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(C) telehealth or mobile health vendors and 
companies. 
(2) Health care providers, including— 
(A) physicians; and 
(B) hospitals. 
(3) Health insurers. 
(4) Language service companies. 
(5) Interpreter or translator professional asso-
ciations. 
(6) Health and language services quality certifi-
cation organizations. 
(7) Patient and consumer advocates, including 
such advocates that work with individuals with lim-
ited English proficiency. 
SEC. 6214. INCLUSION OF VIRTUAL DIABETES PREVENTION 
PROGRAM SUPPLIERS IN MDPP EXPANDED 
MODEL. 
(a) IN GENERAL.—For the period beginning on Jan-
uary 1, 2026, and ending on December 31, 2029— 
(1) an entity may participate in the MDPP by 
offering only MDPP services via distance learning or 
online delivery modalities if such entity meets the 
conditions for enrollment as an MDPP supplier; 
(2) if an entity participates in the MDPP in the 
manner described in paragraph (1), in the case of 
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online MDPP services furnished by such entity to an 
MDPP beneficiary who was not located in the same 
State as the entity at the time such services were 
furnished, the entity shall not be prohibited from 
submitting a claim for payment for such services 
solely by reason of the location of such beneficiary 
at such time; and 
(3) no limit is applied on the number of times 
an individual may enroll in the MDPP. 
(b) DEFINITIONS.—In this section: 
(1) MDPP.—The term ‘‘MDPP’’ means the 
Medicare Diabetes Prevention Program (as such 
term is defined in section 410.79(b) of title 42, Code 
of Federal Regulations). 
(2) REGULATORY TERMS.—The terms ‘‘distance 
learning’’, ‘‘MDPP beneficiary’’, ‘‘MDPP services’’, 
‘‘MDPP supplier’’, and ‘‘online’’ have the meanings 
given such terms in section 410.79(b) of title 42, 
Code of Federal Regulations. 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(c) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement this section 
by program instruction or otherwise. 
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SEC. 6215. MEDICATION-INDUCED MOVEMENT DISORDER 
OUTREACH AND EDUCATION. 
Not later than January 1, 2028, the Secretary of 
Health and Human Services shall use existing communica-
tions mechanisms to provide education and outreach to 
physicians and appropriate non-physician practitioners 
participating under the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 
with respect to periodic screening for medication-induced 
movement disorders that are associated with the treat-
ment of mental health disorders in at-risk patients, as well 
as resources related to clinical guidelines and best prac-
tices for furnishing such screening services through tele-
health. Such education and outreach shall include infor-
mation on how to account for such screening services in 
evaluation and management code selection. The Secretary 
shall, to the extent practicable, seek input from relevant 
stakeholders to inform such education and outreach. Such 
education and outreach may also address other relevant 
screening services furnished through telehealth, as the 
Secretary determines appropriate. 
SEC. 6216. REPORT ON WEARABLE MEDICAL DEVICES. 
Not later than 18 months after the date of the enact-
ment of this Act, the Comptroller General of the United 
States shall conduct a technology assessment of, and sub-
mit to Congress a report on, the capabilities and limita-
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tions of wearable medical devices used to support clinical 
decision-making. Such report shall include a description 
of— 
(1) the potential for such devices to accurately 
prescribe treatments; 
(2) an examination of the benefits and chal-
lenges of artificial intelligence to augment such ca-
pabilities; and 
(3) policy options to enhance the benefits and 
mitigate potential challenges of developing or using 
such devices. 
SEC. 6217. EXTENSION OF TEMPORARY INCLUSION OF AU-
THORIZED ORAL ANTIVIRAL DRUGS AS COV-
ERED PART D DRUGS. 
Section 1860D–2(e)(1)(C) of the Social Security Act 
(42 U.S.C. 1395w–102(e)(1)(C)) is amended by striking 
‘‘January 30, 2026’’ and inserting ‘‘December 31, 2026’’. 
SEC. 6218. EXTENSION OF ADJUSTMENT TO CALCULATION 
OF HOSPICE CAP AMOUNT UNDER MEDI-
CARE. 
Section 1814(i)(2)(B) of the Social Security Act (42 
U.S.C. 1395f(i)(2)(B)) is amended— 
(1) in clause (ii), by striking ‘‘2033’’ and in-
serting ‘‘2035’’; and 
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(2) in clause (iii), by striking ‘‘2033’’ and in-
serting ‘‘2035’’. 
SEC. 6219. ADJUSTMENTS TO MEDICARE PART D COST- 
SHARING REDUCTIONS FOR LOW-INCOME IN-
DIVIDUALS. 
Section 1860D–14(a) of the Social Security Act (42 
U.S.C. 1395w–114(a)) is amended— 
(1) in paragraph (1)(D)(ii), by striking ‘‘that 
does not exceed $1 for’’ and all that follows through 
the period at the end and inserting ″that does not 
exceed— ‘‘ 
‘‘(I) for a plan year before 
2028— 
‘‘(aa) for a generic drug or a 
preferred drug that is a multiple 
source drug (as defined in section 
1927(k)(7)(A)(i)), $1 or, if less, 
the copayment amount applicable 
to an individual under clause 
(iii); and 
‘‘(bb) for any other drug, $3 
or, if less, the copayment amount 
applicable to an individual under 
clause (iii); and 
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‘‘(II) for plan year 2028 and 
each subsequent plan year— 
‘‘(aa) for a generic drug, $0; 
‘‘(bb) for a preferred drug 
that is a multiple source drug (as 
defined 
in 
section 
1927(k)(7)(A)(i)), 
the 
dollar 
amount applied under this clause 
for such a drug for the preceding 
plan year, increased by the an-
nual percentage increase in the 
consumer price index (all items; 
U.S. city average) as of Sep-
tember of such preceding year, 
or, if less, the copayment amount 
applicable to an individual under 
clause (iii); and 
‘‘(cc) for a drug not de-
scribed in either item (aa) or 
(bb), the dollar amount applied 
under this clause for such a drug 
for the preceding plan year, in-
creased in the manner specified 
in item (bb), or, if less, the co-
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payment amount applicable to an 
individual under clause (iii). 
Any amount established under item (bb) or 
(cc) of subclause (II), that is based on an 
increase of $1 or $3, that is not a multiple 
of 5 cents or 10 cents, respectively, shall 
be rounded to the nearest multiple of 5 
cents or 10 cents, respectively.’’; and 
(2) in paragraph (4)(A)(ii), by inserting ‘‘(be-
fore 2028)’’ after ‘‘a subsequent year’’. 
SEC. 6220. REQUIRING ENHANCED AND ACCURATE LISTS 
OF (REAL) HEALTH PROVIDERS ACT. 
(a) IN GENERAL.—Section 1852(c) of the Social Se-
curity Act (42 U.S.C. 1395w–22(c)) is amended— 
(1) in paragraph (1)(C)— 
(A) by striking ‘‘plan, and any’’ and insert-
ing ‘‘plan, any’’; and 
(B) by inserting the following before the 
period: ‘‘, and, in the case of a specified MA 
plan (as defined in paragraph (3)(C)), for plan 
year 2028 and subsequent plan years, the infor-
mation described in paragraph (3)(B)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(3) PROVIDER DIRECTORY ACCURACY.— 
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‘‘(A) IN GENERAL.—For plan year 2028 
and subsequent plan years, each MA organiza-
tion offering a specified MA plan (as defined in 
subparagraph (C)) shall, for each such plan of-
fered by the organization— 
‘‘(i) maintain, on a publicly available 
internet website, an accurate provider di-
rectory that includes the information de-
scribed in subparagraph (B); 
‘‘(ii) not less frequently than once 
every 90 days (or, in the case of a hospital 
or any other facility determined appro-
priate by the Secretary, at a lesser fre-
quency specified by the Secretary but in no 
case less frequently than once every 12 
months), verify the provider directory in-
formation of each provider listed in such 
directory and, if applicable, update such 
information; 
‘‘(iii) if the organization is unable to 
verify such information with respect to a 
provider, include in such directory an indi-
cation that the information of such pro-
vider may not be up to date; and 
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‘‘(iv) remove a provider from such di-
rectory within 5 business days if the orga-
nization determines that the provider is no 
longer a provider participating in the net-
work of such plan. 
‘‘(B) PROVIDER
DIRECTORY
INFORMA-
TION.—The information described in this sub-
paragraph is information enrollees may need to 
access covered benefits from a provider with 
which such organization offering such plan has 
an agreement for furnishing items and services 
covered under such plan, such as name, spe-
cialty, contact information, primary office or fa-
cility addresses where items or services are fur-
nished, whether the provider is accepting new 
patients, accommodations for people with dis-
abilities, cultural and linguistic capabilities, and 
telehealth capabilities. 
‘‘(C) SPECIFIED MA PLAN.—In this para-
graph, the term ‘specified MA plan’ means— 
‘‘(i) a network-based plan (as defined 
in subsection (d)(5)(C)); or 
‘‘(ii) a Medicare Advantage private 
fee-for-service plan (as defined in section 
1859(b)(2)) that meets the access stand-
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ards under subsection (d)(4), in whole or 
in part, through entering into contracts or 
agreements as provided for under subpara-
graph (B) of such subsection.’’. 
(b) ACCOUNTABILITY
FOR PROVIDER DIRECTORY 
ACCURACY.— 
(1) COST SHARING FOR SERVICES FURNISHED 
BASED ON RELIANCE ON INCORRECT PROVIDER DI-
RECTORY
INFORMATION.—Section 1852(d) of the 
Social Security Act (42 U.S.C. 1395w–22(d)) is 
amended— 
(A) in paragraph (1)(C)— 
(i) in clause (ii), by striking ‘‘or’’ at 
the end; 
(ii) in clause (iii), by striking the 
semicolon at the end and inserting ‘‘, or’’; 
and 
(iii) by adding at the end the fol-
lowing new clause: 
‘‘(iv) for plan year 2028 and subse-
quent plan years, in the case of a specified 
MA 
plan 
(as 
defined 
in 
subsection 
(c)(3)(C)), the services were furnished by a 
provider that was not participating in the 
network of such plan but was listed in the 
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provider directory of such plan on the date 
on which the appointment was made, as 
described in paragraph (7)(A);’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(7) COST SHARING FOR SERVICES FURNISHED 
BASED ON RELIANCE ON INCORRECT PROVIDER DI-
RECTORY INFORMATION.— 
‘‘(A) IN GENERAL.—For plan year 2028 
and subsequent plan years, if an enrollee in a 
specified MA plan (as defined in subsection 
(c)(3)(C)) is furnished an item or service by a 
provider that is not participating in the network 
of such plan but is listed in the provider direc-
tory of such plan (as required to be provided to 
an enrollee pursuant to subsection (c)(1)(C)) on 
the date on which the appointment is made, 
and if such item or service would otherwise be 
covered under such plan if furnished by a pro-
vider that is participating in the network of 
such plan, the MA organization offering such 
plan shall ensure that the enrollee is only re-
sponsible for the lesser of— 
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‘‘(i) the amount of cost sharing that 
would apply if such provider had been par-
ticipating in the network of such plan; or 
‘‘(ii) the amount of cost sharing that 
would otherwise apply (without regard to 
this subparagraph). 
‘‘(B) NOTIFICATION REQUIREMENT.—For 
plan year 2028 and subsequent plan years, each 
MA organization that offers a specified MA 
plan shall— 
‘‘(i) notify enrollees of their cost-shar-
ing protections under this paragraph and 
make such notifications, to the extent 
practicable, by not later than the first day 
of an annual, coordinated election period 
under section 1851(e)(3) with respect to a 
year; 
‘‘(ii) include information regarding 
such cost-sharing protections in the pro-
vider directory of each specified MA plan 
offered by the MA organization.; and 
‘‘(iii) notify enrollees of their cost- 
sharing protections under this paragraph 
in the first explanation of benefits issued 
in a plan year.’’. 
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(2) REQUIRED
PROVIDER
DIRECTORY
ACCU-
RACY ANALYSIS AND REPORTS.— 
(A) IN GENERAL.—Section 1857(e) of the 
Social Security Act (42 U.S.C. 1395w–27(e)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(6) PROVIDER
DIRECTORY
ACCURACY
ANAL-
YSIS AND REPORTS.— 
‘‘(A) IN GENERAL.—Beginning with plan 
years beginning on or after January 1, 2028, 
subject to subparagraph (C), a contract under 
this section with an MA organization shall re-
quire the organization, for each specified MA 
plan (as defined in section 1852(c)(3)(C)) of-
fered by the organization, to annually do the 
following: 
‘‘(i) Conduct an analysis estimating 
the accuracy of the provider directory in-
formation of such plan using a random 
sample of providers included in such pro-
vider directory as follows: 
‘‘(I) Such a random sample shall 
include a random sample of each spe-
cialty of providers with a high inaccu-
racy rate of provider directory infor-
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mation relative to other specialties of 
providers, as determined by the Sec-
retary. 
‘‘(II) For purposes of subclause 
(I), one type of specialty may be pro-
viders specializing in mental health or 
substance use disorder treatment. 
‘‘(ii) Submit to the Secretary a report 
containing the results of the analysis con-
ducted under clause (i), including an accu-
racy score for such provider directory in-
formation (as determined using a plan 
verification method specified by the Sec-
retary under subparagraph (B)(i)). 
‘‘(B) 
DETERMINATION
OF
ACCURACY 
SCORE.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall specify plan verification methods, 
such as using telephonic verification or 
other approaches using data sources main-
tained by an MA organization or using 
publicly available data sets, that MA orga-
nizations may use for estimating accuracy 
scores of the provider directory information 
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of specified MA plans offered by such or-
ganizations. 
‘‘(ii) 
ACCURACY
SCORE
METHOD-
OLOGY.—With respect to each such meth-
od specified by the Secretary as described 
in clause (i), the Secretary shall specify a 
methodology for MA organizations to use 
in estimating such accuracy scores. Each 
such methodology shall take into account 
the administrative burden on plans and 
providers and the relative importance of 
certain provider directory information on 
enrollee ability to access care. 
‘‘(C) EXCEPTION.—The Secretary may 
waive the requirements of this paragraph in the 
case of a specified MA plan with low enrollment 
(as defined by the Secretary). 
‘‘(D) 
TRANSPARENCY.—Beginning 
with 
plan years beginning on or after January 1, 
2029, the Secretary shall post accuracy scores 
(as reported under subparagraph (A)(ii)), in a 
machine readable file, on an internet website 
maintained by the Centers for Medicare & Med-
icaid Services.’’. 
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(B) PROVISION
OF
INFORMATION
TO 
BENEFICIARIES.—Section 1851(d)(4) of the So-
cial Security Act (42 U.S.C. 1395w–21(d)(4)) 
is amended by adding at the end the following 
new subparagraph: 
‘‘(F) PROVIDER
DIRECTORY.—Beginning 
with plan years beginning on or after January 
1, 2029, in the case of a specified MA plan (as 
defined in section 1852(c)(3)(C)), the accuracy 
score of the plan’s provider directory (as re-
ported under section 1857(e)(6)(A)(ii)) listed 
prominently on the plan’s provider directory.’’. 
(C) FUNDING.—In addition to amounts 
otherwise available, there is appropriated to the 
Centers for Medicare & Medicaid Services Pro-
gram Management Account, out of any money 
in the Treasury not otherwise appropriated, 
$4,000,000 for fiscal year 2026, to remain 
available until expended, to carry out the 
amendments made by this paragraph. 
(3) GAO STUDY AND REPORT.— 
(A) ANALYSIS.—The Comptroller General 
of the United States (in this paragraph referred 
to as the ‘‘Comptroller General’’) shall conduct 
a study of the implementation of the amend-
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ments made by paragraphs (1) and (2). To the 
extent data are available and reliable, such 
study shall include an analysis of— 
(i) the use of cost-sharing protections 
required under section 1852(d)(7)(A) of 
the Social Security Act, as added by para-
graph (1); 
(ii) the trends in provider directory in-
formation accuracy scores submitted to the 
Secretary of Health and Human Services 
under section 1857(e)(6)(A)(ii) of the So-
cial Security Act (as added by paragraph 
(2)(A)), both overall and among providers 
specializing in mental health or substance 
use disorder treatment; 
(iii) provider response rates by plan 
verification methods; 
(iv) administrative costs to providers 
and Medicare Advantage organizations; 
and 
(v) other items determined appro-
priate by the Comptroller General. 
(B) REPORT.—Not later than January 15, 
2033, the Comptroller General shall submit to 
Congress a report containing the results of the 
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study conducted under subparagraph (A), to-
gether with recommendations for such legisla-
tion and administrative action as the Comp-
troller General determines appropriate. 
(c) GUIDANCE
ON MAINTAINING ACCURATE PRO-
VIDER DIRECTORIES.— 
(1) STAKEHOLDER MEETING.— 
(A) IN
GENERAL.—Not later than 6 
months after the date of enactment of this Act, 
the Secretary of Health and Human Services 
(referred to in this subsection as the ‘‘Sec-
retary’’) shall hold a public meeting to receive 
input on approaches for maintaining accurate 
provider directories for Medicare Advantage 
plans under part C of title XVIII of the Social 
Security Act (42 U.S.C. 1395w–21 et seq.), in-
cluding input on approaches for reducing ad-
ministrative burden, such as data standardiza-
tion, and best practices to maintain accurate 
provider directory information. 
(B) PARTICIPANTS.—Participants of the 
meeting under subparagraph (A) shall include 
representatives from the Centers for Medicare & 
Medicaid Services and the Assistant Secretary 
for Technology Policy and Office of the Na-
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tional Coordinator for Health Information 
Technology. Such meeting shall be open to the 
public. To the extent practicable, the Secretary 
shall include health care providers, companies 
that specialize in relevant technologies, health 
insurers, and patient advocates. 
(2) GUIDANCE TO MEDICARE ADVANTAGE OR-
GANIZATIONS.—Not later than 18 months after the 
date of enactment of this Act, the Secretary shall 
issue guidance to Medicare Advantage organizations 
offering Medicare Advantage plans under part C of 
title XVIII of the Social Security Act (42 U.S.C. 
1395w–21 et seq.) on maintaining accurate provider 
directories for such plans, taking into consideration 
input received during the stakeholder meeting under 
paragraph (1). Such guidance may include the fol-
lowing, as determined appropriate by the Secretary: 
(A) Best practices for Medicare Advantage 
organizations on how to work with providers to 
maintain the accuracy of provider directories 
and reduce provider and Medicare Advantage 
organization burden with respect to maintaining 
the accuracy of provider directories. 
(B) Information on data sets and data 
sources with information that could be used by 
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Medicare Advantage organizations to maintain 
accurate provider directories. 
(C) Approaches for utilizing data sources 
maintained by Medicare Advantage organiza-
tions and publicly available data sets to main-
tain accurate provider directories. 
(D) Information that may be useful to in-
clude in provider directories for Medicare bene-
ficiaries to use in assessing plan networks when 
selecting a plan and accessing providers partici-
pating in plan networks during the plan year. 
(3) GUIDANCE
TO
PART
B
PROVIDERS.—Not 
later than 12 months after the date of enactment of 
this Act, the Secretary shall issue guidance to pro-
viders of services and suppliers who furnish items or 
services for which benefits are available under part 
B of title XVIII of the Social Security Act (42 
U.S.C. 1395j et seq.) on when to update the Na-
tional Plan and Provider Enumeration System (or a 
successor system) for information changes. 
SEC. 6221. MEDICARE COVERAGE OF MULTI-CANCER EARLY 
DETECTION SCREENING TESTS. 
(a) COVERAGE.—Section 1861 of the Social Security 
Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
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(A) by striking the semicolon at the end of 
subparagraph (JJ) and inserting ‘‘; and’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(KK) multi-cancer early detection screening 
tests (as defined in subsection (nnn));’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(nnn) MULTI-CANCER EARLY DETECTION SCREEN-
ING TESTS.— 
‘‘(1) IN
GENERAL.—The term ‘multi-cancer 
early detection screening test’ means a test fur-
nished to an individual for the concurrent detection 
of multiple cancer types across multiple organ sites 
on or after January 1, 2029, that— 
‘‘(A) is cleared under section 510(k), clas-
sified under section 513(f)(2), or approved 
under section 515 of the Federal Food, Drug, 
and Cosmetic Act; 
‘‘(B) is— 
‘‘(i) a genomic sequencing blood or 
blood product test that includes the anal-
ysis of cell-free nucleic acids; or 
‘‘(ii) a test based on samples of bio-
logical material that provide results com-
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parable to those obtained with a test de-
scribed in clause (i), as determined by the 
Secretary; and 
‘‘(C) the Secretary determines is— 
‘‘(i) reasonable and necessary for the 
prevention or early detection of an illness 
or disability; and 
‘‘(ii) appropriate for individuals enti-
tled to benefits under part A or enrolled 
under part B. 
‘‘(2) NCD PROCESS.—In making determina-
tions under paragraph (1)(C) regarding the coverage 
of a new test, the Secretary shall use the process for 
making national coverage determinations (as defined 
in section 1869(f)(1)(B)) under this title.’’. 
(b) PAYMENT AND STANDARDS FOR MULTI-CANCER 
EARLY DETECTION SCREENING TESTS.— 
(1) IN GENERAL.—Section 1834 of the Social 
Security Act (42 U.S.C. 1395m) is amended by add-
ing at the end the following new subsection: 
‘‘(aa) PAYMENT AND STANDARDS FOR MULTI-CAN-
CER EARLY DETECTION SCREENING TESTS.— 
‘‘(1) 
PAYMENT
AMOUNT.—The 
payment 
amount for a multi-cancer early detection screening 
test (as defined in section 1861(nnn)) is— 
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‘‘(A) with respect to such a test furnished 
before January 1, 2031, equal to the payment 
amount in effect on the date of the enactment 
of this subsection for a multi-target stool 
screening DNA test covered pursuant to section 
1861(pp)(1)(D); and 
‘‘(B) with respect to such a test furnished 
on or after January 1, 2031, equal to the lesser 
of— 
‘‘(i) the amount described in subpara-
graph (A); or 
‘‘(ii) the payment amount determined 
for such test under section 1834A. 
‘‘(2) LIMITATIONS.— 
‘‘(A) IN GENERAL.—No payment may be 
made under this part for a multi-cancer early 
detection screening test furnished during a year 
to an individual if— 
‘‘(i) such individual— 
‘‘(I) is under 50 years of age; or 
‘‘(II) as of January 1 of such 
year, has attained the age specified in 
subparagraph (B) for such year; or 
‘‘(ii) such a test was furnished to the 
individual during the previous 11 months. 
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‘‘(B) AGE
SPECIFIED.—For purposes of 
subparagraph (A)(i)(II), the age specified in 
this subparagraph is— 
‘‘(i) for 2029, 65 years of age; and 
‘‘(ii) for a succeeding year, the age 
specified in this subparagraph for the pre-
ceding year, increased by 1 year. 
‘‘(C) STANDARDS
FOLLOWING
USPSTF 
RATING OF A OR B.—In the case of a multi-can-
cer early detection screening test that is rec-
ommended with a grade of A or B by the 
United States Preventive Services Task Force, 
beginning on the date on which coverage for 
such test is provided pursuant to section 
1861(ddd)(1), the preceding provisions of this 
paragraph shall not apply.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1833 of the Social Security 
Act (42 U.S.C. 1395l) is amended— 
(i) in subsection (a)— 
(I) in paragraph (1)(D)(i)(I), by 
striking ‘‘section 1834(d)(1)’’ and in-
serting ‘‘subsection (d)(1) or (aa) of 
section 1834’’; and 
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cial Security Act for other cancer screening tests 
covered under such title, such as screening tests for 
breast, cervical, colorectal, lung, or prostate cancer; 
or 
(2) in the case of an individual who undergoes 
another cancer screening test, to affect coverage 
under such part for a multi-cancer early detection 
screening test or the use of such a test as a diag-
nostic or confirmatory test for a result of the other 
cancer screening test. 
(d) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Centers for Medi-
care & Medicaid Services Program Management Account, 
out of any money in the Treasury not otherwise appro-
priated, $2,000,000 for fiscal year 2026, to remain avail-
able until expended, to carry out this section. 
SEC. 6222. MEDICARE COVERAGE OF EXTERNAL INFUSION 
PUMPS 
AND 
NON-SELF-ADMINISTRABLE 
HOME INFUSION DRUGS. 
(a) IN GENERAL.—Section 1861(n) of the Social Se-
curity Act (42 U.S.C. 1395x(n)) is amended by adding 
at the end the following new sentence: ‘‘Beginning with 
the first calendar quarter beginning on or after the date 
that is 1 year after the date of the enactment of this sen-
tence, an external infusion pump and associated home in-
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fusion drug (as defined in subsection (iii)(3)(C)) or other 
associated supplies that do not meet the appropriate for 
use in the home requirement applied to the definition of 
durable medical equipment under section 414.202 of title 
42, Code of Federal Regulations (or any successor to such 
regulation) shall be treated as meeting such requirement 
if each of the following criteria is satisfied: 
‘‘(1) The prescribing information approved by 
the Food and Drug Administration for the home in-
fusion drug associated with the pump instructs that 
the drug should be administered by or under the su-
pervision of a health care professional. 
‘‘(2) A qualified home infusion therapy supplier 
(as defined in subsection (iii)(3)(D)) administers or 
supervises the administration of the drug or biologi-
cal in a safe and effective manner in the patient’s 
home (as defined in subsection (iii)(3)(B)). 
‘‘(3) The prescribing information described in 
paragraph (1) instructs that the drug should be in-
fused at least 12 times per year— 
‘‘(A) intravenously or subcutaneously; or 
‘‘(B) at infusion rates that the Secretary 
determines would require the use of an external 
infusion pump.’’. 
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(b) COST SHARING NOTIFICATION.—The Secretary 
of Health and Human Services shall ensure that patients 
are notified of the cost sharing for electing home infusion 
therapy compared to other applicable settings of care for 
the furnishing of infusion drugs under the Medicare pro-
gram. 
SEC. 6223. ASSURING PHARMACY ACCESS AND CHOICE FOR 
MEDICARE BENEFICIARIES. 
(a) IN GENERAL.—Section 1860D–4(b)(1) of the So-
cial Security Act (42 U.S.C. 1395w–104(b)(1)) is amend-
ed by striking subparagraph (A) and inserting the fol-
lowing: 
‘‘(A) IN GENERAL.— 
‘‘(i) PARTICIPATION OF ANY WILLING 
PHARMACY.—A PDP sponsor offering a 
prescription drug plan shall permit any 
pharmacy that meets the standard contract 
terms and conditions under such plan to 
participate as a network pharmacy of such 
plan. 
‘‘(ii) CONTRACT TERMS AND CONDI-
TIONS.— 
‘‘(I) 
IN
GENERAL.—Notwith-
standing any other provision of law, 
for plan years beginning on or after 
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January 1, 2029, in accordance with 
clause (i), contract terms and condi-
tions offered by such PDP sponsor 
shall be reasonable and relevant ac-
cording to standards established by 
the Secretary under subclause (II). 
‘‘(II) 
STANDARDS.—Not 
later 
than the first Monday in April of 
2028, the Secretary shall establish 
standards for reasonable and relevant 
contract terms and conditions for pur-
poses of this clause. 
‘‘(III) REQUEST
FOR
INFORMA-
TION.—Not later than April 1, 2027, 
for purposes of establishing the stand-
ards under subclause (II), the Sec-
retary shall issue a request for infor-
mation to seek input on trends in pre-
scription drug plan and network phar-
macy contract terms and conditions, 
current prescription drug plan and 
network pharmacy contracting prac-
tices, whether pharmacy reimburse-
ment and dispensing fees paid by 
PDP sponsors to network pharmacies 
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sufficiently cover the ingredient and 
operational costs of such pharmacies, 
the use and application of pharmacy 
quality measures by PDP sponsors for 
network pharmacies, PDP sponsor re-
strictions or limitations on the dis-
pensing of covered part D drugs by 
network pharmacies (or any subsets of 
such pharmacies), PDP sponsor au-
diting practices for network phar-
macies, areas in current regulations or 
program guidance related to con-
tracting between prescription drug 
plans and network pharmacies requir-
ing clarification or additional speci-
ficity, factors for consideration in de-
termining the reasonableness and rel-
evance of contract terms and condi-
tions between prescription drug plans 
and network pharmacies, and other 
issues as determined appropriate by 
the Secretary.’’. 
(b) 
ESSENTIAL
RETAIL
PHARMACIES.—Section 
1860D–42 of the Social Security Act (42 U.S.C. 1395w– 
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152) is amended by adding at the end the following new 
subsection: 
‘‘(e) ESSENTIAL RETAIL PHARMACIES.— 
‘‘(1) IN GENERAL.—With respect to plan years 
beginning on or after January 1, 2028, the Sec-
retary shall publish reports, at least once every 2 
years until 2034, and periodically thereafter, that 
provide information, to the extent feasible, on— 
‘‘(A) trends in ingredient cost reimburse-
ment, dispensing fees, incentive payments and 
other fees paid by PDP sponsors offering pre-
scription drug plans and MA organizations of-
fering MA–PD plans under this part to essen-
tial retail pharmacies (as defined in paragraph 
(2)) with respect to the dispensing of covered 
part D drugs, including a comparison of such 
trends between essential retail pharmacies and 
pharmacies that are not essential retail phar-
macies; 
‘‘(B) trends in amounts paid to PDP spon-
sors offering prescription drug plans and MA 
organizations offering MA–PD plans under this 
part by essential retail pharmacies with respect 
to the dispensing of covered part D drugs, in-
cluding a comparison of such trends between 
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implement this paragraph by program instruc-
tion or otherwise. 
‘‘(E) NONAPPLICATION
OF
PAPERWORK 
REDUCTION
ACT.—Chapter 35 of title 44, 
United States Code, shall not apply to the im-
plementation of this paragraph. 
‘‘(4) DEFINITION
OF
AFFILIATE; PHARMACY 
BENEFIT MANAGER.—In this subsection, the terms 
‘affiliate’ and ‘pharmacy benefit manager’ have the 
meaning given those terms in section 1860D– 
12(h)(7).’’. 
(c) ENFORCEMENT.— 
(1) IN
GENERAL.—Section 1860D–4(b)(1) of 
the Social Security Act (42 U.S.C. 1395w– 
104(b)(1)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(F) ENFORCEMENT OF STANDARDS FOR 
REASONABLE AND RELEVANT CONTRACT TERMS 
AND CONDITIONS.— 
‘‘(i) ALLEGATION SUBMISSION PROC-
ESS.— 
‘‘(I) IN
GENERAL.—Not later 
than January 1, 2029, the Secretary 
shall establish a process through 
which a pharmacy may submit to the 
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Secretary an allegation of a violation 
by a PDP sponsor offering a prescrip-
tion drug plan of the standards for 
reasonable 
and 
relevant 
contract 
terms and conditions under subpara-
graph (A)(ii), or of subclause (VIII) 
of this clause. 
‘‘(II) FREQUENCY
OF
SUBMIS-
SION.— 
‘‘(aa) IN GENERAL.—Except 
as provided in item (bb), the alle-
gation submission process under 
this clause shall allow pharmacies 
to submit any allegations of vio-
lations described in subclause (I) 
not more frequently than once 
per plan year per contract be-
tween a pharmacy and a PDP 
sponsor. 
‘‘(bb) ALLEGATIONS RELAT-
ING
TO
CONTRACT
MODIFICA-
TIONS.—In the case where a con-
tract between a pharmacy and a 
PDP sponsor is modified fol-
lowing the submission of allega-
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tions by a pharmacy with respect 
to such contract and plan year, 
the allegation submission process 
under this clause shall allow such 
pharmacy to submit an additional 
allegation related to those modi-
fications with respect to such 
contract and plan year. 
‘‘(III) ACCESS
TO
RELEVANT 
DOCUMENTS
AND
MATERIALS.—A 
PDP sponsor subject to an allegation 
under this clause— 
‘‘(aa) shall provide docu-
ments or materials, as specified 
by the Secretary, including con-
tract offers made by such spon-
sor to such pharmacy or cor-
respondence related to such of-
fers, to the Secretary at a time, 
and in a form and manner, speci-
fied by the Secretary; and 
‘‘(bb) shall not prohibit or 
otherwise limit the ability of a 
pharmacy to submit such docu-
ments or materials to the Sec-
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retary for the purpose of submit-
ting an allegation or providing 
evidence for such an allegation 
under this clause. 
‘‘(IV) 
STANDARDIZED
TEM-
PLATE.—The Secretary shall establish 
a standardized template for phar-
macies to use for the submission of al-
legations described in subclause (I). 
Such template shall require that the 
submission include a certification by 
the pharmacy that the information in-
cluded is accurate, complete, and true 
to the best of the knowledge, informa-
tion, and belief of such pharmacy. 
‘‘(V) PREVENTING
FRIVOLOUS 
ALLEGATIONS.—In the case where the 
Secretary determines that a pharmacy 
has submitted frivolous allegations 
under this clause on a routine basis, 
the Secretary may temporarily pro-
hibit such pharmacy from using the 
allegation submission process under 
this clause, as determined appropriate 
by the Secretary. 
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‘‘(VI) EXEMPTION
FROM
FREE-
DOM OF INFORMATION ACT.—Allega-
tions submitted under this clause shall 
be exempt from disclosure under sec-
tion 552 of title 5, United States 
Code. 
‘‘(VII) 
RULE
OF
CONSTRUC-
TION.—Nothing in this clause shall be 
construed as limiting the ability of a 
pharmacy to pursue other legal ac-
tions or remedies, consistent with ap-
plicable Federal or State law, with re-
spect to a potential violation of a re-
quirement described in this subpara-
graph. 
‘‘(VIII) ANTI-RETALIATION
AND 
ANTI-COERCION.—Consistent with ap-
plicable Federal or State law, a PDP 
sponsor shall not— 
‘‘(aa) retaliate against a 
pharmacy for submitting any al-
legations under this clause; or 
‘‘(bb) 
coerce, 
intimidate, 
threaten, or interfere with the 
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ability of a pharmacy to submit 
any such allegations. 
‘‘(ii) INVESTIGATION.—The Secretary 
shall investigate, as determined appro-
priate by the Secretary, allegations sub-
mitted pursuant to clause (i). 
‘‘(iii) ENFORCEMENT.— 
‘‘(I) IN GENERAL.—In the case 
where the Secretary determines that a 
PDP sponsor offering a prescription 
drug plan has violated the standards 
for reasonable and relevant contract 
terms and conditions under subpara-
graph (A)(ii) or the provisions of 
clause (i)(VIII) of this subparagraph, 
the Secretary may use authorities 
under sections 1857(g) and 1860D– 
12(b)(3)(E) to impose civil monetary 
penalties or other intermediate sanc-
tions. 
‘‘(II) 
APPLICATION
OF
CIVIL 
MONETARY
PENALTIES.—The provi-
sions of section 1128A (other than 
subsections (a) and (b)) shall apply to 
a civil monetary penalty under this 
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clause in the same manner as such 
provisions apply to a penalty or pro-
ceeding under section 1128A(a).’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1857(g)(1) of the Social Security Act (42 U.S.C. 
1395w–27(g)(1)) is amended— 
(A) in subparagraph (J), by striking ‘‘or’’ 
after the semicolon; 
(B) by redesignating subparagraph (K) as 
subparagraph (L); 
(C) by inserting after subparagraph (J), 
the following new subparagraph: 
‘‘(K) fails to comply with the standards for 
reasonable and relevant contract terms and con-
ditions under subparagraph (A)(ii) of section 
1860D–4(b)(1) or violates the provisions of 
subparagraph (F)(i)(VIII) of such section; or’’; 
(D) in subparagraph (L), as redesignated 
by subparagraph (B), by striking ‘‘through (J)’’ 
and inserting ‘‘through (K)’’; and 
(E) in the flush matter following subpara-
graph (L), as so redesignated, by striking ‘‘sub-
paragraphs (A) through (K)’’ and inserting 
‘‘subparagraphs (A) through (L)’’. 
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(d) ACCOUNTABILITY OF PHARMACY BENEFIT MAN-
AGERS FOR VIOLATIONS OF REASONABLE AND RELEVANT 
CONTRACT TERMS AND CONDITIONS.— 
(1) IN GENERAL.—Section 1860D–12(b) of the 
Social Security Act (42 U.S.C. 1395w–112) is 
amended by adding at the end the following new 
paragraph: 
‘‘(9) ACCOUNTABILITY OF PHARMACY BENEFIT 
MANAGERS FOR VIOLATIONS OF REASONABLE AND 
RELEVANT
CONTRACT
TERMS
AND
CONDITIONS.— 
For plan years beginning on or after January 1, 
2029, each contract entered into with a PDP spon-
sor under this part with respect to a prescription 
drug plan offered by such sponsor shall provide that 
any pharmacy benefit manager acting on behalf of 
such sponsor has a written agreement with the PDP 
sponsor under which the pharmacy benefit manager 
agrees to reimburse the PDP sponsor for any 
amounts paid by such sponsor under section 1860D– 
4(b)(1)(F)(iii)(I) to the Secretary as a result of a 
violation described in such section if such violation 
is related to a responsibility delegated to the phar-
macy benefit manager by such PDP sponsor.’’. 
(2) MA–PD PLANS.—Section 1857(f)(3) of the 
Social Security Act (42 U.S.C. 1395w–27(f)(3)) is 
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amended by adding at the end the following new 
subparagraph: 
‘‘(F) 
ACCOUNTABILITY
OF
PHARMACY 
BENEFIT MANAGERS FOR VIOLATIONS OF REA-
SONABLE AND RELEVANT CONTRACT TERMS.— 
For plan years beginning on or after January 
1, 2029, section 1860D–12(b)(9).’’. 
(e) BIENNIAL
REPORT
ON
ENFORCEMENT
AND 
OVERSIGHT OF PHARMACY ACCESS REQUIREMENTS.— 
Section 1860D–42 of the Social Security Act (42 U.S.C. 
1395w–152), as amended by subsection (b), is amended 
by adding at the end the following new subsection: 
‘‘(f) BIENNIAL REPORT
ON ENFORCEMENT
AND 
OVERSIGHT OF PHARMACY ACCESS REQUIREMENTS.— 
‘‘(1) IN
GENERAL.—Not later than 2 years 
after the date of enactment of this subsection, and 
at least once every 2 years thereafter, the Secretary 
shall publish a report on enforcement and oversight 
actions and activities undertaken by the Secretary 
with respect to the requirements under section 
1860D–4(b)(1). 
‘‘(2) LIMITATION.—A report under paragraph 
(1) shall not disclose— 
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‘‘(A) identifiable information about individ-
uals or entities unless such information is oth-
erwise publicly available; or 
‘‘(B) trade secrets with respect to any enti-
ties.’’. 
(f) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Centers for Medi-
care & Medicaid Services Program Management Account, 
out of any money in the Treasury not otherwise appro-
priated, $188,000,000 for fiscal year 2026, to remain 
available until expended, to carry out this section. 
SEC. 6224. MODERNIZING AND ENSURING PBM ACCOUNT-
ABILITY. 
(a) IN GENERAL.— 
(1) 
PRESCRIPTION
DRUG
PLANS.—Section 
1860D–12 of the Social Security Act (42 U.S.C. 
1395w–112) is amended by adding at the end the 
following new subsection: 
‘‘(h) REQUIREMENTS RELATING TO PHARMACY BEN-
EFIT MANAGERS.—For plan years beginning on or after 
January 1, 2028: 
‘‘(1) AGREEMENTS WITH PHARMACY BENEFIT 
MANAGERS.—Each contract entered into with a 
PDP sponsor under this part with respect to a pre-
scription drug plan offered by such sponsor shall 
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provide that any pharmacy benefit manager acting 
on behalf of such sponsor has a written agreement 
with the PDP sponsor under which the pharmacy 
benefit manager, and any affiliates of such phar-
macy benefit manager, as applicable, agree to meet 
the following requirements: 
‘‘(A) NO INCOME OTHER THAN BONA FIDE 
SERVICE FEES.— 
‘‘(i) IN
GENERAL.—The pharmacy 
benefit manager and any affiliate of such 
pharmacy benefit manager shall not derive 
any remuneration with respect to any serv-
ices provided on behalf of any entity or in-
dividual, in connection with the utilization 
of covered part D drugs, from any such en-
tity or individual other than bona fide serv-
ice fees, subject to clauses (ii) and (iii). 
‘‘(ii) INCENTIVE PAYMENTS.—For the 
purposes of this subsection, an incentive 
payment (as determined by the Secretary) 
paid by a PDP sponsor to a pharmacy 
benefit manager or an affiliate of a phar-
macy benefit manager that is performing 
services on behalf of such sponsor shall be 
deemed a ‘bona fide service fee’ (even if 
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such payment does not otherwise meet the 
definition of such term under paragraph 
(7)(B)) if such payment is a flat dollar 
amount, is consistent with fair market 
value (as specified by the Secretary), is re-
lated to services actually performed by the 
pharmacy benefit manager or affiliate of 
such pharmacy benefit manager, on behalf 
of the PDP sponsor making such payment, 
in connection with the utilization of cov-
ered part D drugs, and meets additional 
requirements, if any, as determined appro-
priate by the Secretary. 
‘‘(iii) CLARIFICATION
ON
REBATES 
AND DISCOUNTS USED TO LOWER COSTS 
FOR COVERED PART D DRUGS.—Rebates, 
discounts, and other price concessions re-
ceived by a pharmacy benefit manager or 
an affiliate of a pharmacy benefit manager 
from manufacturers, even if such price 
concessions are calculated as a percentage 
of a drug’s price, shall not be considered a 
violation of the requirements of clause (i) 
if they are fully passed through to a PDP 
sponsor and are compliant with all regu-
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latory and subregulatory requirements re-
lated to direct and indirect remuneration 
for manufacturer rebates, discounts, and 
other price concessions under this part, in-
cluding in cases where a PDP sponsor is 
acting as a pharmacy benefit manager on 
behalf of a prescription drug plan offered 
by such PDP sponsor. 
‘‘(iv) EVALUATION OF REMUNERATION 
ARRANGEMENTS.—Components of subsets 
of remuneration arrangements (such as 
fees or other forms of compensation paid 
to or retained by the pharmacy benefit 
manager or affiliate of such pharmacy ben-
efit manager), as determined appropriate 
by the Secretary, between pharmacy ben-
efit managers or affiliates of such phar-
macy benefit managers, as applicable, and 
other entities involved in the dispensing or 
utilization of covered part D drugs (includ-
ing PDP sponsors, manufacturers, phar-
macies, and other entities as determined 
appropriate by the Secretary) shall be sub-
ject to review by the Secretary, in con-
sultation with the Office of the Inspector 
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General of the Department of Health and 
Human Services, as determined appro-
priate by the Secretary. The Secretary, in 
consultation with the Office of the Inspec-
tor General, shall review whether remu-
neration under such arrangements is con-
sistent with fair market value (as specified 
by the Secretary) through reviews and as-
sessments of such remuneration, as deter-
mined appropriate. 
‘‘(v) DISGORGEMENT.—The pharmacy 
benefit manager shall disgorge any remu-
neration paid to such pharmacy benefit 
manager or an affiliate of such pharmacy 
benefit manager in violation of this sub-
paragraph to the PDP sponsor. 
‘‘(vi) ADDITIONAL REQUIREMENTS.— 
The pharmacy benefit manager shall— 
‘‘(I) enter into a written agree-
ment with any affiliate of such phar-
macy benefit manager, under which 
the affiliate shall identify and disgorge 
any remuneration described in clause 
(v) to the pharmacy benefit manager; 
and 
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‘‘(II) attest, subject to any re-
quirements determined appropriate by 
the Secretary, that the pharmacy ben-
efit manager has entered into a writ-
ten agreement described in subclause 
(I) with any affiliate of the pharmacy 
benefit manager. 
‘‘(B) TRANSPARENCY REGARDING GUARAN-
TEES
AND
COST
PERFORMANCE
EVALUA-
TIONS.—The pharmacy benefit manager shall— 
‘‘(i) define, interpret, and apply, in a 
fully transparent and consistent manner 
for purposes of calculating or otherwise 
evaluating pharmacy benefit manager per-
formance against pricing guarantees or 
similar cost performance measurements re-
lated to rebates, discounts, price conces-
sions, or net costs, terms such as— 
‘‘(I) ‘generic drug’, in a manner 
consistent with the definition of the 
term under section 423.4 of title 42, 
Code of Federal Regulations, or a suc-
cessor regulation; 
‘‘(II) ‘brand name drug’, in a 
manner consistent with the definition 
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of the term under section 423.4 of 
title 42, Code of Federal Regulations, 
or a successor regulation; 
‘‘(III) ‘specialty drug’; 
‘‘(IV) ‘rebate’; and 
‘‘(V) ‘discount’; 
‘‘(ii) identify any drugs, claims, or 
price concessions excluded from any pric-
ing guarantee or other cost performance 
measure in a clear and consistent manner; 
and 
‘‘(iii) where a pricing guarantee or 
other cost performance measure is based 
on a pricing benchmark other than the 
wholesale acquisition cost (as defined in 
section 1847A(c)(6)(B)) of a drug, cal-
culate and provide a wholesale acquisition 
cost-based equivalent to the pricing guar-
antee or other cost performance measure. 
‘‘(C) PROVISION OF INFORMATION.— 
‘‘(i) IN
GENERAL.—Not later than 
July 1 of each year, beginning in 2028, the 
pharmacy benefit manager shall submit to 
the PDP sponsor, and to the Secretary, a 
report, in accordance with this subpara-
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graph, and shall make such report avail-
able to such sponsor at no cost to such 
sponsor in a format specified by the Sec-
retary under paragraph (5). Each such re-
port shall include, with respect to such 
PDP sponsor and each plan offered by 
such sponsor, the following information 
with respect to the previous plan year: 
‘‘(I) A list of all drugs covered by 
the plan that were dispensed includ-
ing, with respect to each such drug— 
‘‘(aa) the brand name, ge-
neric or non-proprietary name, 
and National Drug Code; 
‘‘(bb) the number of plan 
enrollees for whom the drug was 
dispensed, the total number of 
prescription claims for the drug 
(including original prescriptions 
and refills, counted as separate 
claims), and the total number of 
dosage units of the drug dis-
pensed; 
‘‘(cc) the number of pre-
scription claims described in item 
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(bb) by each type of dispensing 
channel through which the drug 
was dispensed, including retail, 
mail order, specialty pharmacy, 
long term care pharmacy, home 
infusion pharmacy, or other types 
of pharmacies or dispensers; 
‘‘(dd) the average wholesale 
acquisition cost, listed as cost per 
day’s supply, cost per dosage 
unit, and cost per typical course 
of treatment (as applicable); 
‘‘(ee) the average wholesale 
price for the drug, listed as price 
per day’s supply, price per dos-
age unit, and price per typical 
course of treatment (as applica-
ble); 
‘‘(ff) the total out-of-pocket 
spending by plan enrollees on 
such drug after application of 
any benefits under the plan, in-
cluding plan enrollee spending 
through copayments, coinsurance, 
and deductibles; 
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‘‘(gg) total rebates paid by 
the manufacturer on the drug as 
reported under the Detailed DIR 
Report (or any successor report) 
submitted by such sponsor to the 
Centers for Medicare & Medicaid 
Services; 
‘‘(hh) all other direct or in-
direct remuneration on the drug 
as reported under the Detailed 
DIR Report (or any successor re-
port) submitted by such sponsor 
to the Centers for Medicare & 
Medicaid Services; 
‘‘(ii) the average pharmacy 
reimbursement amount paid by 
the plan for the drug in the ag-
gregate and disaggregated by dis-
pensing channel identified in item 
(cc); 
‘‘(jj) the average National 
Average Drug Acquisition Cost 
(NADAC); and 
‘‘(kk) total manufacturer-de-
rived revenue, inclusive of bona 
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