section 3(16)(B) of the Employee Retirement In-
come Security Act of 1974) of such group health 
plan a report in accordance with this subsection and 
make such report available to the plan sponsor in a 
machine-readable format. Each such report shall in-
clude, with respect to the applicable group health 
plan— 
‘‘(A) as applicable, information collected 
from drug manufacturers by such entity on the 
total amount of copayment assistance dollars 
paid, or copayment cards applied, that were 
funded by the drug manufacturer with respect 
to the participants and beneficiaries in such 
plan; 
‘‘(B) a list of each drug covered by such 
plan or entity providing pharmacy benefits 
management services that was dispensed during 
the reporting period, including, with respect to 
each such drug during the reporting period— 
‘‘(i) the brand name, chemical entity, 
and National Drug Code; 
‘‘(ii) the number of participants and 
beneficiaries for whom the drug was filled 
during the plan year, the total number of 
prescription fills for the drug (including 
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original prescriptions and refills), and the 
total number of dosage units of the drug 
dispensed across the plan year, including 
whether the dispensing channel was by re-
tail, mail order, or specialty pharmacy; 
‘‘(iii) the wholesale acquisition cost, 
listed as cost per days supply and cost per 
pill, or in the case of a drug in another 
form, per dose; 
‘‘(iv) the total out-of-pocket spending 
by participants and beneficiaries on such 
drug, including participant and beneficiary 
spending through copayments, coinsurance, 
and deductibles; and 
‘‘(v) for any drug for which gross 
spending of the group health plan exceeded 
$10,000 during the reporting period— 
‘‘(I) a list of all other drugs in 
the same therapeutic category or 
class, including brand name drugs 
and biological products and generic 
drugs or biosimilar biological products 
that are in the same therapeutic cat-
egory or class as such drug; and 
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‘‘(II) the rationale for preferred 
formulary placement of such drug in 
that therapeutic category or class, if 
applicable; 
‘‘(C) a list of each therapeutic category or 
class of drugs that were dispensed under the 
health plan during the reporting period, and, 
with respect to each such therapeutic category 
or class of drugs, during the reporting period— 
‘‘(i) total gross spending by the plan, 
before manufacturer rebates, fees, or other 
manufacturer remuneration; 
‘‘(ii) the number of participants and 
beneficiaries who filled a prescription for a 
drug in that category or class; 
‘‘(iii) if applicable to that category or 
class, a description of the formulary tiers 
and utilization mechanisms (such as prior 
authorization or step therapy) employed 
for drugs in that category or class; 
‘‘(iv) the total out-of-pocket spending 
by participants and beneficiaries, including 
participant 
and 
beneficiary 
spending 
through copayments, coinsurance, and 
deductibles; and 
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‘‘(v) for each therapeutic category or 
class under which 3 or more drugs are in-
cluded on the formulary of such plan— 
‘‘(I) the amount received, or ex-
pected to be received, from drug man-
ufacturers in rebates, fees, alternative 
discounts, or other remuneration— 
‘‘(aa) that has been paid, or 
is to be paid, by drug manufac-
turers for claims incurred during 
the reporting period; or 
‘‘(bb) that is related to utili-
zation of drugs, in such thera-
peutic category or class; 
‘‘(II) the total net spending, after 
deducting rebates, price concessions, 
alternative discounts or other remu-
neration from drug manufacturers, by 
the health plan on that category or 
class of drugs; and 
‘‘(III) the net price per course of 
treatment or single fill, such as a 30- 
day supply or 90-day supply, incurred 
by the health plan and its participants 
and beneficiaries, after manufacturer 
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rebates, fees, and other remuneration 
for drugs dispensed within such thera-
peutic category or class during the re-
porting period; 
‘‘(D) total gross spending on prescription 
drugs by the plan during the reporting period, 
before rebates and other manufacturer fees or 
remuneration; 
‘‘(E) total amount received, or expected to 
be received, by the health plan in drug manu-
facturer rebates, fees, alternative discounts, and 
all other remuneration received from the manu-
facturer or any third party, other than the plan 
sponsor, related to utilization of drug or drug 
spending under that health plan during the re-
porting period; 
‘‘(F) the total net spending on prescription 
drugs by the health plan during the reporting 
period; and 
‘‘(G) amounts paid directly or indirectly in 
rebates, fees, or any other type of remuneration 
to brokers, consultants, advisors, or any other 
individual or firm who referred the group health 
plan’s business to the pharmacy benefits man-
ager. 
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‘‘(2) PRIVACY
REQUIREMENTS.—Entities pro-
viding pharmacy benefits management services on 
behalf of a group health plan shall provide informa-
tion under paragraph (1) in a manner consistent 
with the privacy, security, and breach notification 
regulations promulgated under section 264(c) of the 
Health Insurance Portability and Accountability Act 
of 1996, and shall restrict the use and disclosure of 
such information according to such privacy regula-
tions. 
‘‘(3) DISCLOSURE AND REDISCLOSURE.— 
‘‘(A) LIMITATION
TO
BUSINESS
ASSOCI-
ATES.—A group health plan receiving a report 
under paragraph (1) may disclose such informa-
tion only to business associates of such plan as 
defined in section 160.103 of title 45, Code of 
Federal Regulations (or successor regulations). 
‘‘(B) CLARIFICATION REGARDING PUBLIC 
DISCLOSURE
OF
INFORMATION.—Nothing in 
this section prevents an entity providing phar-
macy benefits management services on behalf of 
a group health plan from placing reasonable re-
strictions on the public disclosure of the infor-
mation contained in a report described in para-
graph (1), except that such entity may not re-
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strict disclosure of such report to the Depart-
ment of Health and Human Services, the De-
partment of Labor, the Department of the 
Treasury, the Comptroller General of the 
United States, or applicable State agencies. 
‘‘(C) LIMITED
FORM
OF
REPORT.—The 
Secretary shall define through rulemaking a 
limited form of the report under paragraph (1) 
required of plan sponsors who are drug manu-
facturers, drug wholesalers, or other direct par-
ticipants in the drug supply chain, in order to 
prevent anti-competitive behavior. 
‘‘(4) REPORT
TO
GAO.—An entity providing 
pharmacy benefits management services on behalf of 
a group health plan shall submit to the Comptroller 
General of the United States each of the first 4 re-
ports submitted to a plan sponsor under paragraph 
(1) with respect to such plan, and other such reports 
as requested, in accordance with the privacy require-
ments under paragraph (2), the disclosure and re-
disclosure standards under paragraph (3), the stand-
ards specified pursuant to paragraph (5), and such 
other information that the Comptroller General de-
termines necessary to carry out the study under sec-
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tion 2(d) of the Pharmacy Benefits Manager Ac-
countability Act. 
‘‘(5) STANDARD FORMAT.—Not later than June 
1, 2023, the Secretary shall specify through rule-
making standards for entities required to submit re-
ports under paragraph (4) to submit such reports in 
a standard format. 
‘‘(c) ENFORCEMENT.— 
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with the Secretary of Labor and the Secretary 
of Health and Human Services, shall enforce this 
section. 
‘‘(2) FAILURE TO PROVIDE TIMELY INFORMA-
TION.—An entity providing pharmacy benefits man-
agement services that violates subsection (a) or fails 
to provide information required under subsection (b) 
shall be subject to a civil monetary penalty in the 
amount of $10,000 for each day during which such 
violation continues or such information is not dis-
closed or reported. 
‘‘(3) FALSE
INFORMATION.—An entity pro-
viding pharmacy benefits management services that 
knowingly provides false information under this sec-
tion shall be subject to a civil money penalty in an 
amount not to exceed $100,000 for each item of 
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false information. Such civil money penalty shall be 
in addition to other penalties as may be prescribed 
by law. 
‘‘(4) PROCEDURE.—The provisions of section 
1128A of the Social Security Act, other than sub-
section (a) and (b) and the first sentence of sub-
section (c)(1) of such section shall apply to civil 
monetary penalties under this subsection in the 
same manner as such provisions apply to a penalty 
or proceeding under section 1128A of the Social Se-
curity Act. 
‘‘(5) WAIVERS.—The Secretary may waive pen-
alties under paragraph (2), or extend the period of 
time for compliance with a requirement of this sec-
tion, for an entity in violation of this section that 
has made a good-faith effort to comply with this sec-
tion. 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to permit a group health plan or 
other entity to restrict disclosure to, or otherwise limit the 
access of, the Department of the Treasury to a report de-
scribed in subsection (b)(1) or information related to com-
pliance with subsection (a) by such plan or entity. 
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‘‘(e) DEFINITION.—In this section, the term ‘whole-
sale acquisition cost’ has the meaning given such term in 
section 1847A(c)(6)(B) of the Social Security Act.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for subchapter B of chapter 100 of the Inter-
nal Revenue Code of 1986 is amended by adding at 
the end the following new item: 
‘‘Sec. 9826. Oversight of pharmacy benefits manager services.’’. 
(d) GAO STUDY.— 
(1) IN GENERAL.—Not later than 3 years after 
the date of enactment of this Act, the Comptroller 
General of the United States shall submit to Con-
gress a report on— 
(A) pharmacy networks of group health 
plans, health insurance issuers, and entities 
providing pharmacy benefits management serv-
ices under such group health plan or group or 
individual health insurance coverage, including 
networks that have pharmacies that are under 
common ownership (in whole or part) with 
group health plans, health insurance issuers, or 
entities providing pharmacy benefits manage-
ment services or pharmacy benefits administra-
tive services under group health plan or group 
or individual health insurance coverage; 
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(B) as it relates to pharmacy networks 
that include pharmacies under common owner-
ship described in subparagraph (A)— 
(i) whether such networks are de-
signed to encourage enrollees of a plan or 
coverage to use such pharmacies over other 
network pharmacies for specific services or 
drugs, and if so, the reasons the networks 
give for encouraging use of such phar-
macies; and 
(ii) whether such pharmacies are used 
by enrollees disproportionately more in the 
aggregate or for specific services or drugs 
compared to other network pharmacies; 
(C) whether group health plans and health 
insurance issuers offering group or individual 
health insurance coverage have options to elect 
different network pricing arrangements in the 
marketplace with entities that provide phar-
macy benefits management services, the preva-
lence of electing such different network pricing 
arrangements; 
(D) pharmacy network design parameters 
that encourage enrollees in the plan or coverage 
to fill prescriptions at mail order, specialty, or 
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retail pharmacies that are wholly or partially- 
owned by that issuer or entity; and 
(E) the degree to which mail order, spe-
cialty, or retail pharmacies that dispense pre-
scription drugs to an enrollee in a group health 
plan or health insurance coverage that are 
under common ownership (in whole or part) 
with group health plans, health insurance 
issuers, or entities providing pharmacy benefits 
management services or pharmacy benefits ad-
ministrative services under group health plan or 
group or individual health insurance coverage 
receive reimbursement that is greater than the 
median price charged to the group health plan 
or health insurance issuer when the same drug 
is dispensed to enrollees in the plan or coverage 
by other pharmacies included in the pharmacy 
network of that plan, issuer, or entity that are 
not wholly or partially owned by the health in-
surance issuer or entity providing pharmacy 
benefits management services. 
(2) REQUIREMENT.—The Comptroller General 
of the United States shall ensure that the report 
under paragraph (1) does not contain information 
that would allow a reader to identify a specific plan 
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or entity providing pharmacy benefits management 
services or otherwise contain commercial or financial 
information that is privileged or confidential. 
(3) DEFINITIONS.—In this subsection, the 
terms ‘‘group health plan’’, ‘‘health insurance cov-
erage’’, and ‘‘health insurance issuer’’ have the 
meanings given such terms in section 2791 of the 
Public Health Service Act (42 U.S.C. 300gg–91). 
TITLE 
II—SUPPORTING 
PA-
TIENTS, HEALTH CARE WORK-
ERS, 
COMMUNITY 
HEALTH 
CENTERS, AND HOSPITALS 
SEC. 201. EXTENSION FOR COMMUNITY HEALTH CENTERS, 
THE NATIONAL HEALTH SERVICE CORPS, 
AND TEACHING HEALTH CENTERS THAT OP-
ERATE GME PROGRAMS. 
(a) TEACHING HEALTH CENTERS THAT OPERATE 
GRADUATE MEDICAL EDUCATION PROGRAMS.—Section 
340H(g) of the Public Health Service Act (42 U.S.C. 
256h(g)) is amended— 
(1) by amending paragraph (1) to read as fol-
lows: 
‘‘(1) IN GENERAL.—To carry out this section, 
there are appropriated such sums as may be nec-
essary, not to exceed— 
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‘‘(A) $230,000,000, for the period of fiscal 
years 2011 through 2015; 
‘‘(B) $60,000,000 for each of fiscal years 
2016 and 2017; 
‘‘(C) $126,500,000 for each of fiscal years 
2018 through 2023; 
‘‘(D) $175,000,000 for each of fiscal years 
2024 and 2025; 
‘‘(E) $225,000,000 for each of fiscal years 
2026 and 2027; and 
‘‘(F) $275,000,000 for each of fiscal years 
2028 and 2029.’’; and 
(2) by adding at the end the following: 
‘‘(3) AVAILABILITY.—The amounts made avail-
able under paragraph (1) shall remain available until 
expended.’’. 
(b) EXTENSION
FOR COMMUNITY HEALTH CEN-
TERS.—Section 10503(b)(1)(F) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 254b–2(b)(1)(F)) is 
amended— 
(1) by striking ‘‘and’’ before ‘‘$4,000,000,000’’ 
and inserting a comma; and 
(2) by inserting ‘‘, and $4,200,000,000 for each 
of fiscal years 2024 and 2025’’ before the semicolon. 
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(c) EXTENSION FOR THE NATIONAL HEALTH SERV-
ICE CORPS.—Section 10503(b)(2) of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 254b–2(b)(2)) 
is amended— 
(1) in subparagraph (G), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (H), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(I) $350,000,000 for each of fiscal years 
2024 and 2025.’’. 
(d) APPLICATION OF PROVISIONS.—Amounts appro-
priated pursuant to the amendments made by this section 
shall be subject to the requirements contained in Public 
Law 117–328 for funds for programs authorized under 
sections 330 through 340 of the Public Health Service 
Act. 
(e) CONFORMING AMENDMENT.—Paragraph (4) of 
section 3014(h) of title 18, United States Code, is amend-
ed by striking ‘‘and section 301(d) of division BB of the 
Consolidated Appropriations Act, 2021.’’ and inserting 
‘‘section 301(d) of division BB of the Consolidated Appro-
priations Act, 2021, and section 201(d) of the PATIENT 
Act of 2023’’. 
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SEC. 202. EXTENSION OF SPECIAL DIABETES PROGRAMS. 
(a) EXTENSION OF SPECIAL DIABETES PROGRAMS 
FOR TYPE I DIABETES.—Section 330B(b)(2) of the Pub-
lic Health Service Act (42 U.S.C. 254c–2(b)(2)) is amend-
ed— 
(1) in subparagraph (C), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (D), by striking the period 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(E) $170,000,000 for each of fiscal years 
2024 and 2025.’’. 
(b) EXTENDING FUNDING FOR SPECIAL DIABETES 
PROGRAMS
FOR INDIANS.—Section 330C(c)(2) of the 
Public Health Service Act (42 U.S.C. 254c–3(c)(2)) is 
amended— 
(1) in subparagraph (C), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (D), by striking the period 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(E) $170,000,000 for each of fiscal years 
2024 and 2025.’’. 
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SEC. 203. DELAYING CERTAIN DISPROPORTIONATE SHARE 
HOSPITAL PAYMENT REDUCTIONS UNDER 
THE MEDICAID PROGRAM. 
Section 1923(f)(7)(A) of the Social Security Act (42 
U.S.C.1396r–4(f)(7)(A)) is amended— 
(1) in clause (i), in the matter preceding sub-
clause (I), by striking ‘‘2024’’ and inserting ‘‘2026’’; 
and 
(2) in clause (ii), by striking ‘‘2024’’ and in-
serting ‘‘2026’’. 
SEC. 204. MEDICAID IMPROVEMENT FUND. 
Section 1941(b)(3)(A) of the Social Security Act (42 
U.S.C. 1396w–1(b)(3)(A)) is amended by striking 
‘‘$7,000,000,000’’ and inserting ‘‘$0’’. 
TITLE III—REDUCING HEALTH 
CARE COSTS 
SEC. 301. INCREASING TRANSPARENCY IN GENERIC DRUG 
APPLICATIONS. 
(a) IN GENERAL.—Section 505(j)(3) of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 355(j)(3)) is 
amended by adding at the end the following: 
‘‘(H)(i) Upon request (in controlled correspondence 
or an analogous process) by a person that has submitted 
or intends to submit an abbreviated application under this 
subsection for a drug that is required by regulation to con-
tain one or more of the same inactive ingredients in the 
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same concentrations as the listed drug referred to, or for 
which the Secretary determines there is a scientific jus-
tification for an approach that is in vitro in whole or in 
part to be used to demonstrate bioequivalence for a drug 
if such a drug contains one or more of the same inactive 
ingredients in the same concentrations as the listed drug, 
the Secretary shall inform the person whether such drug 
is qualitatively and quantitatively the same as the listed 
drug. The Secretary may also provide such information 
to such a person on the Secretary’s own initiative during 
the review of an abbreviated application under this sub-
section for such drug. 
‘‘(ii) Notwithstanding section 301(j), if the Secretary 
determines that such drug is not qualitatively or quan-
titatively the same as the listed drug, the Secretary shall 
identify and disclose to the person— 
‘‘(I) the ingredient or ingredients that cause 
such drug not to be qualitatively or quantitatively 
the same as the listed drug; and 
‘‘(II) for any ingredient for which there is an 
identified quantitative deviation, whether the quan-
tity or proportion of any ingredient in such drug is 
greater than or less than the quantity or proportion 
of such ingredient in the listed drug. 
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