I 
116TH CONGRESS 
1ST SESSION H. R. 4946 
To amend title XVIII of the Social Security Act to ensure equal access 
of Medicare beneficiaries to community pharmacies in underserved areas 
as network pharmacies under Medicare prescription drug coverage, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 31, 2019 
Mr. WELCH (for himself, Mr. GRIFFITH, Mr. LOEBSACK, Mr. CARTER of 
Georgia, Mr. GONZALEZ of Texas, Mr. CRAWFORD, Mr. WESTERMAN, 
Mr. DAVID P. ROE of Tennessee, Mrs. RODGERS of Washington, Mrs. 
AXNE, Mr. ALLEN, and Mr. PETERSON) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to ensure 
equal access of Medicare beneficiaries to community 
pharmacies in underserved areas as network pharmacies 
under Medicare prescription drug coverage, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Ensuring Seniors Ac-
cess to Local Pharmacies Act of 2019’’. 
SEC. 2. ALLOWING ANY STATE LICENSED PHARMACY SERV-
ING AN UNDERSERVED AREA TO BECOME A 
NETWORK 
PHARMACY 
UNDER 
MEDICARE 
PRESCRIPTION DRUG COVERAGE. 
(a) IN GENERAL.—Section 1860D–4(b)(1)(B) of the 
Social Security Act (42 U.S.C. 1395w–104(b)(1)(B)) is 
amended— 
(1) by striking ‘‘DISCOUNTS
ALLOWED
FOR 
NETWORK
PHARMACIES.—For’’ and inserting the 
following: ‘‘DISCOUNTS
ALLOWED
FOR
NETWORK 
PHARMACIES.— 
‘‘(i) IN GENERAL.—For’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(ii) INCLUSION OF PHARMACIES LO-
CATED IN UNDERSERVED AREAS IN NET-
WORKS.—For plan years beginning on or 
after January 1, 2020, in the case of a 
prescription drug plan that has, in its net-
work of pharmacies, one or more phar-
macies located in a health professional 
shortage area (as defined in section 
332(a)(1)(A) of the Public Health Service 
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Act), in a medically underserved area (ac-
cording to a designation under section 
330(b)(3)(A) of the Public Health Service 
Act), among a medically underserved popu-
lation 
(as 
defined 
in 
such 
section 
330(b)(3)(A) of such Act), or in a rural 
area (as defined by the Federal Office of 
Rural Health Policy), and that provides a 
reduction in coinsurance or copayments de-
scribed in clause (i) for covered part D 
drugs dispensed through such pharmacies, 
such plan shall extend to any pharmacy lo-
cated in such area or among such popu-
lation the option to be an in-network phar-
macy with respect to such plan under 
terms and conditions (including the reduc-
tions described in clause (i)) comparable to 
those the plan has agreed upon with other 
in-network pharmacies located in such area 
or among such population.’’. 
SEC. 3. REASONABLE REIMBURSEMENT REQUIREMENTS. 
Section 1860D–2(d)(1)(B) of the Social Security Act 
(42 U.S.C. 1395w–102(d)(1)(B)) is amended— 
(1) by striking ‘‘PRICES.—For purposes’’ and 
inserting ‘‘PRICES.— 
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‘‘(i) IN
GENERAL.—For purposes’’; 
and 
(2) by adding at the end the following new 
clauses: 
‘‘(ii) 
REASONABLE
REIMBURSE-
MENT.—For plan years beginning on or 
after January 1, 2020, a PDP sponsor and 
a Medicare Advantage organization shall 
ensure that— 
‘‘(I) each prescription drug plan 
or MA–PD plan offered by the spon-
sor or organization does not reimburse 
a pharmacy or pharmacist an amount 
less than the amount that the phar-
macy benefits manager reimburses a 
pharmacy benefits manager affiliate 
(as defined in clause (iv)) providing 
the same pharmacist services; and 
‘‘(II) in no case may the nego-
tiated price for a covered part D drug 
furnished by a pharmacy under a pre-
scription drug plan or MA–PD plan 
offered by the sponsor or organiza-
tion, be less than such pharmacy’s 
cost of purchasing and dispensing 
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such drug and providing such other 
services associated with furnishing 
such drug as may be specified by the 
Secretary. 
‘‘(iii) CLAIM
REIMBURSEMENT
DIS-
CLOSURE
REQUIREMENTS.—With respect 
to payment made by a PDP sponsor or a 
Medicare Advantage organization to a 
pharmacy for a covered part D drug fur-
nished by such pharmacy during a plan 
year beginning on or after January 1, 
2020, such sponsor or organization shall 
promptly furnish all pricing components 
including the Network Reimbursement ID 
used to price the claim, any fees, pharmacy 
price concessions, discounts, subsidies, re-
bates, incentives, or any other forms of di-
rect or indirect remuneration that affect 
payment and pricing of the claim as part 
of the claim adjudication response at the 
point-of sale. All pricing components de-
scribed in the preceding sentence shall 
each be identified in a predetermined line 
item in the remittance advice that is stand-
ard across the industry. The PDP sponsor 
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or Medicare Advantage organization shall 
include suitable claim-level detail on the 
electronic remittance advice that accom-
panies each payment. This claim-level de-
tail shall include, in an industry standard-
ized format, all fields needed to properly 
identify the claim, including the Claim Au-
thorization Number, date of service, date 
of payment remittance, ingredient cost re-
imbursed, dispensing fee reimbursed, pay-
ment amounts including the Network ID 
used to price the claim, the specific dollar 
amounts and the appropriate qualifier 
codes for each payment adjustment includ-
ing fees, pharmacy price concessions, or in-
centives. 
‘‘(iv) PHARMACY BENEFITS MANAGER 
AFFILIATE
DEFINED.—For purposes of 
clause (ii), the term ‘pharmacy benefits 
manager affiliate’ means a pharmacy or 
pharmacist that directly or indirectly, 
through one or more intermediaries, owns 
or controls, is owned or controlled by, or is 
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