(42 U.S.C. 1395w–102) is amended by adding at the end 
the following new subsection: 
‘‘(f) APPLICATION
OF STANDARDIZED PHARMACY 
PERFORMANCE MEASURES.— 
‘‘(1) MEASURES.—For plan years beginning on 
or after January 1, 2025, a PDP sponsor offering 
a prescription drug plan and an MA organization of-
fering an MA–PD plan shall, for purposes of incen-
tive payments, price concessions, or any fees or 
other remuneration paid or charged to a pharmacy 
based on performance measures, only use measures 
that are— 
‘‘(A) established or adopted by the Sec-
retary under paragraph (2) and included on the 
list described in subparagraph (B) of such 
paragraph; and 
‘‘(B) relevant to the performance of such 
pharmacy based on the type of pharmacy (in-
cluding retail, mail order, specialty, long-term 
care, and home infusion or other types of phar-
macies), drugs dispensed, and pharmacy serv-
ices used to dispense and manage drugs. 
‘‘(2) STANDARDIZED PHARMACY PERFORMANCE 
MEASURES.— 
‘‘(A) MEASURES.— 
VerDate Sep 11 2014 
23:15 Sep 13, 2023
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5393.IH
H5393
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(i) IN GENERAL .—Notwithstanding 
any other provision of law, the Secretary 
shall establish (or adopt pursuant to clause 
(iii)) standardized pharmacy performance 
measures to be used by a PDP sponsor of-
fering a prescription drug plan and an MA 
organization offering an MA–PD plan for 
the purpose of determining incentive pay-
ments, price concessions, or fees described 
in paragraph (1). 
‘‘(ii) REQUIREMENTS.—The measures 
under clause (i) shall focus on pharmacy 
performance and quality of care based on 
the type of pharmacy, as determined by 
the Secretary. Such measures shall be evi-
dence-based, feasible, appropriate and rea-
sonable. The Secretary may rely on data 
and information collected from relevant 
stakeholders to make determinations about 
whether a measure satisfies the require-
ments of this clause. 
‘‘(iii) ADOPTION
OF
MEASURE.—In 
lieu of establishing some or all of the 
measures under this paragraph, the Sec-
retary may adopt measures and measure 
VerDate Sep 11 2014 
02:48 Sep 13, 2023
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5393.IH
H5393
pbinns on DSKJLVW7X2PROD with $$_JOB
performance criteria that are endorsed by 
1 or more multi-stakeholder consensus or-
ganizations (such as the Pharmacy Quality 
Alliance), that has participation from phar-
macies (including retail and specialty phar-
macies not owned or affiliated with a plan, 
pharmacy benefit manager, or other phar-
macy), health plans, pharmacy benefit 
managers, and the Centers for Medicare & 
Medicaid Services. Any measure adopted 
under this clause shall be deemed to meet 
the requirements under clause (ii). 
‘‘(B) MAINTENANCE OF LIST.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall maintain, and publish on a publicly 
available internet website, a list of meas-
ures established or adopted under this 
paragraph. Such list shall initially be pub-
lished no later than June 1, 2024. 
‘‘(ii) UPDATE.—The Secretary shall 
periodically evaluate measures, measure 
criteria, and how measures are applied by 
type of pharmacy and update the measures 
on the list under clause (i) to ensure such 
VerDate Sep 11 2014 
02:48 Sep 13, 2023
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5393.IH
H5393
pbinns on DSKJLVW7X2PROD with $$_JOB
measures meet the requirements under 
subparagraph (A)(ii). 
‘‘(3) OIG REPORTS ON PHARMACY PERFORM-
ANCE MEASURES.— 
‘‘(A) OIG STUDY.—The Office of the In-
spector General of the Department of Health 
and Human Services (in this paragraph re-
ferred to as the ‘Inspector General’) shall con-
duct a study of the use of performance meas-
ures and other quality-related mechanisms in 
network pharmacy agreements and other rel-
evant contracting arrangements among PDP 
sponsors offering a prescription drug plan, MA 
organizations offering a MA–PD plan, phar-
macy benefit managers acting on behalf of such 
sponsors and organizations, and network phar-
macies. Such study may include audits, reviews 
of relevant enforcement actions, consultation 
with relevant stakeholders, and other activities 
determined appropriate by the Inspector Gen-
eral, consistent with other provisions of law. 
Such study shall, to the extent feasible, include 
analysis of— 
‘‘(i) oversight and enforcement activi-
ties undertaken with respect to current 
VerDate Sep 11 2014 
02:48 Sep 13, 2023
Jkt 039200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5393.IH
H5393
pbinns on DSKJLVW7X2PROD with $$_JOB
statutory and regulatory requirements re-
lated to network pharmacy agreements, in-
cluding under sections 423.505(b)(18) and 
423.505(i) of title 42 of the Code of Fed-
eral Regulations (or any successor regula-
tion) and under section 1860D–4(b)(1)(A); 
‘‘(ii) penalties or other corrective ac-
tions imposed with respect to the require-
ments described in clause (i); 
‘‘(iii) the prevalence of the application 
of performance measures in network phar-
macy agreements, and the manner in 
which such measures are applied, including 
variation based on the type of pharmacy, 
the type of drug dispensed, and the serv-
ices required to manage and dispense such 
drug; 
‘‘(iv) the extent to which the perform-
ance measures and related criteria applied 
under network agreements vary among 
similar types of pharmacies within a single 
network, and the extent to which the appli-
cation of such measures or criteria differ 
between pharmacies— 
VerDate Sep 11 2014 
02:48 Sep 13, 2023
Jkt 039200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5393.IH
H5393
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(I) affiliated with a pharmacy 
benefit manager, a PDP sponsor of-
fering a prescription drug plan, or an 
MA organization offering a MA–PD 
plan; and 
‘‘(II) those not affiliated with an 
entity described in subclause (I); 
‘‘(v) patterns and trends in the per-
formance measures applied under phar-
macy network agreements, including if the 
measure is being used in accordance with 
published measure specifications which 
have been validated and tested, if the 
measure is being used according to licens-
ing agreements with measure stewards, 
and the level of attribution and attribution 
criteria; 
‘‘(vi) the extent to which performance 
measures result in incentive payments, 
fees, price concessions, or other forms of 
remuneration between pharmacies and 
PDP sponsors or MA organizations (or 
pharmacy benefit managers acting on their 
behalf), including an analysis of which 
measures most often result in incentive 
VerDate Sep 11 2014 
02:48 Sep 13, 2023
Jkt 039200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5393.IH
H5393
pbinns on DSKJLVW7X2PROD with $$_JOB
payments to pharmacies (and the general 
amount of such payments) and which 
measures most often result in remunera-
tion paid by pharmacies to other entities 
(and the general amount of such pay-
ments); 
‘‘(vii) variation in the type of remu-
neration (as described in clause (vi) result-
ing from the application of performance 
measures, 
including 
between 
different 
types of pharmacies, different types of 
drugs dispensed, and affiliation status of 
pharmacies (as described in clause (iv)); 
‘‘(viii) when, in what manner, dif-
ferent types of pharmacies receive notice of 
the application of performance measures, 
the measures that will be utilized, the per-
formance criteria that will be applied, and 
the data and methodologies that will be 
used to evaluate performance; and 
‘‘(ix) the extent to which the Centers 
for Medicare & Medicaid Services has im-
plemented the pharmacy performance re-
porting 
requirements 
of 
section 
423.514(a)(5) of title 42, Code of Federal 
VerDate Sep 11 2014 
02:48 Sep 13, 2023
Jkt 039200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H5393.IH
H5393
pbinns on DSKJLVW7X2PROD with $$_JOB
Regulations, the extent to which PDP 
sponsors or MA organizations (or phar-
macy benefit managers acting on their be-
half) comply with such provision, and the 
extent to which the Centers for Medicare & 
Medicaid Services has sought enforcement. 
‘‘(B) OIG REPORTS.— 
‘‘(i) REPORT ON INITIAL FINDINGS.— 
Not later than December 31, 2024, the In-
spector General shall submit a report to 
Congress outlining, to the extent prac-
ticable, a status update on the study under 
subparagraph (A), together with initial 
findings with respect to the issues included 
under such study. Such report may include 
an analysis of barriers to accessing any of 
the information required under such study, 
along with recommendations for addressing 
such barriers. Such report may also in-
clude recommendations for the effective 
implementation of the requirements en-
acted under this subsection as well as ex-
isting 
regulations, 
including 
section 
423.514(a)(5) of title 42, Code of Federal 
Regulations, along with other recommenda-
VerDate Sep 11 2014 
02:48 Sep 13, 2023
Jkt 039200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H5393.IH
H5393
pbinns on DSKJLVW7X2PROD with $$_JOB
tions, as determined appropriate by the In-
spector General. 
‘‘(ii) INTERIM
REPORT.—Not later 
than July 31, 2025, the Inspector General 
shall submit to Congress an interim report 
on the study under subparagraph (A), in-
cluding additional recommendations for the 
implementation of the requirements en-
acted under this subsection as well as 
under existing regulations, including sec-
tion 423.514(a)(5) of title 42, Code of 
Federal Regulations. 
‘‘(iii) FINAL REPORT.—Not later than 
December 31, 2025, the Inspector General 
shall submit to Congress a final report on 
the study under subparagraph (A), to-
gether with additional recommendations, 
as determined appropriate by the Inspector 
General. 
‘‘(4) NONAPPLICATION OF PAPERWORK REDUC-
TION ACT.—Chapter 35 of title 44, United States 
Code, shall not apply to any data collection under-
taken by the Secretary under this paragraph.’’. 
(b) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Centers for Medi-
VerDate Sep 11 2014 
02:48 Sep 13, 2023
Jkt 039200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H5393.IH
H5393
pbinns on DSKJLVW7X2PROD with $$_JOB
care & Medicaid Services Program Management Account, 
out of any money in the Treasury not otherwise appro-
priated, $4,000,000 for fiscal year 2025, to remain avail-
able until expended, to carry out the amendment made 
by subsection (a). 
SEC. 2. PROMOTING TRANSPARENCY FOR PHARMACIES 
UNDER MEDICARE PART D. 
(a) TRANSPARENCY
FOR
PHARMACIES.—Section 
1860D–2(f) of the Social Security Act (42 U.S.C. 1395w– 
102(f)), as added by section 3, is amended by adding at 
the end the following new paragraph: 
‘‘(3) TRANSPARENCY FOR PHARMACIES.— 
‘‘(A) IN GENERAL.—For plan years begin-
ning on or after January 1, 2025, a PDP spon-
sor offering a prescription drug plan and an 
MA organization offering an MA–PD plan, with 
respect to payment made by such PDP sponsor 
or such MA organization to a pharmacy for a 
covered part D drug dispensed by such phar-
macy during a plan year, shall promptly fur-
nish, upon receiving a claim for a covered Part 
D drug from a pharmacy, to such pharmacy in-
formation related to such claim, such as the 
Network Reimbursement ID, fees, pharmacy 
price concessions, discounts, incentives, or any 
VerDate Sep 11 2014 
02:48 Sep 13, 2023
Jkt 039200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H5393.IH
H5393
pbinns on DSKJLVW7X2PROD with $$_JOB
other forms of remuneration that affect pay-
ment and pricing of the claim. 
‘‘(B) STANDARDIZED FORMAT.—The PDP 
sponsor and the MA organization shall furnish 
the information described in subparagraph (A) 
in a standardized format (as specified by the 
Secretary) that includes all fields needed to 
price the claim for a covered part D drug dis-
pensed by such pharmacy. 
‘‘(C) IMPLEMENTATION.—The Secretary 
shall implement this paragraph by program in-
struction or other forms of program guidance.’’. 
(b) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Centers for Medi-
care & Medicaid Services Program Management Account, 
out of any money in the Treasury not otherwise appro-
priated, $2,000,000 for fiscal year 2025, to remain avail-
able until expended, to carry out the amendment made 
by subsection (a). 
Æ 
VerDate Sep 11 2014 
02:48 Sep 13, 2023
Jkt 039200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6301
E:\BILLS\H5393.IH
H5393
pbinns on DSKJLVW7X2PROD with $$_JOB