(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 
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; 
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emcdonald on DSK2BSOYB1PROD with BILLS
(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.— 
(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 
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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 
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 
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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 
the provision of prescription drugs at discounted 
prices to qualified residents in a reasonably acces-
sible manner. Such arrangements shall provide 
that— 
(A) each participating pharmacy shall— 
(i) provide discounts on prices for out-
patient prescription drugs for qualified 
residents in return for prompt reimburse-
ment of the amount of such discounts and 
a reasonable dispensing fee; 
(ii) not charge qualified residents 
more (before such discounts) for outpatient 
prescription drugs than the amount that 
individuals who are not qualified residents 
are charged for such drugs; and 
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(iii) report to the Secretary (or the 
Secretary’s designee) information regard-
ing the discounts provided and fees in-
curred; and 
(B) the program shall— 
(i) ensure the reasonable and timely 
payment to a participating retail pharmacy 
on a prompt basis (no less promptly than 
as provided under the Medicare program) 
for discounted prices provided to qualified 
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-
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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 
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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