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 Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Common 
Ownership Transparency Act of 2023’’. 
SEC. 2. REPORT ON INTEGRATION IN MEDICARE. 
(a) REQUIRED MA AND PDP REPORTING.— 
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(1) MA PLANS.—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) REQUIRED DISCLOSURE OF CERTAIN IN-
FORMATION RELATING TO HEALTH CARE PROVIDER 
OWNERSHIP.— 
‘‘(A) IN GENERAL.—For plan year 2025 
and for every third plan year thereafter, each 
MA organization offering an MA plan under 
this part during such plan year shall submit to 
the Secretary, at a time and in a manner speci-
fied by the Secretary— 
‘‘(i) the taxpayer identification num-
ber for each health care provider that was 
a specified health care provider with re-
spect to such organization during such 
year; 
‘‘(ii) the total amount of incentive- 
based payments made to, and the total 
amount of shared losses recoupments col-
lected from, such specified health care pro-
viders during such plan year; and 
‘‘(iii) the total amount of incentive- 
based payments made to, and the total 
amount of shared losses recoupments col-
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lected from, providers of services and sup-
pliers not described in clause (ii) during 
such plan year. 
‘‘(B) DEFINITION.—For purposes of this 
paragraph, the term ‘specified health care pro-
vider’ means, with respect to an MA organiza-
tion and a plan year, a provider of services or 
supplier with respect to which such organization 
(or any person with an ownership or control in-
terest (as defined in section 1124(a)(3)) in such 
organization) is a person with an ownership or 
control interest (as so defined).’’. 
(2) 
PRESCRIPTION
DRUG
PLANS.—Section 
1860D–12(b) of the Social Security Act (42 U.S.C. 
1395w–112(b)) is amended by adding at the end the 
following new paragraph: 
‘‘(9) PROVISION OF INFORMATION RELATING TO 
PHARMACY OWNERSHIP.— 
‘‘(A) IN GENERAL.—For plan year 2025 
and for every third plan year thereafter, each 
PDP sponsor offering a prescription drug plan 
under this part during such plan year shall sub-
mit to the Secretary, at a time and in a manner 
specified by the Secretary, the taxpayer identi-
fication number and National Provider Identi-
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fier for each pharmacy that was a specified 
pharmacy with respect to such sponsor during 
such year. 
‘‘(B) DEFINITION.—For purposes of this 
paragraph, 
the 
term 
‘specified 
pharmacy’ 
means, with respect to an PDP sponsor offering 
a prescription drug plan and a plan year, a 
pharmacy with respect to which— 
‘‘(i) such sponsor (or any person with 
an ownership or control interest (as de-
fined in section 1124(a)(3)) in such spon-
sor) is a person with an ownership or con-
trol interest (as so defined); or 
‘‘(ii) a pharmacy benefit manager of-
fering services under such plan (or any 
person with an ownership or control inter-
est (as so defined) in such sponsor) is a 
person with an ownership or control inter-
est (as so defined).’’. 
(b) MEDPAC REPORTS.—Part E of title XVIII of the 
Social Security Act (42 U.S.C. 1395x et seq.) is amended 
by adding at the end the following new section: 
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‘‘SEC. 1899C. REPORTS ON VERTICAL INTEGRATION UNDER 
MEDICARE. 
‘‘(a) IN GENERAL.—Not later than June 15, 2029, 
and every 3 years thereafter, the Medicare Payment Advi-
sory Commission shall submit to Congress a report on the 
state of vertical integration in the health care sector dur-
ing the applicable year with respect to entities partici-
pating in the Medicare program, including health care pro-
viders, pharmacies, prescription drug plan sponsors, Medi-
care Advantage organizations, and pharmacy benefit man-
agers. Such report shall include— 
‘‘(1) with respect to Medicare Advantage orga-
nizations, the evaluation described in subsection (b); 
‘‘(2) with respect to prescription drug plans, 
pharmacy benefit managers, and pharmacies, the 
comparisons and evaluations described in subsection 
(c); 
‘‘(3) with respect to Medicare Advantage plans 
under which benefits are available for physician-ad-
ministered drugs, the information described in sub-
section (d); and 
‘‘(4) the identifications described in subsection 
(e); and 
‘‘(5) an analysis of the impact of such integra-
tion on health care access, price, quality, and out-
comes. 
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‘‘(b) MEDICARE ADVANTAGE ORGANIZATIONS.—For 
purposes of subsection (a)(1), the evaluation described in 
this subsection is, with respect to Medicare Advantage or-
ganizations and an applicable year, an evaluation, taking 
into account patient acuity and the types of areas serviced 
by such organization, of— 
‘‘(1) the average number of qualifying diag-
noses made during such year with respect to enroll-
ees of a Medicare Advantage plan offered by such 
organization who, during such year, received a 
health risk assessment from a specified health care 
provider; 
‘‘(2) the average risk score for such enrollees 
who received such an assessment during such year; 
‘‘(3) any relationship between such risk scores 
for such enrollees receiving such an assessment from 
such a provider during such year and incentive pay-
ments made to such providers; 
‘‘(4) the average risk score for enrollees of such 
plan who received any item or service from a speci-
fied health care provider during such year; 
‘‘(5) any relationship between the risk scores of 
enrollees under such plan and whether the enrollees 
have received any item or service from a specified 
provider; and 
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‘‘(6) any relationship between the risk scores of 
enrollees under such plan that have received any 
item or service from a specified provider and incen-
tive payments made under the plan to specified pro-
viders. 
‘‘(c) PRESCRIPTION DRUG PLANS.—For purposes of 
subsection (a)(2), the comparisons and evaluations de-
scribed in this subsection are, with respect to prescription 
drug plans and an applicable year, the following: 
‘‘(1) For each covered part D drug for which 
benefits are available under such a plan, a compari-
son of the average negotiated rate in effect with 
specified pharmacies with such rates in effect for in- 
network pharmacies that are not specified phar-
macies. 
‘‘(2) Comparisons of the following: 
‘‘(A) The total amount paid by pharmacy 
benefit managers to specified pharmacies for 
covered part D drugs and the total amount so 
paid to pharmacies that are not specified phar-
macies for such drugs. 
‘‘(B) The total amount paid by such spon-
sors to specified pharmacy benefit managers as 
reimbursement for covered part D drugs and 
the total amount so paid to pharmacy benefit 
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managers that are not specified pharmacy ben-
efit managers as such reimbursement. 
‘‘(C) Fees paid under by plan to specified 
pharmacy benefit managers compared to such 
fees paid to pharmacy benefit managers that 
are not specified pharmacy benefit managers. 
‘‘(3) An evaluation of the total amount of direct 
and indirect remuneration for covered part D drugs 
passed through to prescription drug plan sponsors 
and the total amount retained by pharmacy benefit 
managers (including entities under contract with 
such a manager). 
‘‘(4) To the extent that the available data per-
mits, an evaluation of fees charged by rebate 
aggregators that are affiliated with plan sponsors. 
‘‘(d) PHYSICIAN-ADMINISTERED DRUGS.—For pur-
poses of subsection (a)(3), the information described in 
this subsection is, with respect to physician-administered 
drugs for which benefits are available under a Medicare 
Advantage plan during an applicable year, the following: 
‘‘(1) With respect to each such plan, an identi-
fication of each drug for which benefits were avail-
able under such plan only when administered by a 
health care provider that acquired such drug from 
an affiliated pharmacy. 
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‘‘(2) An evaluation of the difference between 
the total number of drugs administered by a health 
care provider that were acquired from affiliated 
pharmacies compared to the number of such drugs 
so administered that were acquired from pharmacies 
other than affiliated pharmacies, and an evaluation 
of the difference in payments for such drugs so ad-
ministered when acquired from a specified pharmacy 
and when acquired from a pharmacy that is not a 
specified pharmacy. 
‘‘(3) An evaluation of the dollar value of all 
such drugs that were not so administered because of 
a delay attributable to an affiliated pharmacy com-
pared to the dollar value of all such drugs that were 
not so administered because of a delay attributable 
to pharmacy that is not an affiliated pharmacy. 
‘‘(4) The number of enrollees administered such 
a drug that was acquired from an affiliated phar-
macy. 
‘‘(5) The number of enrollees furnished such a 
drug that was acquired from a pharmacy that is not 
an affiliated pharmacy. 
‘‘(e) IDENTIFICATIONS.—For purposes of subsection 
(a)(4), the identifications described in this subsection are, 
with respect to an applicable year, identifications of each 
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health care entity participating under the Medicare pro-
gram with respect to which another health care entity so 
participating is a person with an ownership or control in-
terest (as defined in section 1124(a)(3) of the Social Secu-
rity Act (42 U.S.C. 1320a–3(a)(3))). 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) AFFILIATED PHARMACY.—The term ‘affili-
ated pharmacy’ means, with respect to a Medicare 
Advantage plan offered by a Medicare Advantage or-
ganization, a pharmacy with respect to which such 
organization (or any person with an ownership or 
control interest (as defined in section 1124(a)(3)) in 
such organization) is a person with an ownership or 
control interest (as so defined). 
‘‘(2) APPLICABLE YEAR.—The term ‘applicable 
year’ means, with respect to a report submitted 
under subsection (a), the first calendar year begin-
ning at least 4 years prior to the date of the submis-
sion of such report. 
‘‘(3) COVERED PART D DRUG.—The term ‘cov-
ered part D drug’ has the meaning given such term 
in section 1860D–2(e). 
‘‘(4) DIRECT AND INDIRECT REMUNERATION.— 
The term ‘direct and indirect remuneration’ has the 
meaning given such term in section 423.308 of title 
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42, Code of Federal Regulations (or any successor 
regulation). 
‘‘(5) QUALIFYING DIAGNOSIS.—The term ‘quali-
fying diagnosis’ means, with respect to an enrollee of 
a Medicare Advantage plan, a diagnosis that is 
taken into account in calculating a risk score for 
such enrollee under the risk adjustment methodology 
established by the Secretary pursuant to section 
1853(a)(3). 
‘‘(6) RISK
SCORE.—The term ‘risk score’ 
means, with respect to an enrollee of a Medicare Ad-
vantage plan, the score calculated for such individual 
using the methodology described in paragraph (5). 
‘‘(7) PHYSICIAN-ADMINISTERED
DRUG.—The 
term ‘physician-administered drug’ means a drug 
furnished to an individual that, had such individual 
been enrolled under part B and not enrolled under 
part C, would have been payable under section 
1842(o). 
‘‘(8) SPECIFIED
HEALTH
CARE
PROVIDER.— 
The term ‘specified health care provider’ means, 
with respect to a Medicare Advantage plan offered 
by a Medicare Advantage organization, a health care 
provider with respect to which such organization (or 
any person with an ownership or control interest (as 
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defined in section 1124(a)(3)) in such organization) 
is a person with an ownership or control interest (as 
so defined). 
‘‘(9) SPECIFIED PHARMACY.—The term ‘speci-
fied pharmacy’ means, with respect to a prescription 
drug plan offered by a prescription drug plan spon-
sor, a pharmacy with respect to which— 
‘‘(A) such sponsor (or any person with an 
ownership or control interest (as defined in sec-
tion 1124(a)(3)) in such sponsor) is a person 
with an ownership or control interest (as so de-
fined); or 
‘‘(B) a pharmacy benefit manager offering 
services under such plan (or any person with an 
ownership or control interest (as so defined) in 
such sponsor) is a person with an ownership or 
control interest (as so defined). 
‘‘(10) SPECIFIED
PHARMACY
BENEFIT
MAN-
AGER.—The term ‘specified pharmacy benefit man-
ager’ means, with respect to a prescription drug 
plan offered by a prescription drug plan sponsor, a 
pharmacy benefit manager with respect to which 
such sponsor (or any person with an ownership or 
control interest (as defined in section 1124(a)(3)) in 
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such sponsor) is a person with an ownership or con-
trol interest (as so defined).’’. 
Æ 
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