(i) the per-unit ingredient cost, as re-
ported to the Secretary by prescription 
drug plans and Medicare Advantage pre-
scription drug plans, minus any per-unit 
rebate, discount, or other price concession 
provided, as reported to the Secretary by 
the prescription drug plans and the Medi-
care Advantage prescription drug plans; 
and 
(ii) the number of units of such appli-
cable antimicrobial drug paid for under 
such part D. 
(C) MEDICARE
PART
B
PROGRAM.—For 
purposes of subparagraph (A), the Secretary 
shall report, for each applicable antimicrobial 
drug covered under part B of title XVIII of the 
Social Security Act (42 U.S.C. 1395j et seq.), 
the product of— 
(i) the per-unit average sales price (as 
defined in section 1847A(c) of such Act 
(42 U.S.C. 1395w–3a(c))) or the per-unit 
payment rate under such part B for a sep-
arately paid prescription drug without a 
reported average sales price; and 
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(ii) the number of units of such appli-
cable antimicrobial drug paid for under 
such part B. 
(D) MEDICARE PART A PROGRAM.— 
(i) IN
GENERAL.—For purposes of 
subparagraph (A), the Secretary shall re-
port, for each applicable antimicrobial drug 
covered under part A of title XVIII of the 
Social Security Act (42 U.S.C. 1395c et 
seq.), the product of— 
(I) the per-unit price under such 
part A for the antimicrobial drug; and 
(II) the number of units of such 
antimicrobial drug paid for under 
such part A. 
(ii) SPECIAL RULE.—For purposes of 
clause (i), the Secretary shall establish a 
process for determining the units and the 
allocated price for those prescription drugs 
that are not separately payable or for 
which National Drug Codes are not re-
ported in the diagnosis-related groups. 
(E) MEDICAID PROGRAM.—Under the au-
thority of section 1902(a)(6) of the Social Secu-
rity Act (42 U.S.C. 1396a(a)(6)), the Secretary 
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shall require each State that makes medical as-
sistance available under the State Medicaid pro-
gram for an applicable antimicrobial drug (in-
cluding, if applicable, any such drug which is a 
covered outpatient drug under a rebate agree-
ment entered into under section 1927 of such 
Act (42 U.S.C. 1396r–8)) to report to the Sec-
retary, not later than the date established 
under subparagraph (A), for each dosage form 
and strength and package size of each such 
drug dispensed during the preceding calendar 
year under the State Medicaid program, the 
amount equal to— 
(i) the product of— 
(I) the per-unit ingredient cost 
paid by the State for each such drug; 
and 
(II) the number of units of such 
drug paid for under the State Med-
icaid program; minus 
(ii) any discounts or other price con-
cessions provided and rebates paid to the 
State with respect to such drug and such 
calendar year (including rebates paid 
under a rebate agreement under section 
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1927 of such Act (42 U.S.C. 1396r–8) and 
any State supplemental rebates paid under 
a supplemental rebate agreement). 
(F) DEPARTMENT
OF
VETERANS
AF-
FAIRS.—For purposes of subparagraph (A), the 
Secretary of Veterans Affairs shall report the 
total amount paid for each applicable anti-
microbial drug procured by the Veterans Health 
Administration for individuals who receive 
health care from the Administration. 
(G) DEPARTMENT
OF
DEFENSE
AND 
TRICARE PROGRAM.—For purposes of subpara-
graph (A), the Secretary of Defense shall report 
the sum of— 
(i) the total amount paid for each ap-
plicable antimicrobial drug procured by the 
Department of Defense for individuals who 
receive health care from the Department; 
and 
(ii) for each applicable antimicrobial 
drug dispensed under the TRICARE retail 
pharmacy program, the product of— 
(I) the per-unit ingredient cost, 
minus any per-unit rebate paid by the 
covered entity; and 
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(II) the number of units of such 
applicable antimicrobial drug dis-
pensed under such program. 
(H) DEPARTMENT
OF
HOMELAND
SECU-
RITY.—For purposes of subparagraph (A), the 
Secretary of Homeland Security shall report the 
total amount paid for each applicable anti-
microbial drug procured by the Department of 
Homeland Security for individuals who receive 
health care through a program carried out by 
the Department. 
(I) BUREAU OF PRISONS.—For purposes of 
subparagraph (A), the Director of the Bureau 
of Prisons shall report the total amount paid 
for each applicable antimicrobial drug procured 
by the Bureau of Prisons for individuals who 
receive health care through the Bureau. 
(J) INDIAN HEALTH SERVICE.—For pur-
poses of subparagraph (A), the Secretary, act-
ing through the Indian Health Service, shall re-
port the total amount paid for each applicable 
antimicrobial drug procured by the Service for 
individuals who receive health care through the 
Service. 
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(2) GUIDANCE.—Not later than 1 year after 
the date of enactment of this Act, the Secretary 
shall publish guidance to assist the heads (or des-
ignees) of Federal agencies carrying out specified 
government programs in carrying out the require-
ments under this section. 
(3) SUBSCRIPTION CONTRACT ADJUSTMENT.— 
Pursuant to the contract entered into under this sec-
tion with respect to an applicable antimicrobial drug, 
for each year of the term of such contract, the Sec-
retary shall subtract from the payment installments 
determined for such contract under subsection (c)(1) 
for such year the revenue of the sponsor of such 
drug from the previous year from sales of the appli-
cable antimicrobial drug reported under paragraph 
(1) for specified government programs. 
(4) DEFINITIONS.—In this subsection: 
(A) APPLICABLE ANTIMICROBIAL DRUG.— 
The term ‘‘applicable antimicrobial drug’’ 
means an antimicrobial drug for which the 
sponsor of such drug receives a subscription 
contract under subsection (a). 
(B) SPECIFIED GOVERNMENT PROGRAM.— 
The term ‘‘specified government program’’ 
means— 
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(i) the Medicare part D program 
under part D of title XVIII of the Social 
Security Act (42 U.S.C. 1395w–101 et 
seq.); 
(ii) the Medicare Part B program 
under part B of such title XVIII (42 
U.S.C. 1395j et seq.); 
(iii) the Medicare Part A program 
under part A of such title XVIII (42 
U.S.C. 1395c et seq.); 
(iv) the Medicaid program established 
under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) and includes, 
with respect to a State, any waiver in ef-
fect with respect to such program; 
(v) any program under which pre-
scription drugs are procured by the De-
partment of Veterans Affairs; 
(vi) any program under which brand-
ed prescription drugs are procured by the 
Department of Defense; 
(vii) the TRICARE retail pharmacy 
program under section 1074g of title 10, 
United States Code; 
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(viii) any program under which pre-
scription drugs are procured by the De-
partment of Homeland Security; 
(ix) any program under which pre-
scription drugs are procured by the Bu-
reau of Prisons; or 
(x) any program under which pre-
scription drugs are procured by the Indian 
Health Service. 
(e) FAILURE TO ADHERE
TO TERMS.—The Sec-
retary shall cease any payment installments under a con-
tract under this section if— 
(1) the sponsor— 
(A) permanently withdraws the anti-
microbial drug from the market in the United 
States; 
(B) fails to meet criteria under subsection 
(b); or 
(C) does not complete a postmarket study 
required by the Food and Drug Administration 
during the length of the term of the contract; 
or 
(2) the annual international and private insur-
ance market revenues with respect to an anti-
microbial drug (not counting any subscription reve-
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nues from any source pursuant to a contract under 
this section or other international or private entities) 
exceed 5 times the average annual amount of the 
subscription contract paid by the Secretary as cer-
tified by the sponsor annually. 
(f) PRIVATE PAYER
AND INTERNATIONAL PAYER 
PARTICIPATION.—The Secretary shall make efforts to in-
crease the participation of domestic private payors and 
international payors in subscription contracts or other 
types of pull incentives that are similar to the subscription 
contracts authorized under this section. 
SEC. 5. ENCOURAGING APPROPRIATE USE OF ANTIBIOTICS 
AND COMBATING RESISTANCE. 
(a) ESTABLISHMENT
OF HOSPITAL GRANT PRO-
GRAM.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Secretary and 
the Director of the Centers for Disease Control and 
Prevention shall coordinate with the Administrator 
of the Health Resources and Services Administra-
tion, the Administrator of the Centers for Medicare 
& Medicaid Services, the National Coordinator for 
Health Information Technology, and other relevant 
agencies, to establish a grant program under the 
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Centers for Disease Control and Prevention to sup-
port hospital and other inpatient facility efforts— 
(A) to judiciously use antimicrobial drugs, 
such as by establishing or implementing appro-
priate use programs, including infectious dis-
ease telehealth programs, using appropriate di-
agnostic tools, partnering with academic hos-
pitals, increasing health care-associated infec-
tion reporting, and monitoring antimicrobial re-
sistance; and 
(B) 
to 
participate 
in 
the 
National 
Healthcare Safety Network Antimicrobial Use 
and Resistance Module or the Emerging Infec-
tions Program Healthcare-Associated Infections 
Community Interface activity of the Centers for 
Disease Control and Prevention or a similar re-
porting program, as specified by the Secretary, 
relating to antimicrobial drugs. 
(2) 
PRIORITIZATION.—In 
awarding 
grants 
under paragraph (1), the Secretary shall prioritize 
hospitals without an existing program to judiciously 
use antimicrobial drugs, subsection (d) hospitals (as 
defined in subparagraph (B) of section 1886(d)(2) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(d)(2))) that are located in rural areas (as 
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defined in subparagraph (D) of such section), crit-
ical 
access 
hospitals 
(as 
defined 
in 
section 
1861(mm)(1) 
of 
such 
Act 
(42 
U.S.C. 
1395x(mm)(1))), 
hospitals 
serving 
Tribal-popu-
lations, and safety-net hospitals. 
(3) FUNDING.—Of the amounts appropriated 
under section 6, the Secretary shall reserve 
$500,000,000 to carry out this subsection. 
(b) SURVEILLANCE AND REPORTING OF ANTIBIOTIC 
USE AND RESISTANCE.— 
(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Director of the Centers for Disease 
Control and Prevention, shall use the National 
Healthcare Safety Network and other appropriate 
surveillance systems to assess— 
(A) appropriate conditions, outcomes, and 
measures causally related to antibacterial resist-
ance, including types of infections, the causes 
for infections, and whether infections are ac-
quired in a community or hospital setting, in-
creased lengths of hospital stay, increased costs, 
and rates of mortality; and 
(B) changes in bacterial resistance to anti-
microbial drugs in relation to patient outcomes, 
including changes in percent resistance, preva-
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lence of antibiotic-resistant infections, and other 
such changes. 
(2) ANTIBIOTIC
USE
DATA.—The Secretary, 
acting through the Director of the Centers for Dis-
ease Control and Prevention, shall work with Fed-
eral agencies (including the Department of Veterans 
Affairs, the Department of Defense, the Department 
of Homeland Security, the Bureau of Prisons, the 
Indian Health Service, and the Centers for Medicare 
& Medicaid Services), private vendors, health care 
organizations, pharmacy benefit managers, and 
other entities as appropriate to obtain reliable and 
comparable human antibiotic drug consumption data 
(including, as available and appropriate, volume an-
tibiotic distribution data and antibiotic use data, in-
cluding prescription data) by State or metropolitan 
areas. 
(3) ANTIBIOTIC
RESISTANCE
TREND
DATA.— 
The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, shall in-
tensify and expand efforts to collect antibiotic resist-
ance data and encourage adoption of the antibiotic 
resistance and use module within the National 
Healthcare Safety Network among all health care fa-
cilities across the continuum of care, including, as 
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