Secretary may establish for individuals identified pursuant 
to section 1860D–4(c)(4)(A)(i)’’ after ‘‘the Secretary’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning after the date that is 8 months after the date of the 
enactment of this Act. 
SEC. 3. PART D SUSPENSION OF CLAIMS PAYMENT. 
Amend 1860D–12(b)(4) of the Social Security Act 
(42 U.S.C. 1395w–112(b)(4)) is amended by adding at 
the end the following new subparagraph: 
‘‘(H) SUSPENSION OF PAYMENTS PENDING 
INVESTIGATION OF CREDIBLE ALLEGATIONS OF 
FRAUD BY PHARMACIES.— 
‘‘(i) IN
GENERAL.—A PDP sponsor 
may suspend payments and clean claim no-
tifications to a pharmacy pending an inves-
tigation of a credible allegation of fraud 
(as defined in clause (ii)) against the phar-
macy, unless the Secretary determines 
there is a good cause not to suspend pay-
ments. 
‘‘(ii) 
CREDIBLE
ALLEGATION
OF 
FRAUD DEFINED.—In this subparagraph, 
the term ‘credible allegation of fraud’ in-
cludes— 
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‘‘(I) a complaint made on the 
Medicare fraud hotline; 
‘‘(II) detection of potential fraud 
through the analysis of claims data; 
‘‘(III) detection of potential fraud 
through identification of inappropriate 
dispensing through audits, civil false 
claims cases, and law enforcement in-
vestigations; and 
‘‘(IV) claims referred to Medicare 
drug integrity contractors (MEDICs). 
‘‘(iii) RULE
OF
CONSTRUCTION.— 
Nothing in this subparagraph shall be con-
strued as limited the authority of a PDP 
sponsor to conduct post-claim payment re-
view.’’. 
SEC. 4. IMPROVING ACTIVITIES OF MEDICARE DRUG IN-
TEGRITY CONTRACTORS (MEDICS). 
(a) IN GENERAL.—Section 1893 of the Social Secu-
rity Act (42 U.S.C. 1395ddd) is amended by adding at 
the end the following new subsection: 
‘‘(j) IMPROVING ACTIVITIES OF MEDICARE DRUG IN-
TEGRITY CONTRACTORS (MEDICS).— 
‘‘(1) ACCESS
TO
IN
GENERAL.—Under con-
tracts entered into under this section (each in this 
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subsection referred to as a ‘MEDIC contract’) with 
Medicare drug integrity contractors (each in this 
subsection referred to as a ‘MEDIC’), the Secretary 
shall authorize MEDICs to directly obtain prescrip-
tion and medical records from entities such as phar-
macies, PDP and physicians. 
‘‘(2) REQUIREMENT
FOR
ACKNOWLEDGMENT 
OF REFERRALS.—If a PDP sponsor refers informa-
tion to a MEDIC for investigation, under the 
MEDIC contract the MEDIC must acknowledge re-
ceipt of the referral and must report back to the 
sponsor the result of the MEDIC’s investigation 
within 45 days of the date of the referral and share 
such results with appropriate agencies, such as law 
enforcement officials and State licensing authority. 
‘‘(3) UNIFORM ANNUAL REPORT CRITERIA.—In 
order to assess the performance of MEDICs, the 
Secretary shall develop a uniform reporting criteria 
for the annual reporting of the results of investiga-
tions by MEDICs to the Secretary and to Congress. 
Each such annual report shall include information 
on the number of referrals for investigation made to 
a MEDIC, the average time required for investiga-
tion, the results of the investigation, and the number 
of results that were referred to the Inspector Gen-
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eral of the Department of Health and Human Serv-
ices and to State licensing officials for further inves-
tigations.’’. 
(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 as quickly as possible 
to MEDIC contracts, including MEDIC contracts entered 
into before such date of enactment. 
SEC. 5. REQUIRING E-PRESCRIBING FOR COVERAGE OF 
COVERED 
PART 
D 
CONTROLLED 
SUB-
STANCES. 
(a) IN GENERAL.—Section 1860D–4(e) of the Social 
Security Act (42 U.S.C. 1395w–104(e)) is amended by 
adding at the end the following: 
‘‘(7) REQUIREMENT
OF
E-PRESCRIBING
FOR 
CONTROLLED SUBSTANCES.—Except in such emer-
gent circumstances as the Secretary may specify, 
coverage shall not be provided for a covered part D 
drug under a prescription drug plan (or under an 
MA–PD plan) for a schedule II, III, IV, or V con-
trolled substance unless the prescription for the drug 
has been transmitted electronically in accordance 
with an electronic prescription drug program that 
meets the requirements of paragraph (2).’’. 
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(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to coverage of drugs prescribed 
on or after January 1, 2015. 
Æ 
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