I 
119TH CONGRESS 
1ST SESSION H. R. 6166 
To expand the drug price negotiation program under title XI of the Social 
Security Act and repeal certain changes to the program made by Public 
Law 119–21, to apply prescription drug inflation rebates under the 
Medicare program to drugs furnished in the commercial market, and 
to establish out-of-pocket limits on expenditures for prescription drugs 
under private health insurance. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 20, 2025 
Mr. PALLONE (for himself, Mr. NEAL, and Mr. SCOTT of Virginia) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committees on Ways and Means, and 
Education and Workforce, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned 
A BILL 
To expand the drug price negotiation program under title 
XI of the Social Security Act and repeal certain changes 
to the program made by Public Law 119–21, to apply 
prescription drug inflation rebates under the Medicare 
program to drugs furnished in the commercial market, 
and to establish out-of-pocket limits on expenditures for 
prescription drugs under private health insurance. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Lowering Drug Costs 
for American Families Act’’. 
TITLE I—DRUG PRICE 
NEGOTIATION PROGRAM 
SEC. 101. EXPANDING THE DRUG PRICE NEGOTIATION PRO-
GRAM. 
(a) INCREASING THE NUMBER OF DRUGS SUBJECT 
TO NEGOTIATION.—Section 1192(a)(4) of the Social Se-
curity Act (42 U.S.C. 1320f–1(a)(4)) is amended by strik-
ing ‘‘20’’ each place it appears and inserting ‘‘50’’ in each 
such place. 
(b) EXPANSION OF DEFINITION OF MAXIMUM FAIR 
PRICE ELIGIBLE INDIVIDUAL.—Section 1191(c)(2) of the 
Social Security Act (42 U.S.C. 1320f(c)(2)) is amended— 
(1) in subparagraph (A), by inserting ‘‘, or a 
participant, beneficiary, or enrollee who is enrolled 
under a group health plan or health insurance cov-
erage offered in the group or individual market (as 
such terms are defined in section 2791 of the Public 
Health Service Act) with respect to which there is in 
effect an agreement with the Secretary under section 
1197 with respect to such selected drug as so fur-
nished or dispensed’’ after ‘‘such selected drug’’; and 
(2) in subparagraph (B), by inserting ‘‘, or a 
participant, beneficiary, or enrollee who is enrolled 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
under a group health plan or health insurance cov-
erage offered in the group or individual market (as 
such terms are defined in section 2791 of the Public 
Health Service Act) with respect to which there is in 
effect an agreement with the Secretary under section 
1197 with respect to such selected drug as so fur-
nished or administered’’ after ‘‘such selected drug’’. 
(c) APPLICATION OF ADMINISTRATIVE PROCEDURES 
TO NEW MAXIMUM FAIR PRICE ELIGIBLE INDIVID-
UALS.—Section 1196(a)(3) of the Social Security Act (42 
U.S.C. 1320f–5(a)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (B), by striking the period 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(C) maximum fair price eligible individ-
uals not described in subparagraph (A) or 
(B).’’. 
(d) HEALTH INSURER AGREEMENTS.—Part E of 
title XI of the Social Security Act (42 U.S.C. 1320f et 
seq.) is amended— 
(1) by redesignating sections 1197 and 1198 as 
sections 1198 and 1199, respectively; and 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(2) by inserting after section 1196 the following 
new section: 
‘‘SEC. 
1197. 
VOLUNTARY 
PARTICIPATION 
BY 
OTHER 
HEALTH PLANS. 
‘‘(a) AGREEMENT TO PARTICIPATE UNDER PRO-
GRAM.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
under the program under this part the Secretary 
shall be treated as having in effect an agreement 
with a group health plan or health insurance issuer 
offering group or individual health insurance cov-
erage (as such terms are defined in section 2791 of 
the Public Health Service Act), with respect to a 
price applicability period and a selected drug with 
respect to such period— 
‘‘(A) in the case such selected drug fur-
nished or dispensed at a pharmacy or by mail 
order service if coverage is provided under such 
plan or coverage during such period for such se-
lected drug as so furnished or dispensed; and 
‘‘(B) in the case such selected drug fur-
nished or administered by a hospital, physician, 
or other provider of services or supplier if cov-
erage is provided under such plan or coverage 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
during such period for such selected drug as so 
furnished or administered. 
‘‘(2) OPTING OUT OF AGREEMENT.—The Sec-
retary shall not be treated as having in effect an 
agreement under the program under this part with 
a group health plan or health insurance issuer offer-
ing group or individual health insurance coverage 
with respect to a price applicability period and a se-
lected drug with respect to such period if such a 
plan or issuer affirmatively elects, through a process 
specified by the Secretary, not to participate under 
the program with respect to such period and drug. 
‘‘(b) PUBLICATION OF ELECTION.—With respect to 
each price applicability period and each selected drug with 
respect to such period, the Secretary and the Secretary 
of Labor and the Secretary of the Treasury, as applicable, 
shall make public a list of each group health plan and each 
health insurance issuer offering group or individual health 
insurance coverage, with respect to which coverage is pro-
vided under such plan or coverage for such drug, that has 
elected under subsection (a) not to participate under the 
program with respect to such period and drug.’’. 
(e) APPLICATION TO GROUP HEALTH PLANS AND 
HEALTH INSURANCE COVERAGE.— 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(1) PHSA.—Part D of title XXVII of the Pub-
lic Health Service Act (42 U.S.C. 300gg–111 et 
seq.) is amended by adding at the end the following 
new section: 
‘‘SEC. 2799A–11. DRUG PRICE NEGOTIATION PROGRAM AND 
APPLICATION OF MAXIMUM FAIR PRICES. 
‘‘(a) IN GENERAL.—In the case of a group health 
plan or health insurance issuer offering group or indi-
vidual health insurance coverage that is treated under sec-
tion 1197 of the Social Security Act as having in effect 
an agreement with the Secretary under the Drug Price 
Negotiation Program under part E of title XI of such Act, 
with respect to a price applicability period (as defined in 
section 1191(b) of such Act) and a selected drug (as de-
fined in section 1192(c) of such Act) with respect to such 
period for which coverage is provided under such plan or 
coverage— 
‘‘(1) the provisions of such part shall apply— 
‘‘(A) in the case the drug is furnished or 
dispensed at a pharmacy or by a mail order 
service, to such plan or coverage, and to the 
participants, beneficiaries, and enrollees en-
rolled under such plan or coverage, during such 
period, with respect to such selected drug, in 
the same manner as such provisions apply to 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
prescription drug plans and MA–PD plans, and 
to participants, beneficiaries, and enrollees en-
rolled under such prescription drug plans and 
MA–PD plans during such period; and 
‘‘(B) in the case the drug is furnished or 
administered by a hospital, physician, or other 
provider of services or supplier, to such plan or 
coverage, and to the participants, beneficiaries, 
and enrollees enrolled under such plan or cov-
erage, and to hospitals, physicians, and other 
providers of services and suppliers during such 
period, with respect to such drug in the same 
manner as such provisions apply to the Sec-
retary, to participants, beneficiaries, and enroll-
ees entitled to benefits under part A of title 
XVIII or enrolled under part B of such title, 
and to hospitals, physicians, and other pro-
viders and suppliers participating under title 
XVIII during such period; 
‘‘(2) the plan or issuer shall apply any cost- 
sharing responsibilities under such plan or coverage, 
with respect to such selected drug, by substituting 
an amount not more than the maximum fair price 
negotiated under such part E of title XI for such 
drug in lieu of the drug price upon which the cost- 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
sharing would have otherwise applied, and such cost- 
sharing responsibilities with respect to such selected 
drug may not exceed such maximum fair price; and 
‘‘(3) the Secretary shall apply the provisions of 
such part E to such plan, issuer, and coverage, such 
participants, beneficiaries, and enrollees so enrolled 
in such plans and coverage, and such hospitals, phy-
sicians, and other providers and suppliers partici-
pating in such plans and coverage. 
‘‘(b) NOTIFICATION REGARDING NONPARTICIPATION 
IN DRUG PRICE NEGOTIATION PROGRAM.—A group 
health plan or a health insurance issuer offering group or 
individual health insurance coverage shall publicly dis-
close, in a manner and in accordance with a process speci-
fied by the Secretary, any election made under section 
1197 of the Social Security Act by such plan or issuer 
to not participate in the Drug Price Negotiation Program 
under part E of title XI of such Act with respect to a 
selected drug (as defined in section 1192(c) of such Act) 
for which coverage is provided under such plan or coverage 
before the beginning of the plan year for which such elec-
tion was made.’’. 
(2) ERISA.— 
(A) IN GENERAL.—Subpart B of part 7 of 
subtitle B of title I of the Employee Retirement 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
Income Security Act of 1974 (29 U.S.C. 1185 
et seq.) is amended by adding at the end the 
following new section: 
‘‘SEC. 726. DRUG PRICE NEGOTIATION PROGRAM AND AP-
PLICATION OF MAXIMUM FAIR PRICES. 
‘‘(a) IN GENERAL.—In the case of a group health 
plan or health insurance issuer offering group health in-
surance coverage that is treated under section 1197 of the 
Social Security Act as having in effect an agreement with 
the Secretary of Health and Human Services under the 
Drug Price Negotiation Program under part E of title XI 
of such Act, with respect to a price applicability period 
(as defined in section 1191(b) of such Act) and a selected 
drug (as defined in section 1192(c) of such Act) with re-
spect to such period for which coverage is provided under 
such plan or coverage— 
‘‘(1) the provisions of such part shall apply, as 
applicable— 
‘‘(A) in the case the drug is furnished or 
dispensed at a pharmacy or by a mail order 
service, to such plan or coverage, and to the 
participants and beneficiaries enrolled under 
such plan or coverage, during such period, with 
respect to such selected drug, in the same man-
ner as such provisions apply to prescription 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
drug plans and MA–PD plans, and to partici-
pants and beneficiaries enrolled under such pre-
scription drug plans and MA–PD plans during 
such period; and 
‘‘(B) in the case the drug is furnished or 
administered by a hospital, physician, or other 
provider of services or supplier, to the group 
health plan or coverage offered by an issuer, to 
the participants and beneficiaries enrolled 
under such plans or coverage, and to hospitals, 
physicians, and other providers of services and 
suppliers during such period, with respect to 
such drug in the same manner as such provi-
sions apply to the Secretary of Health and 
Human Services, to participants and bene-
ficiaries entitled to benefits under part A of 
title XVIII or enrolled under part B of such 
title, and to hospitals, physicians, and other 
providers and suppliers participating under title 
XVIII during such period; 
‘‘(2) the plan or issuer shall apply any cost- 
sharing responsibilities under such plan or coverage, 
with respect to such selected drug, by substituting 
an amount not more than the maximum fair price 
negotiated under such part E of title XI for such 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
drug in lieu of the drug price upon which the cost- 
sharing would have otherwise applied, and such cost- 
sharing responsibilities with respect to such selected 
drug may not exceed such maximum fair price; and 
‘‘(3) the Secretary shall apply the provisions of 
such part E to such plan, issuer, and coverage, and 
such participants and beneficiaries so enrolled in 
such plans. 
‘‘(b) NOTIFICATION REGARDING NONPARTICIPATION 
IN DRUG PRICE NEGOTIATION PROGRAM.—A group 
health plan or a health insurance issuer offering group 
health insurance coverage shall publicly disclose in a man-
ner and in accordance with a process specified by the Sec-
retary any election made under section 1197 of the Social 
Security Act by the plan or issuer to not participate in 
the Drug Price Negotiation Program under part E of title 
XI of such Act with respect to a selected drug (as defined 
in section 1192(c) of such Act) for which coverage is pro-
vided under such plan or coverage before the beginning 
of the plan year for which such election was made.’’. 
(B) APPLICATION TO RETIREE AND CER-
TAIN SMALL GROUP HEALTH PLANS.—Section 
732(a) of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1191a(a)) is 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
amended by striking ‘‘section 711’’ and insert-
ing ‘‘sections 711 and 726’’. 
(C) CLERICAL AMENDMENT.—The table of 
contents in section 1 of such Act is amended by 
inserting after the item relating to section 725 
the following new item: 
‘‘Sec. 726. Drug Price Negotiation Program and application of maximum fair 
prices.’’. 
(3) IRC.— 
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986 
is amended by adding at the end the following 
new section: 
‘‘SEC. 9826. DRUG PRICE NEGOTIATION PROGRAM AND AP-
PLICATION OF MAXIMUM FAIR PRICES. 
‘‘(a) IN GENERAL.—In the case of a group health 
plan that is treated under section 1197 of the Social Secu-
rity Act as having in effect an agreement with the Sec-
retary of Health and Human Services under the Drug 
Price Negotiation Program under part E of title XI of 
such Act, with respect to a price applicability period (as 
defined in section 1191(b) of such Act) and a selected 
drug (as defined in section 1192(c) of such Act) with re-
spect to such period for which coverage is provided under 
such plan— 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(1) the provisions of such part shall apply, as 
applicable— 
‘‘(A) if coverage of such selected drug is 
provided under such plan if the drug is fur-
nished or dispensed at a pharmacy or by a mail 
order service, to the plan, and to the partici-
pants and beneficiaries enrolled under such 
plan during such period, with respect to such 
selected drug, in the same manner as such pro-
visions apply to prescription drug plans and 
MA–PD plans, and to participants and bene-
ficiaries enrolled under such prescription drug 
plans and MA–PD plans during such period; 
and 
‘‘(B) if coverage of such selected drug is 
provided under such plan if the drug is fur-
nished or administered by a hospital, physician, 
or other provider of services or supplier, to the 
plan, to the participants and beneficiaries en-
rolled under such plan, and to hospitals, physi-
cians, and other providers of services and sup-
pliers during such period, with respect to such 
drug in the same manner as such provisions 
apply to the Secretary of Health and Human 
Services, to participants and beneficiaries enti-
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
tled to benefits under part A of title XVIII or 
enrolled under part B of such title, and to hos-
pitals, physicians, and other providers and sup-
pliers participating under title XVIII during 
such period; 
‘‘(2) the plan shall apply any cost-sharing re-
sponsibilities under such plan, with respect to such 
selected drug, by substituting an amount not more 
than the maximum fair price negotiated under such 
part E of title XI for such drug in lieu of the drug 
price upon which the cost-sharing would have other-
wise applied, and such cost-sharing responsibilities 
with respect to such selected drug may not exceed 
such maximum fair price; and 
‘‘(3) the Secretary shall apply the provisions of 
such part E to such plan and such participants and 
beneficiaries so enrolled in such plan. 
‘‘(b) NOTIFICATION REGARDING NONPARTICIPATION 
IN DRUG PRICE NEGOTIATION PROGRAM.—A group 
health plan shall publicly disclose in a manner and in ac-
cordance with a process specified by the Secretary any 
election made under section 1197 of the Social Security 
Act by the plan to not participate in the Drug Price Nego-
tiation Program under part E of title XI of such Act with 
respect to a selected drug (as defined in section 1192(c) 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
of such Act) for which coverage is provided under such 
plan before the beginning of the plan year for which such 
election was made.’’. 
(B) APPLICATION TO RETIREE AND CER-
TAIN SMALL GROUP HEALTH PLANS.—Section 
9831(a)(2) of the Internal Revenue Code of 
1986 is amended by inserting ‘‘other than with 
respect to section 9826,’’ before ‘‘any group 
health plan’’. 
(C) CLERICAL AMENDMENT.—The table of 
sections for subchapter B of chapter 100 of the 
Internal Revenue Code of 1986 is amended by 
adding at the end the following new item: 
‘‘Sec. 9826. Drug Price Negotiation Program and application of maximum fair 
prices.’’. 
SEC. 102. REQUIRING CONSIDERATION OF AVERAGE INTER-
NATIONAL MARKET PRICE UNDER DRUG 
PRICE NEGOTIATION PROGRAM. 
(a) IN GENERAL.—Section 1194(e) of the Social Se-
curity Act (42 U.S.C. 1320f–3(e)) is amended by adding 
at the end the following new paragraph: 
‘‘(3) 
AVERAGE
INTERNATIONAL
MARKET 
PRICE.— 
‘‘(A) IN
GENERAL.—The average price 
(which shall be the net average price, if prac-
ticable, and volume-weighted, if practicable) for 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
a unit (as defined in subparagraph (C)) of such 
drug for sales of such drug (calculated across 
different dosage forms and strengths of the 
drug and not based on the specific formulation 
or package size or package type), as computed 
(as of the date of publication of such drug as 
a selected drug under section 1192(a)) in all 
countries described in clause (ii) of subpara-
graph (B) that are applicable countries (as de-
scribed in clause (i) of such subparagraph) with 
respect to such drug. 
‘‘(B) APPLICABLE COUNTRIES.— 
‘‘(i) IN
GENERAL.—For purposes of 
subparagraph (A), a country described in 
clause (ii) is an applicable country de-
scribed in this clause with respect to a 
drug if there is available an average price 
for any unit for the drug for sales of such 
drug in such country. 
‘‘(ii) COUNTRIES
DESCRIBED.—For 
purposes of this paragraph, the following 
are countries described in this clause: 
‘‘(I) Australia. 
‘‘(II) Canada. 
‘‘(III) France. 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(IV) Germany. 
‘‘(V) Japan. 
‘‘(VI) The United Kingdom. 
‘‘(C) UNIT
DEFINED.—For purposes of 
this paragraph, term ‘unit’ means, with respect 
to a drug, the lowest identifiable quantity (such 
as a capsule or tablet, milligram of molecules, 
or grams) of the drug that is dispensed.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply with respect to negotiations 
under the Drug Price Negotiation Program under part E 
of title XI of the Social Security Act (42 U.S.C. 1320f 
et seq.) for initial price applicability years beginning on 
or after January 1, 2028, and renegotiations under such 
program for years beginning on or after such date. 
SEC. 103. REPEALING CERTAIN CHANGES TO THE DRUG 
PRICE NEGOTIATION PROGRAM MADE BY 
PUBLIC LAW 119–21. 
Section 71203 of the Act titled ‘‘An Act to provide 
for reconciliation pursuant to title II of H. Con. Res. 14’’ 
(Public Law 119–21) is repealed, and the provisions of 
law amended by such section are hereby restored as if such 
section had not been enacted into law. 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
TITLE II—PRESCRIPTION DRUG 
INFLATION REBATES 
SEC. 201. APPLICATION OF PRESCRIPTION DRUG INFLA-
TION REBATES TO DRUGS FURNISHED IN 
THE COMMERCIAL MARKET. 
(a) PART B DRUGS.— 
(1) APPLICATION OF PRESCRIPTION DRUG IN-
FLATION REBATES TO DRUGS FURNISHED IN THE 
COMMERCIAL MARKET.—Section 1847A(i) of the So-
cial Security Act (42 U.S.C. 1395w–3a(i)) is amend-
ed— 
(A) in paragraph (1)(A)(i), by striking 
‘‘units’’ and inserting ‘‘billing units’’; 
(B) in paragraph (2)(A), by striking ‘‘for 
which payment is made under this part’’ and 
inserting ‘‘that would be payable under this 
part if such drug were furnished to an indi-
vidual enrolled under this part’’; and 
(C) in paragraph (3)— 
(i) in subparagraph (A)(i), by striking 
‘‘units’’ and inserting ‘‘billing units’’; and 
(ii) by striking subparagraph (B) and 
inserting the following: 
‘‘(B) 
TOTAL
NUMBER
OF
BILLING 
UNITS.—For purposes of subparagraph (A)(i), 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB
the total number of billing units with respect to 
a part B rebatable drug is determined as fol-
lows: 
‘‘(i) Determine the total number of 
units equal to— 
‘‘(I) the total number of units, as 
reported under subsection (c)(1)(B) 
for each National Drug Code of such 
drug during the calendar quarter that 
is two calendar quarters prior to the 
calendar quarter as described in sub-
paragraph (A), minus 
‘‘(II) the total number of units 
with respect to each National Drug 
Code of such drug for which payment 
was made under a State plan under 
title XIX (or waiver of such plan), as 
reported by States under section 
1927(b)(2)(A) for the rebate period 
that is the same calendar quarter as 
described in subclause (I). 
‘‘(ii) Convert the units determined 
under clause (i) to billing units for the bill-
ing and payment code of such drug, using 
a methodology similar to the methodology 
VerDate Sep 11 2014 
18:34 Nov 28, 2025
Jkt 069200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H6166.IH
H6166
kjohnson on DSK7ZCZBW3PROD with $$_JOB