sor) is a person with an ownership or con13 trol interest (as so defined); or 

14 ‘‘(ii) a pharmacy benefit manager of15 fering services under such plan (or any 

16 person with an ownership or control inter17 est (as so defined) in such sponsor) is a 

18 person with an ownership or control inter19 est (as so defined).’’. 

20 (b) MEDPAC REPORTS.—Part E of title XVIII of the 

21 Social Security Act (42 U.S.C. 1395x et seq.) is amended 

22 by adding at the end the following new section: 


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1 ‘‘SEC. 1899C. REPORTS ON VERTICAL INTEGRATION UNDER 

2 MEDICARE. 

3 ‘‘(a) IN GENERAL.—Not later than June 15, 2029, 

4 and every 3 years thereafter, the Medicare Payment Advi5 sory Commission shall submit to Congress a report on the 

6 state of vertical integration in the health care sector dur7 ing the applicable year with respect to entities partici8 pating in the Medicare program, including health care pro9 viders, pharmacies, prescription drug plan sponsors, Medi10 care Advantage organizations, and pharmacy benefit man11 agers. Such report shall include— 

12 ‘‘(1) with respect to Medicare Advantage orga13 nizations, the evaluation described in subsection (b); 

14 ‘‘(2) with respect to prescription drug plans, 

15 pharmacy benefit managers, and pharmacies, the 

16 comparisons and evaluations described in subsection 

17 (c); 

18 ‘‘(3) with respect to Medicare Advantage plans 

19 under which benefits are available for physician-ad20 ministered drugs, the information described in sub21 section (d); and 

22 ‘‘(4) the identifications described in subsection 

23 (e); and 

24 ‘‘(5) an analysis of the impact of such integra25 tion on health care access, price, quality, and out26 comes. 


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1 ‘‘(b) MEDICARE ADVANTAGE ORGANIZATIONS.—For 

2 purposes of subsection (a)(1), the evaluation described in 

3 this subsection is, with respect to Medicare Advantage or4 ganizations and an applicable year, an evaluation, taking 

5 into account patient acuity and the types of areas serviced 

6 by such organization, of— 

7 ‘‘(1) the average number of qualifying diag8 noses made during such year with respect to enroll9 ees of a Medicare Advantage plan offered by such 

10 organization who, during such year, received a 

11 health risk assessment from a specified health care 

12 provider; 

13 ‘‘(2) the average risk score for such enrollees 

14 who received such an assessment during such year; 

15 ‘‘(3) any relationship between such risk scores 

16 for such enrollees receiving such an assessment from 

17 such a provider during such year and incentive pay18 ments made to such providers; 

19 ‘‘(4) the average risk score for enrollees of such 

20 plan who received any item or service from a speci21 fied health care provider during such year; 

22 ‘‘(5) any relationship between the risk scores of 

23 enrollees under such plan and whether the enrollees 

24 have received any item or service from a specified 

25 provider; and 


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1 ‘‘(6) any relationship between the risk scores of 

2 enrollees under such plan that have received any 

3 item or service from a specified provider and incen4 tive payments made under the plan to specified pro5 viders. 

6 ‘‘(c) PRESCRIPTION DRUG PLANS.—For purposes of 

7 subsection (a)(2), the comparisons and evaluations de8 scribed in this subsection are, with respect to prescription 

9 drug plans and an applicable year, the following: 

10 ‘‘(1) For each covered part D drug for which 

11 benefits are available under such a plan, a compari12 son of the average negotiated rate in effect with 

13 specified pharmacies with such rates in effect for in14 network pharmacies that are not specified phar15 macies. 

16 ‘‘(2) Comparisons of the following: 

17 ‘‘(A) The total amount paid by pharmacy 

18 benefit managers to specified pharmacies for 

19 covered part D drugs and the total amount so 

20 paid to pharmacies that are not specified phar21 macies for such drugs. 

22 ‘‘(B) The total amount paid by such spon23 sors to specified pharmacy benefit managers as 

24 reimbursement for covered part D drugs and 

25 the total amount so paid to pharmacy benefit 


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1 managers that are not specified pharmacy ben2 efit managers as such reimbursement. 

3 ‘‘(C) Fees paid under by plan to specified 

4 pharmacy benefit managers compared to such 

5 fees paid to pharmacy benefit managers that 

6 are not specified pharmacy benefit managers. 

7 ‘‘(3) An evaluation of the total amount of direct 

8 and indirect remuneration for covered part D drugs 

9 passed through to prescription drug plan sponsors 

10 and the total amount retained by pharmacy benefit 

11 managers (including entities under contract with 

12 such a manager). 

13 ‘‘(4) To the extent that the available data per14 mits, an evaluation of fees charged by rebate 

15 aggregators that are affiliated with plan sponsors. 

16 ‘‘(d) PHYSICIAN-ADMINISTERED DRUGS.—For pur17 poses of subsection (a)(3), the information described in 

18 this subsection is, with respect to physician-administered 

19 drugs for which benefits are available under a Medicare 

20 Advantage plan during an applicable year, the following: 

21 ‘‘(1) With respect to each such plan, an identi22 fication of each drug for which benefits were avail23 able under such plan only when administered by a 

24 health care provider that acquired such drug from 

25 an affiliated pharmacy. 


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1 ‘‘(2) An evaluation of the difference between 

2 the total number of drugs administered by a health 

3 care provider that were acquired from affiliated 

4 pharmacies compared to the number of such drugs 

5 so administered that were acquired from pharmacies 

6 other than affiliated pharmacies, and an evaluation 

7 of the difference in payments for such drugs so ad8 ministered when acquired from a specified pharmacy 

9 and when acquired from a pharmacy that is not a 

10 specified pharmacy. 

11 ‘‘(3) An evaluation of the dollar value of all 

12 such drugs that were not so administered because of 

13 a delay attributable to an affiliated pharmacy com14 pared to the dollar value of all such drugs that were 

15 not so administered because of a delay attributable 

16 to pharmacy that is not an affiliated pharmacy. 

17 ‘‘(4) The number of enrollees administered such 

18 a drug that was acquired from an affiliated phar19 macy. 

20 ‘‘(5) The number of enrollees furnished such a 

21 drug that was acquired from a pharmacy that is not 

22 an affiliated pharmacy. 

23 ‘‘(e) IDENTIFICATIONS.—For purposes of subsection 

24 (a)(4), the identifications described in this subsection are, 

25 with respect to an applicable year, identifications of each 


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1 health care entity participating under the Medicare pro2 gram with respect to which another health care entity so 

3 participating is a person with an ownership or control in4 terest (as defined in section 1124(a)(3) of the Social Secu5 rity Act (42 U.S.C. 1320a–3(a)(3))). 

6 ‘‘(f) DEFINITIONS.—In this section: 

7 ‘‘(1) AFFILIATED PHARMACY.—The term ‘affili8 ated pharmacy’ means, with respect to a Medicare 

9 Advantage plan offered by a Medicare Advantage or10 ganization, a pharmacy with respect to which such 

11 organization (or any person with an ownership or 

12 control interest (as defined in section 1124(a)(3)) in 

13 such organization) is a person with an ownership or 

14 control interest (as so defined). 

15 ‘‘(2) APPLICABLE YEAR.—The term ‘applicable 

16 year’ means, with respect to a report submitted 

17 under subsection (a), the first calendar year begin18 ning at least 4 years prior to the date of the submis19 sion of such report. 

20 ‘‘(3) COVERED PART D DRUG.—The term ‘cov21 ered part D drug’ has the meaning given such term 

22 in section 1860D–2(e). 

23 ‘‘(4) DIRECT AND INDIRECT REMUNERATION.— 

24 The term ‘direct and indirect remuneration’ has the 

25 meaning given such term in section 423.308 of title 


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1 42, Code of Federal Regulations (or any successor 

2 regulation). 

3 ‘‘(5) QUALIFYING DIAGNOSIS.—The term ‘quali4 fying diagnosis’ means, with respect to an enrollee of 

5 a Medicare Advantage plan, a diagnosis that is 

6 taken into account in calculating a risk score for 

7 such enrollee under the risk adjustment methodology 

8 established by the Secretary pursuant to section 

9 1853(a)(3). 

10 ‘‘(6) RISK SCORE.—The term ‘risk score’ 

11 means, with respect to an enrollee of a Medicare Ad12 vantage plan, the score calculated for such individual 

13 using the methodology described in paragraph (5). 

14 ‘‘(7) PHYSICIAN-ADMINISTERED DRUG.—The 

15 term ‘physician-administered drug’ means a drug 

16 furnished to an individual that, had such individual 

17 been enrolled under part B and not enrolled under 

18 part C, would have been payable under section 

19 1842(o). 

20 ‘‘(8) SPECIFIED HEALTH CARE PROVIDER.— 

21 The term ‘specified health care provider’ means, 

22 with respect to a Medicare Advantage plan offered 

23 by a Medicare Advantage organization, a health care 

24 provider with respect to which such organization (or 

25 any person with an ownership or control interest (as 


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1 defined in section 1124(a)(3)) in such organization) 

2 is a person with an ownership or control interest (as 

3 so defined). 

4 ‘‘(9) SPECIFIED PHARMACY.—The term ‘speci5 fied pharmacy’ means, with respect to a prescription 

6 drug plan offered by a prescription drug plan spon7 sor, a pharmacy with respect to which— 

8 ‘‘(A) such sponsor (or any person with an 

9 ownership or control interest (as defined in sec10 tion 1124(a)(3)) in such sponsor) is a person 

11 with an ownership or control interest (as so de12 fined); or 

13 ‘‘(B) a pharmacy benefit manager offering 

14 services under such plan (or any person with an 

15 ownership or control interest (as so defined) in 

16 such sponsor) is a person with an ownership or 

17 control interest (as so defined). 

18 ‘‘(10) SPECIFIED PHARMACY BENEFIT MAN19 AGER.—The term ‘specified pharmacy benefit man20 ager’ means, with respect to a prescription drug 

21 plan offered by a prescription drug plan sponsor, a 

22 pharmacy benefit manager with respect to which 

23 such sponsor (or any person with an ownership or 

24 control interest (as defined in section 1124(a)(3)) in 


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1 such sponsor) is a person with an ownership or con2 trol interest (as so defined).’’. 

Æ 


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