‘‘(ii) periods of time in which an indi-
vidual is enrolled under an employee wel-
fare benefit plan described in section 
1882(s)(3)(B)(i), under a Medicare Advan-
tage plan, with an organization described 
in section 1882(s)(3)(B)(iii), or under a 
PACE program under section 1894 shall 
not be taken into account. 
‘‘(3) COLLECTION.—The Secretary shall pro-
vide for the collection of premiums for enrollees 
under this part in the same manner as premiums 
under part B are collected under section 1840, ex-
cept that any reference in such section to the Fed-
eral Supplementary Medical Insurance Trust Fund 
shall be deemed a reference to an account (to be 
known as the ‘Direct Medicare Supplemental Insur-
ance Account’) to be established in the Treasury by 
the Secretary to carry out the program under this 
section. Amounts in such account may be invested 
and draw interest in the same manner as such Trust 
Fund under section 1840(c). 
‘‘(4) USE OF FUNDS.—Premium amounts de-
posited into the account established under paragraph 
(3) shall be available without regard to appropria-
tions to the Secretary to make payment for benefits 
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and administrative costs incurred in carrying out 
this section. 
‘‘(e) NONDUPLICATION
OF COVERAGE.—For pur-
poses of applying section 1882(d)(3)(A), coverage under 
this section shall be treated as coverage under a Medicare 
supplemental policy.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act and shall apply to benefits for months 
beginning with January 2022. 
SEC. 5. NEGOTIATION OF LOWER COVERED PART D DRUG 
PRICES ON BEHALF OF MEDICARE BENE-
FICIARIES. 
(a) NEGOTIATION BY SECRETARY.—Section 1860D– 
11 of the Social Security Act (42 U.S.C. 1395w–111) is 
amended by striking subsection (i) (relating to noninter-
ference) and inserting the following: 
‘‘(i) NEGOTIATION OF LOWER DRUG PRICES.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, the Secretary shall negotiate with 
pharmaceutical manufacturers the prices (including 
discounts, rebates, and other price concessions) that 
may be charged to PDP sponsors and MA organiza-
tions for covered part D drugs for part D eligible in-
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dividuals who are enrolled under a prescription drug 
plan or under an MA–PD plan. 
‘‘(2) 
NO
CHANGE
IN
RULES
FOR 
FORMULARIES.— 
‘‘(A) IN GENERAL.—Nothing in paragraph 
(1) shall be construed to authorize the Sec-
retary to establish or require a particular for-
mulary. 
‘‘(B) CONSTRUCTION.—Subparagraph (A) 
shall not be construed as affecting the Sec-
retary’s authority to ensure appropriate and 
adequate access to covered part D drugs under 
prescription drug plans and under MA–PD 
plans, including compliance of such plans with 
formulary requirements under section 1860D– 
4(b)(3). 
‘‘(3) CONSTRUCTION.—Nothing in this sub-
section shall be construed as preventing the sponsor 
of a prescription drug plan, or an organization offer-
ing an MA–PD plan, from obtaining a discount or 
reduction of the price for a covered part D drug 
below the price negotiated under paragraph (1). 
‘‘(4) SEMI-ANNUAL REPORTS TO CONGRESS.— 
Not later than June 1, 2024, and every 6 months 
thereafter, the Secretary shall submit to the Com-
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mittees on Ways and Means, Energy and Commerce, 
and Oversight and Reform of the House of Rep-
resentatives and the Committee on Finance of the 
Senate a report on negotiations conducted by the 
Secretary to achieve lower prices for Medicare bene-
ficiaries, and the prices and price discounts achieved 
by the Secretary as a result of such negotiations.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act and shall first apply to negotiations and 
prices for plan years beginning on January 1, 2024. 
SEC. 6. INDIVIDUAL MARKET REINSURANCE FUND. 
(a) ESTABLISHMENT OF FUND.— 
(1) IN GENERAL.—There is established the ‘‘In-
dividual Market Reinsurance Fund’’ (in this section 
referred to as the ‘‘Fund’’) to be administered by 
the Secretary to provide funding for an individual 
market stabilization reinsurance program in each 
State that complies with the requirements of this 
section. 
(2) FUNDING.—Amounts made available to the 
Fund shall consist of the funds deposited into the 
Fund under paragraph (3) and shall be used to 
carry out this section (other than subsection (c)) for 
each calendar year beginning with 2023. Amounts 
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made available to the Fund shall remain available 
without fiscal or calendar year limitation to carry 
out this section. 
(3) COST-SHARING IN COSTS OF PROGRAM.— 
(A) IN GENERAL.—A qualified health plan 
that participates in the reinsurance program es-
tablished under subsection (b) shall pay the fee 
established under subparagraph (B). 
(B) AUTHORIZATION.—The Secretary is 
authorized to charge a fee to each qualified 
health plan that participates in the reinsurance 
program established under subsection (b). Any 
amounts collected pursuant to this paragraph 
shall be deposited into the Fund for purposes of 
payments under subsection (b). 
(C) REQUIREMENTS.—In establishing the 
fee under subparagraph (B)— 
(i) the Secretary shall consult with in-
terested parties; and 
(ii) shall ensure that the amount of 
such fee is not excessive so as to unduly 
discourage qualified health plans from par-
ticipating in the reinsurance program. 
(b) 
INDIVIDUAL
MARKET
REINSURANCE
PRO-
GRAM.— 
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