drug prices to those residents who are without access to 
discounted prices for outpatient prescription drugs. 
SEC. 2. AMERICA RX PROGRAM. 
(a) ESTABLISHMENT.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of this Act, the Secretary 
of Health and Human Services shall establish a pro-
gram (in this section referred to as the ‘‘America Rx 
program’’) consistent with the provisions of this sec-
tion to provide qualified residents with access to dis-
counted prices for outpatient prescription drugs 
through rebate agreements that the Secretary has 
negotiated with prescription drug manufacturers. 
(2) OUTREACH.—The Secretary shall provide 
for— 
(A) outreach efforts to build public aware-
ness of the program and maximize enrollment 
of qualified residents; and 
(B) simplified eligibility procedures and 
uniform eligibility standards for qualified resi-
dents. 
(b) REBATE
AGREEMENTS
WITH
MANUFACTUR-
ERS.— 
(1) IN GENERAL.—Under the America Rx pro-
gram the Secretary shall negotiate with manufactur-
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ers of outpatient prescription drugs rebate agree-
ments with respect to drugs offered under the pro-
gram to qualified residents. 
(2) MINIMUM AMOUNT OF REBATES.—In nego-
tiating the amount of such a rebate under paragraph 
(1), the Secretary shall take into consideration the 
amount of the rebate calculated under the Medicaid 
program, the average manufacturer price of pre-
scription drugs, and other information on prescrip-
tion drug prices and price discounts. The Secretary 
shall negotiate the amount of such rebates in a man-
ner so that the rebates on average are comparable 
to the average percentage rebate obtained in out-
patient prescription drugs provided under section 
1927(c) of the Social Security Act (42 U.S.C. 
1396r–8(c)). 
(3) DISCOUNTED PRICES.—The Secretary shall 
specify the method for computing and applying such 
discounts, including a method for computing and ap-
plying discounts on a uniform, average percentage 
basis. 
(4) PAYMENT.—Rebates under such agreements 
shall be payable to the Secretary according to a 
schedule (not less often than quarterly) negotiated 
with manufacturers and shall be paid, directly or 
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through States, to participating pharmacies that 
provide discounts to qualified residents. 
(5) INCENTIVE.—In order to induce manufac-
turers of outpatient prescription drugs to enter into 
such rebate agreements to carry out the purpose de-
scribed in section 1(b), the Secretary shall provide, 
in the case of a manufacturer that has not entered 
into such an agreement, for a denial of a deduction 
under chapter 1 of the Internal Revenue Code of 
1986 for the amount of expenses of the manufac-
turer for advertising and marketing of drugs of the 
manufacturer, other than expenses for free samples 
of drugs subject to section 503(b)(1) of the Federal 
Food Drug, and Cosmetic Act intended to be distrib-
uted to patients. 
(6) APPLICATION OF REBATES.—Amounts re-
ceived by the Secretary as rebates under this sub-
section shall be placed into an appropriate account 
in the Treasury and shall be available in advance of 
appropriations to the Secretary for the payment of 
discounts and other costs of participating phar-
macies in carrying out the America Rx program and 
for the payment of administrative costs in carrying 
out the program. Under the America Rx program, 
participating pharmacies shall be ensured reasonable 
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and timely payment of discounts they provide to 
qualified residents under the program. 
(c) ROLE
OF STATES
IN ADMINISTERING PRO-
GRAM.— 
(1) IN GENERAL.—Under the America Rx pro-
gram the Secretary may enter into appropriate ar-
rangements with States under which States provide 
for the administration of the program in return for 
payment of the reasonable administrative expenses 
associated with such administration. 
(2) ADMINISTRATIVE
FUNCTIONS.—Such ad-
ministration functions may include— 
(A) determinations of eligibility of qualified 
residents; 
(B) arrangements with participating phar-
macies; and 
(C) such other functions as the Secretary 
determines appropriate. 
(3) CONTRACTUAL
AUTHORITY.—In carrying 
out responsibilities under this section, the Secretary 
and States may enter into agreements with phar-
macy benefit managers and other third parties. 
(d) PROGRAM ELIGIBILITY.— 
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(1) QUALIFIED RESIDENT DEFINED.—For pur-
poses of this section, the term ‘‘qualified resident’’ 
means an individual who— 
(A) is a citizen or national of the United 
States or is lawfully present in the United 
States (as determined in accordance with sec-
tion 1411 of the Patient Protection and Afford-
able Care Act); and 
(B) as determined under regulations of the 
Secretary, is not covered under any public or 
private program that provides substantial bene-
fits (which may be discounted prices) towards 
the purchase of outpatient prescription drugs. 
(2) SCREENING.— 
(A) FOR
OTHER
GOVERNMENTAL
PRO-
GRAMS.—Individuals who apply for benefits 
under the America Rx program shall be 
screened for eligibility under the Medicaid pro-
gram and other applicable Governmental health 
care programs and, if found eligible, shall be 
enrolled in such program or programs. 
(B) SCREENING
BY
HEALTH
INSURANCE 
EXCHANGES.—In the case of individuals enroll-
ing in a qualified health plan through a Health 
Insurance Exchange under title I of the Patient 
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Protection and Affordable Care Act, the Ex-
change shall provide (at the time of enrollment) 
for a screening of the individual to determine if 
the individual is a qualified resident for pur-
poses of the America Rx program. 
(3) RELATION TO OTHER COVERAGE.—In order 
not to discourage employers and health insurance 
issuers from providing comprehensive prescription 
drug coverage through a group health plan or health 
insurance coverage, no such employer or issuer may 
participate in a Health Insurance Exchange if the 
Secretary determines that the prescription drug ben-
efits under the plan or coverage have been reduced 
as a result of the America Rx program. 
(4) PROTECTION OF THE LOW INCOME.—Noth-
ing in this section shall be construed as reducing the 
prescription drug benefits available to low-income in-
dividuals, as well as senior citizens and the disabled, 
under the Medicare or Medicaid programs as a re-
sult of the implementation of the America Rx pro-
gram. 
(e) ARRANGEMENTS WITH PARTICIPATING PHAR-
MACIES.— 
(1) IN GENERAL.—Under the America Rx pro-
gram arrangements are made with pharmacies for 
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residents under the program and for rea-
sonable dispensing fees; and 
(ii) not impose any additional fees on 
such pharmacies in connection with partici-
pation in the program. 
(2) DISCOUNTED PRICES.—The amount of the 
discount provided to enrolled qualifying residents 
shall reflect the amount of rebates obtained, reduced 
by expenses relating to administrative costs of the 
Federal and State governments and of participating 
pharmacies. 
(f) DEFINITIONS.—For purposes of this section: 
(1) The term ‘‘Health Insurance Exchange’’ 
means such an Exchange as established and oper-
ated under part 3 of subtitle D of title I of the Pa-
tient Protection and Affordable Care Act. 
(2) The term ‘‘manufacturer’’ has the meaning 
given such term in section 1927(k)(5) of the Social 
Security Act (42 U.S.C. 1396r–8(k)(5)). 
(3) The term ‘‘Medicaid program’’ means a 
State program under title XIX of the Social Security 
Act, including such a program operating under a 
Statewide waiver under section 1115 of such Act. 
(4) The term ‘‘outpatient prescription drug’’ 
has the meaning given the term ‘‘covered outpatient 
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drug’’ in section 1927(k)(2) of the Social Security 
Act (42 U.S.C. 1396r–8(k)(2)). 
(5) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
(6) The term ‘‘State’’ has the meaning given 
such term for purposes of title XIX of the Social Se-
curity Act. 
Æ 
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