‘‘(i) the 90th percentile of the actual
charges (computed on a statewide basis,
carrier-wide basis, or other appropriate ge-
ographic area basis, as specified by the
Secretary) for the drug for the second pre-
vious payment calculation period, adjusted
(as the Secretary determines to be appro-
priate) to reflect the number of tablets (or
other dosage units) dispensed; or
‘‘(ii) the amount of the administrative
allowance (established under paragraph
(4)) plus the product of—
‘‘(I) the number of tablets (or
other dosage units) dispensed, and
‘‘(II) the per tablet or unit aver-
age wholesale price for such drug (as
determined under subparagraph (C)
for the period for purposes of this
subparagraph).
‘‘(B) PAYMENT
LIMIT
FOR
MULTIPLE
SOURCE
DRUGS
WITHOUT
RESTRICTIVE
PRE-
SCRIPTIONS.—In the case of a drug that is a
multiple source drug but does not have a re-
strictive prescription, the payment limit for the
drug under this paragraph for a payment cal-
culation period is equal to the amount of the
administrative allowance (established under
paragraph (4)) plus the product of—
‘‘(i) the number of tablets (or other
dosage units) dispensed, and
‘‘(ii) the unweighted median of the
per tablet or unit average wholesale prices
(determined under subparagraph (C) for
purposes of this subparagraph) for such
drug for the period.
‘‘(C) DETERMINATION OF UNIT PRICE.—
‘‘(i) IN
GENERAL.—For purposes of
this paragraph, the Secretary shall deter-
mine, with respect to the dispensing of a
covered outpatient drug in a payment cal-
culation period (beginning on or after Jan-
uary 1, 1995), the per tablet or unit aver-
age wholesale price for the drug.
‘‘(ii) BASIS FOR DETERMINATIONS.—
‘‘(I) DETERMINATION FOR NON-
MULTIPLE-SOURCE DRUGS.—For pur-
poses of subparagraph (A), such de-
termination shall be based on a bian-
nual survey conducted by the Sec-
retary of a representative sample of
direct sellers, wholesalers, or phar-
macies (as appropriate) of wholesale
(or comparable direct) prices (exclud-
ing discounts to pharmacies); except
that if, because of low volume of sales
for the drug or other appropriate rea-
sons or in the case of covered out-
patient drugs during 1995, the Sec-
retary determines that such a survey
is not appropriate with respect to a
specific drug, such determination shall
be based on published average whole-
sale (or comparable direct) prices for
the drug.
‘‘(II) DETERMINATION FOR MUL-
TIPLE-SOURCE DRUGS.—For purposes
of subparagraph (B), the Secretary
may base the determination under
this subparagraph on the published
average wholesale (or comparable di-
rect) prices for the drug or on a bian-
nual survey conducted by the Sec-
retary of a representative sample of
direct sellers, wholesalers, or phar-
macists (as appropriate) of wholesale
(or comparable direct) prices (exclud-
ing discounts to pharmacies).
‘‘(III) COMPLIANCE
WITH
SUR-
VEY
REQUIRED.—If a wholesaler or
direct seller of a covered outpatient
drug refuses, after being requested by
the Secretary, to provide the informa-
tion required in a survey under this
clause, or deliberately provides infor-
mation that is false, the Secretary
may impose a civil money penalty of
not to exceed $10,000 for each such
refusal or provision of false informa-
tion. The provisions of section 1128A
(other than subsections (a) and (b))
shall apply to civil money penalties
under the previous sentence in the
same manner as such provisions apply
to a penalty or proceeding under sec-
tion 1128A(a). Information gathered
pursuant to the survey shall not be
disclosed except as the Secretary de-
termines to be necessary to carry out
the purposes of this part.