I 

117TH CONGRESS 

1ST SESSION H. R. 3554 

To amend title XVIII of the Social Security Act to reform requirements 

with respect to direct and indirect remuneration under Medicare part 

D, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 25, 2021 

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

Mr. CARTER of Georgia, Mr. KRISHNAMOORTHI, Mr. ROSE, Ms. 

SPANBERGER, and Mrs. HARSHBARGER) 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 reform 

requirements with respect to direct and indirect remuneration under Medicare part D, 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 ‘‘Pharmacy DIR Reform 

5 To Reduce Senior Drug Costs Act’’. 


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1 SEC. 2. REQUIRING PHARMACY-NEGOTIATED PRICE CON2 CESSIONS, PAYMENT, AND FEES TO BE IN3 CLUDED IN NEGOTIATED PRICES AT THE 

4 POINT-OF-SALE UNDER PART D OF THE MEDI5 CARE PROGRAM. 

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

7 (42 U.S.C. 1395w–102(d)(1)(B)) is amended— 

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

9 inserting ‘‘PRICES.— 

10 ‘‘(i) IN GENERAL.—For purposes’’; 

11 and 

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

13 clause: 

14 ‘‘(ii) PRICES NEGOTIATED WITH

15 PHARMACY AT POINT-OF-SALE.—For plan 

16 years beginning on or after January 1, 

17 2022, a negotiated price for a covered part 

18 D drug described in clause (i) shall include 

19 price concessions, payments, and fees nego20 tiated with such pharmacy as defined by 

21 the Secretary, but shall not include incen22 tive payments based on pharmacy perform23 ance paid or to be paid to such pharmacy. 

24 Such negotiated price shall be provided at 

25 the point-of-sale of such drug.’’. 


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1 SEC. 3. DISCLOSURE TO PHARMACY OF POST-POINT-OF2 SALE PHARMACY PRICE CONCESSIONS AND 

3 INCENTIVE PAYMENTS. 

4 Section 1860D–2(d)(2) of the Social Security Act (42 

5 U.S.C. 1395w–102(d)(2)) is amended— 

6 (1) by striking ‘‘DISCLOSURE.—A PDP spon7 sor’’ and inserting ‘‘DISCLOSURE.— 

8 ‘‘(A) TO THE SECRETARY.—A PDP spon9 sor’’; and 

10 (2) by adding at the end the following new sub11 paragraph: 

12 ‘‘(B) TO PHARMACIES.— 

13 ‘‘(i) IN GENERAL.—For plan year 

14 2022 and subsequent plan years, a PDP 

15 sponsor offering a prescription drug plan 

16 and an MA organization offering an MA– 

17 PD plan shall report any pharmacy price 

18 concession or incentive payment that oc19 curs with respect to a pharmacy after pay20 ment for covered part D drugs at the 

21 point-of-sale, including by an intermediary 

22 organization with which a PDP sponsor or 

23 MA organization has contracted, to the 

24 pharmacy. 

25 ‘‘(ii) TIMING.—The reporting of price 

26 concessions and incentive payments to a 


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1 pharmacy under clause (i) shall be made 

2 on a periodic basis (but in no case less fre3 quently than annually). 

4 ‘‘(iii) CLAIM LEVEL.—The reporting 

5 of price concessions and incentive pay6 ments to a pharmacy under clause (i) shall 

7 be at the claim level or approximated at 

8 the claim level if the price concession or in9 centive payment was applied at a level 

10 other than at the claim level.’’. 

11 SEC. 4. ESTABLISHMENT OF PHARMACY PERFORMANCE 

12 MEASURES UNDER MEDICARE PART D. 

13 Section 1860D–4(c) of the Social Security Act (42 

14 U.S.C. 1395w–104(c)) is amended— 

15 (1) by redesignating paragraph (6), as added by 

16 section 50354 of division E of the Bipartisan Budg17 et Act of 2018 (Public Law 115–123), as paragraph 

18 (7); and 

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

20 paragraph: 

21 ‘‘(8) APPLICATION OF STANDARDIZED PHAR22 MACY PERFORMANCE MEASURES.— 

23 ‘‘(A) IN GENERAL.—A PDP sponsor and 

24 MA–PD plan that makes incentive payments to 

25 a pharmacy or receives price concessions paid 


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1 by a pharmacy based on performance measures 

2 shall, for the purposes of such incentive pay3 ments and price concessions with respect to cov4 ered part D drugs dispensed by such pharmacy, 

5 only use measures— 

6 ‘‘(i) established or adopted by the Sec7 retary under subparagraph (B), as listed 

8 under clause (ii) of such subparagraph; 

9 and 

10 ‘‘(ii) that are relevant to the perform11 ance of such pharmacy with respect to 

12 areas that the pharmacy can impact based 

13 on covered part D drugs dispensed and 

14 managed. 

15 ‘‘(B) STANDARDIZED PHARMACY PER16 FORMANCE MEASURES.— 

17 ‘‘(i) IN GENERAL.—Notwithstanding 

18 any other provision of law, the Secretary 

19 shall establish or adopt standardized phar20 macy performance measures from one or 

21 more multi-stakeholder, consensus organi22 zations representing all pharmacy types 

23 (including specialty pharmacies) to be used 

24 by a PDP sponsor and MA–PD plan for 

25 the purposes of determining incentive payVerDate Sep 11 2014 11:43 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3554.IH H3554

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1 ments and price concessions described in 

2 subparagraph (A). Such measures shall be 

3 evidence-based and focus on pharmacy per4 formance on patient health outcomes and 

5 other areas, as determined by the Sec6 retary, that the pharmacy can impact 

7 based on covered part D drugs dispensed 

8 and managed. 

9 ‘‘(ii) MAINTENANCE OF LIST.—The 

10 Secretary shall maintain a single list of 

11 measures established or adopted under this 

12 subparagraph and measures shall be evalu13 ated and updated on an ongoing basis 

14 through stakeholder consensus organiza15 tions to ensure they are transparent, 

16 achievable, and clinically meaningful. 

17 ‘‘(iii) APPLICATION TO STAR RAT18 INGS.—The Secretary shall require the de19 velopment of measures to apply in the star 

20 rating system under this part to assess the 

21 use of a standard set of pharmacy per22 formance measures by PDP sponsors and 

23 MA–PD plans. 

24 ‘‘(C) SPECIALTY PHARMACY.—For pur25 poses of subparagraph (B)(i), the Secretary 


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1 shall, not later than December 31, 2022, define 

2 the term ‘specialty pharmacy’ in consultation 

3 with relevant stakeholders. 

4 ‘‘(D) EFFECTIVE DATE.—The requirement 

5 under subparagraph (A) shall take effect for 

6 plan years beginning on January 1, 2022, or 

7 such earlier date specified by the Secretary if 

8 the Secretary determines there are sufficient 

9 measures established or adopted under subpara10 graph (B) for the purposes of the requirement 

11 under subparagraph (A).’’. 

Æ 


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