Public Law No. 117-169 (08/16/2022)
[117th Congress Public Law 169]
[From the U.S. Government Publishing Office]
[[Page 1817]]
[[Page 136 STAT. 1818]]
Public Law 117-169
117th Congress
An Act
To provide for reconciliation pursuant to title II of S. Con. Res.
14. <<NOTE: Aug. 16, 2022 – [H.R. 5376]>>
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled, <<NOTE: Appropriations
authorizations.>>
1TITLE I—COMMITTEE ON FINANCE
Subtitle A—Deficit Reduction
SECTION 10001. AMENDMENT OF 1986 CODE.
Except as otherwise expressly provided, whenever in this subtitle an
amendment or repeal is expressed in terms of an amendment to, or repeal
of, a section or other provision, the reference shall be considered to
be made to a section or other provision of the Internal Revenue Code of
1986.
1.1PART 1—CORPORATE TAX REFORM
1.1.SEC10101. CORPORATE ALTERNATIVE MINIMUM TAX.
(a) Imposition of Tax.—
(1) In general.—Paragraph (2) of section 55(b) <<NOTE: 26
USC 55.>> is amended to read as follows:
✂️✂️(2) Corporations.—
✂️✂️(A) Applicable corporations.—In the case of an
applicable corporation, the tentative minimum tax for
the taxable year shall be the excess of—
✂️✂️(i) 15 percent of the adjusted financial
statement income for the taxable year (as
determined under section 56A), over
✂️✂️(ii) the corporate AMT foreign tax credit
for the taxable year.
✂️✂️(B) Other corporations.—In the case of any
corporation which is not an applicable corporation, the
tentative minimum tax for the taxable year shall be
zero.’'.
(2) Applicable corporation.—Section 59 is amended by adding
at the end the following new subsection:
✂️✂️(k) <<NOTE: Determinations.>> Applicable Corporation.—For
purposes of this part—
✂️✂️(1) Applicable corporation defined.—
✂️✂️(A) In general.—The term ✂️applicable corporation’
means, with respect to any taxable year, any corporation
(other than an S corporation, a regulated investment
company, or a real estate investment trust) which meets
the
[[Page 136 STAT. 1819]]
average annual adjusted financial statement income test
of subparagraph (B) for one or more taxable years
which—
✂️✂️(i) are prior to such taxable year, and
✂️✂️(ii) <<NOTE: Effective date.>> end after
December 31, 2021.
✂️✂️(B) <<NOTE: Time period.>> Average annual
adjusted financial statement income test.—For purposes
of this subsection—
✂️✂️(i) a corporation meets the average annual
adjusted financial statement income test for a
taxable year if the average annual adjusted
financial statement income of such corporation
(determined without regard to section 56A(d)) for
the 3-taxable-year period ending with such taxable
year exceeds $1,000,000,000, and
✂️✂️(ii) in the case of a corporation described
in paragraph (2), such corporation meets the
average annual adjusted financial statement income
test for a taxable year if—
✂️✂️(I) the corporation meets the
requirements of clause (i) for such
taxable year (determined after the
application of paragraph (2)), and
✂️✂️(II) the average annual adjusted
financial statement income of such
corporation (determined without regard
to the application of paragraph (2) and
without regard to section 56A(d)) for
the 3-taxable-year-period ending with
such taxable year is $100,000,000 or
more.
✂️✂️(C) Exception.—Notwithstanding subparagraph (A),
the term ✂️applicable corporation’ shall not include any
corporation which otherwise meets the requirements of
subparagraph (A) if—
✂️✂️(i) such corporation—
✂️✂️(I) has a change in ownership, or
✂️✂️(II) has a specified number (to be
determined by the Secretary and which
shall, as appropriate, take into account
the facts and circumstances of the
taxpayer) of consecutive taxable years,
including the most recent taxable year,
in which the corporation does not meet
the average annual adjusted financial
statement income test of subparagraph
(B), and
✂️✂️(ii) the Secretary determines that it would
not be appropriate to continue to treat such
corporation as an applicable corporation.
The preceding sentence shall not apply to any
corporation if, after the Secretary makes the
determination described in clause (ii), such corporation
meets the average annual adjusted financial statement
income test of subparagraph (B) for any taxable year
beginning after the first taxable year for which such
determination applies.
✂️✂️(D) <<NOTE: Definition.>> Special rules for
determining applicable corporation status.—
✂️✂️(i) In general.—Solely for purposes of
determining whether a corporation is an applicable
corporation under this paragraph, all adjusted
financial statement income of persons treated as a
single employer with such corporation under
subsection (a) or (b) of section 52 (determined
with the modifications described in clause (ii))
shall be treated as adjusted financial
[[Page 136 STAT. 1820]]
statement income of such corporation, and adjusted
financial statement income of such corporation
shall be determined without regard to paragraphs
(2)(D)(i) and (11) of section 56A(c).
✂️✂️(ii) Modifications.—For purposes of this
subparagraph—
✂️✂️(I) <<NOTE: Applicability.>>
section 52(a) shall be applied by
substituting ✂️component members’ for
✂️members’, and
✂️✂️(II) for purposes of applying
section 52(b), the term ✂️trade or
business’ shall include any activity
treated as a trade or business under
paragraph (5) or (6) of section 469(c)
(determined without regard to the phrase
✂️To the extent provided in regulations’
in such paragraph (6)).
✂️✂️(iii) Component member.—For purposes of
this subparagraph, the term ✂️component member’ has
the meaning given such term by section 1563(b),
except that the determination shall be made
without regard to section 1563(b)(2).
✂️✂️(E) Other special rules.—
✂️✂️(i) <<NOTE: Applicability.>> Corporations
in existence for less than 3 years.—If the
corporation was in existence for less than 3-
taxable years, subparagraph (B) shall be applied
on the basis of the period during which such
corporation was in existence.
✂️✂️(ii) <<NOTE: Time period.>> Short taxable
years.—Adjusted financial statement income for
any taxable year of less than 12 months shall be
annualized by multiplying the adjusted financial
statement income for the short period by 12 and
dividing the result by the number of months in the
short period.
✂️✂️(iii) Treatment of predecessors.—Any
reference in this subparagraph to a corporation
shall include a reference to any predecessor of
such corporation.
✂️✂️(2) Special rule for foreign-parented multinational
groups.—
✂️✂️(A) In general.—If a corporation is a member of a
foreign-parented multinational group for any taxable
year, then, solely for purposes of determining whether
such corporation meets the average annual adjusted
financial statement income test under paragraph
(1)(B)(ii)(I) for such taxable year, the adjusted
financial statement income of such corporation for such
taxable year shall include the adjusted financial
statement income of all members of such group. Solely
for purposes of this subparagraph, adjusted financial
statement income shall be determined without regard to
paragraphs (2)(D)(i), (3), (4), and (11) of section
56A(c).
✂️✂️(B) <<NOTE: Definition.>> Foreign-parented
multinational group.—For purposes of subparagraph (A),
the term ✂️foreign-parented multinational group’ means,
with respect to any taxable year, two or more entities
if—
✂️✂️(i) at least one entity is a domestic
corporation and another entity is a foreign
corporation,
[[Page 136 STAT. 1821]]
✂️✂️(ii) such entities are included in the same
applicable financial statement with respect to
such year, and
✂️✂️(iii) either—
✂️✂️(I) the common parent of such
entities is a foreign corporation, or
✂️✂️(II) if there is no common parent,
the entities are treated as having a
common parent which is a foreign
corporation under subparagraph (D).
✂️✂️(C) Foreign corporations engaged in a trade or
business within the united states.—For purposes of this
paragraph, if a foreign corporation is engaged in a
trade or business within the United States, such trade
or business shall be treated as a separate domestic
corporation that is wholly owned by the foreign
corporation.
✂️✂️(D) <<NOTE: Applicability.>> Other rules.—The
Secretary shall, applying the principles of this
section, prescribe rules for the application of this
paragraph, including rules for the determination of—
✂️✂️(i) the entities (if any) which are to be to
be treated under subparagraph (B)(iii)(II) as
having a common parent which is a foreign
corporation,
✂️✂️(ii) the entities to be included in a
foreign-parented multinational group, and
✂️✂️(iii) the common parent of a foreign-
parented multinational group.
✂️✂️(3) Regulations or other guidance.—The Secretary shall
provide regulations or other guidance for the purposes of
carrying out this subsection, including regulations or other
guidance—
✂️✂️(A) providing a simplified method for determining
whether a corporation meets the requirements of
paragraph (1), and
✂️✂️’(B) addressing the application of this subsection
to a corporation that experiences a change in
ownership.’'.
(3) Reduction for base erosion and anti-abuse tax.—Section
55(a)(2) <<NOTE: 26 USC 55.>> is amended by inserting ✂️✂️plus,
in the case of an applicable corporation, the tax imposed by
section 59A’' before the period at the end.
(4) Conforming amendments.—
(A) Section 55(a) is amended by striking ✂️✂️In the
case of a taxpayer other than a corporation, there’' and
inserting ✂️✂️There’'.
(B)(i) Section 55(b)(1) is amended—
(I) by striking so much as precedes
subparagraph (A) and inserting the following:
✂️✂️(1) Noncorporate taxpayers.—In the case of a taxpayer
other than a corporation—’', and
(II) by adding at the end the following new
subparagraph:
✂️✂️(D) <<NOTE: Definition.>> Alternative minimum
taxable income.—The term ✂️alternative minimum taxable
income’ means the taxable income of the taxpayer for the
taxable year—
✂️✂️(i) determined with the adjustments provided
in section 56 and section 58, and
✂️✂️(ii) increased by the amount of the items of
tax preference described in section 57.
[[Page 136 STAT. 1822]]
If a taxpayer is subject to the regular tax, such
taxpayer shall be subject to the tax imposed by this
section (and, if the regular tax is determined by
reference to an amount other than taxable income, such
amount shall be treated as the taxable income of such
taxpayer for purposes of the preceding sentence).’'.
(ii) <<NOTE: 26 USC 860E.>> Section 860E(a)(4) is
amended by striking ✂️✂️55(b)(2)’' and inserting
✂️✂️55(b)(1)(D)’'.
(iii) Section 897(a)(2)(A)(i) is amended by striking
✂️✂️55(b)(2)’' and inserting ✂️✂️55(b)(1)(D)’'.
(C) Section 11(d) is amended by striking ✂️✂️the tax
imposed by subsection (a)’' and inserting ✂️✂️the taxes
imposed by subsection (a) and section 55’'.
(D) Section 12 is amended by adding at the end the
following new paragraph:
✂️✂️(5) For alternative minimum tax, see section 55.’'.
(E) Section 882(a)(1) is amended by inserting ✂️✂️,
55,’' after ✂️✂️section 11’'.
(F) Section 6425(c)(1)(A) is amended to read as
follows:
✂️✂️(A) the sum of—
✂️✂️(i) the tax imposed by section 11 or
subchapter L of chapter 1, whichever is
applicable, plus
✂️✂️(ii) the tax imposed by section 55, plus
✂️✂️(iii) the tax imposed by section 59A,
over’'.
(G) Section 6655(e)(2) is amended by inserting ✂️✂️,
adjusted financial statement income (as defined in
section 56A),’' before ✂️✂️and modified taxable income’'
each place it appears in subparagraphs (A)(i) and
(B)(i).
(H) Section 6655(g)(1)(A) is amended by
redesignating clauses (ii) and (iii) as clauses (iii)
and (iv), respectively, and by inserting after clause
(i) the following new clause:
✂️✂️(ii) the tax imposed by section 55,’'.
(b) Adjusted Financial Statement Income.—
(1) In general.—Part VI of subchapter A of chapter 1 is
amended by inserting after section 56 the following new section:
✂️✂️SEC. 56A. <<NOTE: 26 USC 56A.>> ADJUSTED FINANCIAL STATEMENT
INCOME.
✂️✂️(a) <<NOTE: Definition.>> In General.—For purposes of this part,
the term ✂️adjusted financial statement income’ means, with respect to
any corporation for any taxable year, the net income or loss of the
taxpayer set forth on the taxpayer’s applicable financial statement for
such taxable year, adjusted as provided in this section.
✂️✂️(b) <<NOTE: Definition.>> Applicable Financial Statement.—For
purposes of this section, the term ✂️applicable financial statement’
means, with respect to any taxable year, an applicable financial
statement (as defined in section 451(b)(3) or as specified by the
Secretary in regulations or other guidance) which covers such taxable
year.
✂️✂️(c) General Adjustments.—
✂️✂️(1) Statements covering different taxable years.—
Appropriate adjustments shall be made in adjusted financial
statement income in any case in which an applicable financial
statement covers a period other than the taxable year.
✂️✂️(2) Special rules for related entities.—
✂️✂️(A) <<NOTE: Applicability.>> Consolidated
financial statements.—If the financial results of a
taxpayer are reported on the
[[Page 136 STAT. 1823]]
applicable financial statement for a group of entities,
rules similar to the rules of section 451(b)(5) shall
apply.
✂️✂️(B) Consolidated returns.—Except as provided in
regulations prescribed by the Secretary, if the taxpayer
is part of an affiliated group of corporations filing a
consolidated return for any taxable year, adjusted
financial statement income for such group for such
taxable year shall take into account items on the
group’s applicable financial statement which are
properly allocable to members of such group.
✂️✂️(C) Treatment of dividends and other amounts.—In
the case <<NOTE: Determination.>> of any corporation
which is not included on a consolidated return with the
taxpayer, adjusted financial statement income of the
taxpayer with respect to such other corporation shall be
determined by only taking into account the dividends
received from such other corporation (reduced to the
extent provided by the Secretary in regulations or other
guidance) and other amounts which are includible in
gross income or deductible as a loss under this chapter
(other than amounts required to be included under
sections 951 and 951A or such other amounts as provided
by the Secretary) with respect to such other
corporation.
✂️✂️(D) Treatment of partnerships.—
✂️✂️(i) In general.—Except as provided by the
Secretary, if the taxpayer is a partner in a
partnership, adjusted financial statement income
of the taxpayer with respect to such partnership
shall be adjusted to only take into account the
taxpayer’s distributive share of adjusted
financial statement income of such partnership.
✂️✂️(ii) Adjusted financial statement income of
partnerships.—For the purposes of this part, the
adjusted financial statement income of a
partnership shall be the partnership’s net income
or loss set forth on such partnership’s applicable
financial statement (adjusted under rules similar
to the rules of this section).
✂️✂️(3) Adjustments to take into account certain items of
foreign income.—
✂️✂️(A) In general.—If, for any taxable year, a
taxpayer is a United States shareholder of one or more
controlled foreign corporations, the adjusted financial
statement income of such taxpayer with respect to such
controlled foreign corporation (as determined under
paragraph (2)(C)) shall be adjusted to also take into
account such taxpayer’s pro rata share (determined under
rules similar to the rules under section 951(a)(2)) of
items taken into account in computing the net income or
loss set forth on the applicable financial statement (as
adjusted under rules similar to those that apply in
determining adjusted financial statement income) of each
such controlled foreign corporation with respect to
which such taxpayer is a United States shareholder.
✂️✂️(B) Negative adjustments.—In any case in which
the adjustment determined under subparagraph (A) would
result in a negative adjustment for such taxable year—
[[Page 136 STAT. 1824]]
✂️✂️(i) no adjustment shall be made under this
paragraph for such taxable year, and
✂️✂️(ii) the amount of the adjustment determined
under this paragraph for the succeeding taxable
year (determined without regard to this paragraph)
shall be reduced by an amount equal to the
negative adjustment for such taxable year.
✂️✂️(4) <<NOTE: Determination. Applicability.>> Effectively
connected income.—In the case of a foreign corporation, to
determine adjusted financial statement income, the principles of
section 882 shall apply.
✂️✂️(5) Adjustments for certain taxes.—Adjusted financial
statement income shall be appropriately adjusted to disregard
any Federal income taxes, or income, war profits, or excess
profits taxes (within the meaning of section 901) with respect
to a foreign country or possession of the United States, which
are taken into account on the taxpayer’s applicable financial
statement. To the extent provided by the Secretary, the
preceding sentence shall not apply to income, war profits, or
excess profits taxes (within the meaning of section 901) that
are imposed by a foreign country or possession of the United
States and taken into account on the taxpayer’s applicable
financial statement if the taxpayer does not choose to have the
benefits of subpart A of part III of subchapter N for the
taxable year. The Secretary shall
prescribe <<NOTE: Regulations. Guidelines.>> such regulations
or other guidance as may be necessary and appropriate to provide
for the proper treatment of current and deferred taxes for
purposes of this paragraph, including the time at which such
taxes are properly taken into account.
✂️✂️(6) Adjustment with respect to disregarded entities.—
Adjusted financial statement income shall be adjusted to take
into account any adjusted financial statement income of a
disregarded entity owned by the taxpayer.
✂️✂️(7) <<NOTE: Applicability.>> Special rule for
cooperatives.—In the case of a cooperative to which section
1381 applies, the adjusted financial statement income
(determined without regard to this paragraph) shall be reduced
by the amounts referred to in section 1382(b) (relating to
patronage dividends and per-unit retain allocations) to the
extent such amounts were not otherwise taken into account in
determining adjusted financial statement income.
✂️✂️(8) Rules for alaska native corporations.—Adjusted
financial statement income shall be appropriately adjusted to
allow—
✂️✂️(A) cost recovery and depletion attributable to
property the basis of which is determined under section
21(c) of the Alaska Native Claims Settlement Act (43
U.S.C. 1620(c)), and
✂️✂️(B) deductions for amounts payable made pursuant
to section 7(i) or section 7(j) of such Act (43 U.S.C.
1606(i) and 1606(j)) only at such time as the deductions
are allowed for tax purposes.
✂️✂️(9) Amounts attributable to elections for direct payment
of certain credits.—Adjusted financial statement income shall
be appropriately adjusted to disregard any amount treated as a
payment against the tax imposed by subtitle A pursuant to an
election under section 48D(d) or 6417, to the
[[Page 136 STAT. 1825]]
extent such amount was not otherwise taken into account under
paragraph (5).
✂️✂️(10) Consistent treatment of mortgage servicing income of
taxpayer other than a regulated investment company.—
✂️✂️(A) In general.—Adjusted financial statement
income shall be adjusted so as not to include any item
of income in connection with a mortgage servicing
contract any earlier than when such income is included
in gross income under any other provision of this
chapter.
✂️✂️(B) Rules for amounts not representing reasonable
compensation.— <<NOTE: Determination.>> The Secretary
shall provide regulations to prevent the avoidance of
taxes imposed by this chapter with respect to amounts
not representing reasonable compensation (as determined
by the Secretary) with respect to a mortgage servicing
contract.
✂️✂️(11) Adjustment with respect to defined benefit
pensions.—
✂️✂️(A) <<NOTE: Regulations. Guidelines.>> In
general.—Except as otherwise provided in rules
prescribed by the Secretary in regulations or other
guidance, adjusted financial statement income shall be—
✂️✂️(i) adjusted to disregard any amount of
income, cost, or expense that would otherwise be
included on the applicable financial statement in
connection with any covered benefit plan,
✂️✂️(ii) increased by any amount of income in
connection with any such covered benefit plan that
is included in the gross income of the corporation
under any other provision of this chapter, and
✂️✂️(iii) reduced by deductions allowed under
any other provision of this chapter with respect
to any such covered benefit plan.
✂️✂️(B) <<NOTE: Definition.>> Covered benefit plan.—
For purposes of this paragraph, the term ✂️covered
benefit plan’ means—
✂️✂️(i) a defined benefit plan (other than a
multiemployer plan described in section 414(f)) if
the trust which is part of such plan is an
employees’ trust described in section 401(a) which
is exempt from tax under section 501(a),
✂️✂️(ii) any qualified foreign plan (as defined
in section 404A(e)), or
✂️✂️(iii) any other defined benefit plan which
provides post-employment benefits other than
pension benefits.
✂️✂️(12) Tax-exempt entities.—In the case of an organization
subject to tax under section 511, adjusted financial statement
income shall be appropriately adjusted to only take into account
any adjusted financial statement income—
✂️✂️(A) of an unrelated trade or business (as defined
in section 513) of such organization, or
✂️✂️(B) derived from debt-financed property (as
defined in section 514) to the extent that income from
such property is treated as unrelated business taxable
income.
✂️✂️(13) Depreciation.—Adjusted financial statement income
shall be—
✂️✂️(A) <<NOTE: Applicability.>> reduced by
depreciation deductions allowed under section 167 with
respect to property to which section 168
[[Page 136 STAT. 1826]]
applies to the extent of the amount allowed as
deductions in computing taxable income for the taxable
year, and
✂️✂️(B) appropriately adjusted—
✂️✂️(i) to disregard any amount of depreciation
expense that is taken into account on the
taxpayer’s applicable financial statement with
respect to such property, and
✂️✂️(ii) to take into account any other item
specified by the Secretary in order to provide
that such property is accounted for in the same
manner as it is accounted for under this chapter.
✂️✂️(14) Qualified wireless spectrum.—
✂️✂️(A) In general.—Adjusted financial statement
income shall be—
✂️✂️(i) reduced by amortization deductions
allowed under section 197 with respect to
qualified wireless spectrum to the extent of the
amount allowed as deductions in computing taxable
income for the taxable year, and
✂️✂️(ii) appropriately adjusted—
✂️✂️(I) to disregard any amount of
amortization expense that is taken into
account on the taxpayer’s applicable
financial statement with respect to such
qualified wireless spectrum, and
✂️✂️(II) to take into account any
other item specified by the Secretary in
order to provide that such qualified
wireless spectrum is accounted for in
the same manner as it is accounted for
under this chapter.
✂️✂️(B) <<NOTE: Definition.>> Qualified wireless
spectrum.—For purposes of this paragraph, the term
✂️qualified wireless spectrum’ means wireless spectrum
which—
✂️✂️(i) is used in the trade or business of a
wireless telecommunications carrier, and
✂️✂️(ii) <<NOTE: Effective date.>> was acquired
after December 31, 2007, and before the date of
enactment of this section.
✂️✂️(15) <<NOTE: Regulations. Guidelines. Determination.>>
Secretarial authority to adjust items.—The Secretary shall
issue regulations or other guidance to provide for such
adjustments to adjusted financial statement income as the
Secretary determines necessary to carry out the purposes of this
section, including adjustments—
✂️✂️(A) to prevent the omission or duplication of any
item, and
✂️✂️(B) to carry out the principles of part II of
subchapter C of this chapter (relating to corporate
liquidations), part III of subchapter C of this chapter
(relating to corporate organizations and
reorganizations), and part II of subchapter K of this
chapter (relating to partnership contributions and
distributions).
✂️✂️(d) <<NOTE: Determinations.>> Deduction for Financial Statement
Net Operating Loss.—
✂️✂️(1) In general.—Adjusted financial statement income
(determined after application of subsection (c) and without
regard to this subsection) shall be reduced by an amount equal
to the lesser of—
✂️✂️(A) the aggregate amount of financial statement
net operating loss carryovers to the taxable year, or
[[Page 136 STAT. 1827]]
✂️✂️(B) 80 percent of adjusted financial statement
income computed without regard to the deduction
allowable under this subsection.
✂️✂️(2) Financial statement net operating loss carryover.—A
financial statement net operating loss for any taxable year
shall be a financial statement net operating loss carryover to
each taxable year following the taxable year of the loss. The
portion of such loss which shall be carried to subsequent
taxable years shall be the amount of such loss remaining (if
any) after the application of paragraph (1).
✂️✂️(3) <<NOTE: Effective date.>> Financial statement net
operating loss defined.—For purposes of this subsection, the
term ✂️financial statement net operating loss’ means the amount
of the net loss (if any) set forth on the corporation’s
applicable financial statement (determined after application of
subsection (c) and without regard to this subsection) for
taxable years ending after December 31, 2019.
✂️✂️(e) Regulations and Other Guidance.—The Secretary shall provide
for such regulations and other guidance as necessary to carry out the
purposes of this section, including regulations and other guidance
relating to the effect of the rules of this section on partnerships with
income taken into account by an applicable corporation.’'.
(2) Clerical amendment.—The table of sections for part VI
of subchapter A of chapter 1 <<NOTE: 26 USC 55 prec.>> is
amended by inserting after the item relating to section 56 the
following new item:
✂️✂️Sec. 56A. Adjusted financial statement income.’'.
(c) Corporate AMT Foreign Tax Credit.—Section 59, as amended by
this section, <<NOTE: 26 USC 59.>> is amended by adding at the end the
following new subsection:
✂️✂️(l) Corporate AMT Foreign Tax Credit.—
✂️✂️(1) In general.—For purposes of this part, if an
applicable corporation chooses to have the benefits of subpart A
of part III of subchapter N for any taxable year, the corporate
AMT foreign tax credit for the taxable year of the applicable
corporation is an amount equal to sum of—
✂️✂️(A) the lesser of—
✂️✂️(i) <<NOTE: Determination.>> the aggregate
of the applicable corporation’s pro rata share (as
determined under section 56A(c)(3)) of the amount
of income, war profits, and excess profits taxes
(within the meaning of section 901) imposed by any
foreign country or possession of the United States
which are—
✂️✂️(I) taken into account on the
applicable financial statement of each
controlled foreign corporation with
respect to which the applicable
corporation is a United States
shareholder, and
✂️✂️(II) paid or accrued (for Federal
income tax purposes) by each such
controlled foreign corporation, or
✂️✂️(ii) the product of the amount of the
adjustment under section 56A(c)(3) and the
percentage specified in section 55(b)(2)(A)(i),
and
✂️✂️(B) in the case of an applicable corporation that
is a domestic corporation, the amount of income, war
profits, and excess profits taxes (within the meaning of
section
[[Page 136 STAT. 1828]]
901) imposed by any foreign country or possession of the
United States to the extent such taxes are—
✂️✂️(i) taken into account on the applicable
corporation’s applicable financial statement, and
✂️✂️(ii) paid or accrued (for Federal income tax
purposes) by the applicable corporation.
✂️✂️(2) <<NOTE: Time period.>> Carryover of excess tax
paid.—For any taxable year for which an applicable corporation
chooses to have the benefits of subpart A of part III of
subchapter N, the excess of the amount described in paragraph
(1)(A)(i) over the amount described in paragraph (1)(A)(ii)
shall increase the amount described in paragraph (1)(A)(i) in
any of the first 5 succeeding taxable years to the extent not
taken into account in a prior taxable year.
✂️✂️(3) Regulations or other guidance.—The Secretary shall
provide for such regulations or other guidance as is necessary
to carry out the purposes of this subsection.’'.
(d) Treatment of General Business Credit.—Section
38(c)(6)(E) <<NOTE: 26 USC 38.>> is amended to read as follows:
✂️✂️(E) <<NOTE: Applicability.>> Corporations.—In
the case of a corporation—
✂️✂️(i) the first sentence of paragraph (1)
shall be applied by substituting ✂️25 percent of
the taxpayer’s net income tax as exceeds $25,000’
for ✂️the greater of’ and all that follows,
✂️✂️(ii) paragraph (2)(A) shall be applied
without regard to clause (ii)(I) thereof, and
✂️✂️(iii) paragraph (4)(A) shall be applied
without regard to clause (ii)(I) thereof.’'.
(e) Credit for Prior Year Minimum Tax Liability.—
(1) In general.—Section 53(e) is amended to read as
follows:
✂️✂️(e) Application to Applicable Corporations.—In the case of a
corporation—
✂️✂️(1) subsection (b)(1) shall be applied by substituting
✂️the net minimum tax for all prior taxable years beginning after
2022’ for ✂️the adjusted net minimum tax imposed for all prior
taxable years beginning after 1986’, and
✂️✂️(2) the amount determined under subsection (c)(1) shall be
increased by the amount of tax imposed under section 59A for the
taxable year.’'.
(2) Conforming amendments.—Section 53(d) is amended—
(A) in paragraph (2), by striking ✂️✂️, except that in
the case’' and all that follows through ✂️✂️treated as
zero’', and
(B) by striking paragraph (3).
(f) <<NOTE: 26 USC 11 note.>> Effective Date.—The amendments made
by this section shall apply to taxable years beginning after December
31, 2022.
1.2PART 2—EXCISE TAX ON REPURCHASE OF CORPORATE STOCK
1.2.SEC10201. EXCISE TAX ON REPURCHASE OF CORPORATE STOCK.
(a) In General.—Subtitle D is amended by inserting after chapter 36
the following new chapter:
[[Page 136 STAT. 1829]]
✂️✂️CHAPTER 37 <<NOTE: 26 USC 4501 prec.>> —REPURCHASE OF CORPORATE STOCK
✂️✂️Sec. 4501. Repurchase of corporate stock.
✂️✂️SEC. 4501. <<NOTE: 26 USC 4501.>> REPURCHASE OF CORPORATE
STOCK.
✂️✂️(a) General Rule.—There is hereby imposed on each covered
corporation a tax equal to 1 percent of the fair market value of any
stock of the corporation which is repurchased by such corporation during
the taxable year.
✂️✂️(b) <<NOTE: Definition.>> Covered Corporation.—For purposes of
this section, the term ✂️covered corporation’ means any domestic
corporation the stock of which is traded on an established securities
market (within the meaning of section 7704(b)(1)).
✂️✂️(c) <<NOTE: Definitions.>> Repurchase.—For purposes of this
section—
✂️✂️(1) In general.—The term ✂️repurchase’ means—
✂️✂️(A) a redemption within the meaning of section
317(b) with regard to the stock of a covered
corporation, and
✂️✂️(B) <<NOTE: Determination.>> any transaction
determined by the Secretary to be economically similar
to a transaction described in subparagraph (A).
✂️✂️(2) Treatment of purchases by specified affiliates.—
✂️✂️(A) In general.—The acquisition of stock of a
covered corporation by a specified affiliate of such
covered corporation, from a person who is not the
covered corporation or a specified affiliate of such
covered corporation, shall be treated as a repurchase of
the stock of the covered corporation by such covered
corporation.
✂️✂️(B) Specified affiliate.—For purposes of this
section, the term ✂️specified affiliate’ means, with
respect to any corporation—
✂️✂️(i) any corporation more than 50 percent of
the stock of which is owned (by vote or by value),
directly or indirectly, by such corporation, and
✂️✂️(ii) any partnership more than 50 percent of
the capital interests or profits interests of
which is held, directly or indirectly, by such
corporation.
✂️✂️(3) Adjustment.—The amount taken into account under
subsection (a) with respect to any stock repurchased by a
covered corporation shall be reduced by the fair market value of
any stock issued by the covered corporation during the taxable
year, including the fair market value of any stock issued or
provided to employees of such covered corporation or employees
of a specified affiliate of such covered corporation during the
taxable year, whether or not such stock is issued or provided in
response to the exercise of an option to purchase such stock.
✂️✂️(d) <<NOTE: Determinations.>> Special Rules for Acquisition of
Stock of Certain Foreign Corporations.—
✂️✂️(1) In general.—In the case of an acquisition of stock of
an applicable foreign corporation by a specified affiliate of
such corporation (other than a foreign corporation or a foreign
partnership (unless such partnership has a domestic entity as a
direct or indirect partner)) from a person who is not the
applicable foreign corporation or a specified affiliate of such
applicable foreign corporation, for purposes of this section—
[[Page 136 STAT. 1830]]
✂️✂️(A) such specified affiliate shall be treated as a
covered corporation with respect to such acquisition,
✂️✂️(B) such acquisition shall be treated as a
repurchase of stock of a covered corporation by such
covered corporation, and
✂️✂️(C) the adjustment under subsection (c)(3) shall
be determined only with respect to stock issued or
provided by such specified affiliate to employees of the
specified affiliate.
✂️✂️(2) Surrogate foreign corporations.—In the case of a
repurchase of stock of a covered surrogate foreign corporation
by such covered surrogate foreign corporation, or an acquisition
of stock of a covered surrogate foreign corporation by a
specified affiliate of such corporation, for purposes of this
section—
✂️✂️(A) the expatriated entity with respect to such
covered surrogate foreign corporation shall be treated
as a covered corporation with respect to such repurchase
or acquisition,
✂️✂️(B) such repurchase or acquisition shall be
treated as a repurchase of stock of a covered
corporation by such covered corporation, and
✂️✂️(C) the adjustment under subsection (c)(3) shall
be determined only with respect to stock issued or
provided by such expatriated entity to employees of the
expatriated entity.
✂️✂️(3) Definitions.—For purposes of this subsection—
✂️✂️(A) Applicable foreign corporation.—The term
✂️applicable foreign corporation’ means any foreign
corporation the stock of which is traded on an
established securities market (within the meaning of
section 7704(b)(1)).
✂️✂️(B) Covered surrogate foreign corporation.—The
term ✂️covered surrogate foreign corporation’ means any
surrogate foreign corporation (as determined under
section 7874(a)(2)(B) by substituting ✂️September 20,
2021’ for ✂️March 4, 2003’ each place it appears) the
stock of which is traded on an established securities
market (within the meaning of section 7704(b)(1)), but
only with respect to taxable years which include any
portion of the applicable period with respect to such
corporation under section 7874(d)(1).
✂️✂️(C) Expatriated entity.—The term ✂️expatriated
entity’ has the meaning given such term by section
7874(a)(2)(A).
✂️✂️(e) Exceptions.—Subsection (a) shall not apply—
✂️✂️(1) to the extent that the repurchase is part of a
reorganization (within the meaning of section 368(a)) and no
gain or loss is recognized on such repurchase by the shareholder
under chapter 1 by reason of such reorganization,
✂️✂️(2) in any case in which the stock repurchased is, or an
amount of stock equal to the value of the stock repurchased is,
contributed to an employer-sponsored retirement plan, employee
stock ownership plan, or similar plan,
✂️✂️(3) in any case in which the total value of the stock
repurchased during the taxable year does not exceed $1,000,000,
✂️✂️(4) under regulations prescribed by the Secretary, in
cases in which the repurchase is by a dealer in securities in
the ordinary course of business,
[[Page 136 STAT. 1831]]
✂️✂️(5) to repurchases by a regulated investment company (as
defined in section 851) or a real estate investment trust, or
✂️✂️(6) to the extent that the repurchase is treated as a
dividend for purposes of this title.
✂️✂️(f) Regulations and Guidance.—The Secretary shall prescribe such
regulations and other guidance as are necessary or appropriate to carry
out, and to prevent the avoidance of, the purposes of this section,
including regulations and other guidance—
✂️✂️(1) to prevent the abuse of the exceptions provided by
subsection (e),
✂️✂️(2) to address special classes of stock and preferred
stock, and
✂️✂️(3) for the application of the rules under subsection
(d).’'.
(b) Tax Not Deductible.—Paragraph (6) of section 275(a) <<NOTE: 26
USC 275.>> is amended by inserting ✂️✂️37,’' before ✂️✂️41’'.
(c) Clerical Amendment.—The table of chapters for subtitle D
is <<NOTE: 26 USC 4001 prec.>> amended by inserting after the item
relating to chapter 36 the following new item:
✂️✂️Chapter 37—Repurchase of Corporate Stock’'.
(d) <<NOTE: 26 USC 4501 note.>> Effective Date.—The amendments
made by this section shall apply to repurchases (within the meaning of
section 4501(c) of the Internal Revenue Code of 1986, as added by this
section) of stock after December 31, 2022.
1.3PART 3—FUNDING THE INTERNAL REVENUE SERVICE AND IMPROVING TAXPAYER
COMPLIANCE
1.3.SEC10301. ENHANCEMENT OF INTERNAL REVENUE SERVICE RESOURCES.
In General.—The following sums are appropriated, out of any money
in the Treasury not otherwise appropriated, for the fiscal year ending
September 30, 2022:
(1) Internal revenue service.—
(A) In general.—
(i) Taxpayer services.—For necessary expenses
of the Internal Revenue Service to provide
taxpayer services, including pre-filing assistance
and education, filing and account services,
taxpayer advocacy services, and other services as
authorized by 5 U.S.C. 3109, at such rates as may
be determined by the Commissioner, $3,181,500,000,
to remain available until September 30, 2031:
Provided, That these amounts shall be in addition
to amounts otherwise available for such purposes.
(ii) Enforcement.—For necessary expenses for
tax enforcement activities of the Internal Revenue
Service to determine and collect owed taxes, to
provide legal and litigation support, to conduct
criminal investigations (including investigative
technology), to provide digital asset monitoring
and compliance activities, to enforce criminal
statutes related to violations of internal revenue
laws and other financial crimes, to purchase and
hire passenger motor vehicles (31 U.S.C.
[[Page 136 STAT. 1832]]
1343(b)), and to provide other services as
authorized by 5 U.S.C. 3109, at such rates as may
be determined by the Commissioner,
$45,637,400,000, to remain available until
September 30, 2031: Provided, That these amounts
shall be in addition to amounts otherwise
available for such purposes.
(iii) Operations support.—For necessary
expenses of the Internal Revenue Service to
support taxpayer services and enforcement
programs, including rent payments; facilities
services; printing; postage; physical security;
headquarters and other IRS-wide administration
activities; research and statistics of income;
telecommunications; information technology
development, enhancement, operations, maintenance,
and security; the hire of passenger motor vehicles
(31 U.S.C. 1343(b)); the operations of the
Internal Revenue Service Oversight Board; and
other services as authorized by 5 U.S.C. 3109, at
such rates as may be determined by the
Commissioner, $25,326,400,000, to remain available
until September 30, 2031: Provided, That these
amounts shall be in addition to amounts otherwise
available for such purposes.
(iv) Business systems modernization.—For
necessary expenses of the Internal Revenue
Service’s business systems modernization program,
including development of callback technology and
other technology to provide a more personalized
customer service but not including the operation
and maintenance of legacy systems, $4,750,700,000,
to remain available until September 30, 2031:
Provided, That these amounts shall be in addition
to amounts otherwise available for such purposes.
(B) Task force to design an irs-run free ✂️✂️direct
efile’' tax return system.—For necessary expenses of
the Internal Revenue Service to deliver to Congress,
within nine months following the date of the enactment
of this Act, a report on (I) the cost (including options
for differential coverage based on taxpayer adjusted
gross income and return complexity) of developing and
running a free direct efile tax return system, including
costs to build and administer each release, with a focus
on multi-lingual and mobile-friendly features and
safeguards for taxpayer data; (II) taxpayer opinions,
expectations, and level of trust, based on surveys, for
such a free direct efile system; and (III) the opinions
of an independent third-party on the overall
feasibility, approach, schedule, cost, organizational
design, and Internal Revenue Service capacity to deliver
such a direct efile tax return system, $15,000,000, to
remain available until September 30, 2023: Provided,
That these amounts shall be in addition to amounts
otherwise available for such purposes.
(2) Treasury inspector general for tax administration.—For
necessary expenses of the Treasury Inspector General for Tax
Administration in carrying out the Inspector General Act of
1978, as amended, including purchase and hire of passenger motor
vehicles (31 U.S.C. 1343(b)); and services
[[Page 136 STAT. 1833]]
authorized by 5 U.S.C. 3109, at such rates as may be determined
by the Inspector General for Tax Administration, $403,000,000,
to remain available until September 30, 2031: Provided, That
these amounts shall be in addition to amounts otherwise
available for such purposes.
(3) Office of tax policy.—For necessary expenses of the
Office of Tax Policy of the Department of the Treasury to carry
out functions related to promulgating regulations under the
Internal Revenue Code of 1986, $104,533,803, to remain available
until September 30, 2031: Provided, That these amounts shall be
in addition to amounts otherwise available for such purposes.
(4) United states tax court.—For necessary expenses of the
United States Tax Court, including contract reporting and other
services as authorized by 5 U.S.C. 3109; $153,000,000, to remain
available until September 30, 2031: Provided, That these amounts
shall be in addition to amounts otherwise available for such
purposes.
(5) Treasury departmental offices.—For necessary expenses
of the Departmental Offices of the Department of the Treasury to
provide for oversight and implementation support for actions by
the Internal Revenue Service to implement this Act and the
amendments made by this Act, $50,000,000, to remain available
until September 30, 2031: Provided, That these amounts shall be
in addition to amounts otherwise available for such purposes.
Subtitle B—Prescription Drug Pricing Reform
1.4PART 1—LOWERING PRICES THROUGH DRUG PRICE NEGOTIATION
1.4.SEC11001. PROVIDING FOR LOWER PRICES FOR CERTAIN HIGH-PRICED SINGLE SOURCE DRUGS.
(a) Program To Lower Prices for Certain High-Priced Single Source
Drugs.—Title XI of the Social Security Act is amended by adding after
section 1184 (42 U.S.C. 1320e-3) the following new part:
1.5✂️✂️PART E—PRICE NEGOTIATION PROGRAM TO LOWER PRICES FOR CERTAIN HIGH-
PRICED SINGLE SOURCE DRUGS
✂️✂️SEC. 1191. <<NOTE: 42 USC 1320f.>> ESTABLISHMENT OF PROGRAM.
✂️✂️(a) In General.—The Secretary shall establish a Drug Price
Negotiation Program (in this part referred to as the ✂️program’). Under
the program, with respect to each price applicability period, the
Secretary shall—
✂️✂️(1) <<NOTE: Publication. Lists.>> publish a list of
selected drugs in accordance with section 1192;
✂️✂️(2) <<NOTE: Contracts.>> enter into agreements with
manufacturers of selected drugs with respect to such period, in
accordance with section 1193;
[[Page 136 STAT. 1834]]
✂️✂️(3) negotiate and, if applicable, renegotiate maximum fair
prices for such selected drugs, in accordance with section 1194;
✂️✂️(4) carry out the publication and administrative duties
and compliance monitoring in accordance with sections 1195 and
1196.
✂️✂️(b) Definitions Relating to Timing.—For purposes of this part:
✂️✂️(1) Initial price applicability year.—The term ✂️initial
price applicability year’ means a year (beginning with 2026).
✂️✂️(2) Price applicability period.—The term ✂️price
applicability period’ means, with respect to a qualifying single
source drug, the period beginning with the first initial price
applicability year with respect to which such drug is a selected
drug and ending with the last year during which the drug is a
selected drug.
✂️✂️(3) Selected drug publication date.—The term ✂️selected
drug publication date’ means, with respect to each initial price
applicability year, February 1 of the year that begins 2 years
prior to such year.
✂️✂️(4) Negotiation period.—The term ✂️negotiation period’
means, with respect to an initial price applicability year with
respect to a selected drug, the period—
✂️✂️(A) beginning on the sooner of—
✂️✂️(i) the date on which the manufacturer of
the drug and the Secretary enter into an agreement
under section 1193 with respect to such drug; or
✂️✂️(ii) February 28 following the selected drug
publication date with respect to such selected
drug; and
✂️✂️(B) ending on November 1 of the year that begins 2
years prior to the initial price applicability year.
✂️✂️(c) Other Definitions.—For purposes of this part:
✂️✂️(1) Manufacturer.—The term ✂️manufacturer’ has the meaning
given that term in section 1847A(c)(6)(A).
✂️✂️(2) Maximum fair price eligible individual.—The term
✂️maximum fair price eligible individual’ means, with respect to
a selected drug—
✂️✂️(A) in the case such drug is dispensed to the
individual at a pharmacy, by a mail order service, or by
another dispenser, an individual who is enrolled in a
prescription drug plan under part D of title XVIII or an
MA-PD plan under part C of such title if coverage is
provided under such plan for such selected drug; and
✂️✂️(B) in the case such drug is furnished or
administered to the individual by a hospital, physician,
or other provider of services or supplier, an individual
who is enrolled under part B of title XVIII, including
an individual who is enrolled in an MA plan under part C
of such title, if payment may be made under part B for
such selected drug.
✂️✂️(3) Maximum fair price.—The term ✂️maximum fair price’
means, with respect to a year during a price applicability
period and with respect to a selected drug (as defined in
section 1192(c)) with respect to such period, the price
negotiated pursuant to section 1194, and updated pursuant to
section 1195(b), as applicable, for such drug and year.
[[Page 136 STAT. 1835]]
✂️✂️(4) Reference product.—The term ✂️reference product’ has
the meaning given such term in section 351(i) of the Public
Health Service Act.
✂️✂️(5) Total expenditures.—The term ✂️total expenditures’
includes, in the case of expenditures with respect to part D of
title XVIII, the total gross covered prescription drug costs (as
defined in section 1860D-15(b)(3)). The term ✂️total
expenditures’ excludes, in the case of expenditures with respect
to part B of such title, expenditures for a drug or biological
product that are bundled or packaged into the payment for
another service.
✂️✂️(6) Unit.—The term ✂️unit’ means, with respect to a drug
or biological product, the lowest identifiable amount (such as a
capsule or tablet, milligram of molecules, or grams) of the drug
or biological product that is dispensed or furnished.
✂️✂️(d) <<NOTE: Regulations. Applicability.>> Timing for Initial
Price Applicability Year 2026.—Notwithstanding the provisions of this
part, in the case of initial price applicability year 2026, the
following rules shall apply for purposes of implementing the program:
✂️✂️(1) Subsection (b)(3) shall be applied by substituting
✂️September 1, 2023’ for ✂️, with respect to each initial price
applicability year, February 1 of the year that begins 2 years
prior to such year’.
✂️✂️(2) Subsection (b)(4) shall be applied—
✂️✂️(A) in subparagraph (A)(ii), by substituting
✂️October 1, 2023’ for ✂️February 28 following the
selected drug publication date with respect to such
selected drug’; and
✂️✂️(B) in subparagraph (B), by substituting ✂️August
1, 2024’ for ✂️November 1 of the year that begins 2 years
prior to the initial price applicability year’.
✂️✂️(3) Section 1192 shall be applied—
✂️✂️(A) in subsection (b)(1)(A), by substituting
✂️during the period beginning on June 1, 2022, and ending
on May 31, 2023’ for ✂️during the most recent period of
12 months prior to the selected drug publication date
(but ending not later than October 31 of the year prior
to the year of such drug publication date), with respect
to such year, for which data are available’; and
✂️✂️(B) in subsection (d)(1)(A), by substituting
✂️during the period beginning on June 1, 2022, and ending
on May 31, 2023’ for ✂️during the most recent period for
which data are available of at least 12 months prior to
the selected drug publication date (but ending no later
than October 31 of the year prior to the year of such
drug publication date), with respect to such year’.
✂️✂️(4) Section 1193(a) shall be applied by substituting
✂️October 1, 2023’ for ✂️February 28 following the selected drug
publication date with respect to such selected drug’.
✂️✂️(5) Section 1194(b)(2) shall be applied—
✂️✂️(A) in subparagraph (A), by substituting ✂️October
2, 2023’ for ✂️March 1 of the year of the selected drug
publication date, with respect to the selected drug’;
✂️✂️(B) in subparagraph (B), by substituting ✂️February
1, 2024’ for ✂️the June 1 following the selected drug
publication date’; and
✂️✂️(C) in subparagraph (E), by substituting ✂️August
1, 2024’ for ✂️the first day of November following the
selected
[[Page 136 STAT. 1836]]
drug publication date, with respect to the initial price
applicability year ‘.
✂️✂️(6) Section 1195(a)(1) shall be applied by substituting
✂️September 1, 2024’ for ✂️November 30 of the year that is 2 years
prior to such initial price applicability year’.
✂️✂️SEC. 1192. <<NOTE: 42 USC 1320f-1.>> SELECTION OF NEGOTIATION-
ELIGIBLE DRUGS AS SELECTED DRUGS.
✂️✂️(a) <<NOTE: Deadlines. Publication. List. Time periods.>> In
General.—Not later than the selected drug publication date with respect
to an initial price applicability year, in accordance with subsection
(b), the Secretary shall select and publish a list of—
✂️✂️(1) with respect to the initial price applicability year
2026, 10 negotiation-eligible drugs described in subparagraph
(A) of subsection (d)(1), but not subparagraph (B) of such
subsection, with respect to such year (or, all (if such number
is less than 10) such negotiation-eligible drugs with respect to
such year);
✂️✂️(2) with respect to the initial price applicability year
2027, 15 negotiation-eligible drugs described in subparagraph
(A) of subsection (d)(1), but not subparagraph (B) of such
subsection, with respect to such year (or, all (if such number
is less than 15) such negotiation-eligible drugs with respect to
such year);
✂️✂️(3) with respect to the initial price applicability year
2028, 15 negotiation-eligible drugs described in subparagraph
(A) or (B) of subsection (d)(1) with respect to such year (or,
all (if such number is less than 15) such negotiation-eligible
drugs with respect to such year); and
✂️✂️(4) with respect to the initial price applicability year
2029 or a subsequent year, 20 negotiation-eligible drugs
described in subparagraph (A) or (B) of subsection (d)(1), with
respect to such year (or, all (if such number is less than 20)
such negotiation-eligible drugs with respect to such year).
Subject to subsection (c)(2) and section 1194(f)(5), each drug published
on the list pursuant to the previous sentence shall be subject to the
negotiation process under section 1194 for the negotiation period with
respect to such initial price applicability year (and the renegotiation
process under such section as applicable for any subsequent year during
the applicable price applicability period).
✂️✂️(b) Selection of Drugs.—
✂️✂️(1) In general.—In carrying out subsection (a), subject
to paragraph (2), the Secretary shall, with respect to an
initial price applicability year, do the following:
✂️✂️(A) <<NOTE: Determination. Time periods.>> Rank
negotiation-eligible drugs described in subsection
(d)(1) according to the total expenditures for such
drugs under parts B and D of title XVIII, as determined
by the Secretary, during the most recent period of 12
months prior to the selected drug publication date (but
ending not later than October 31 of the year prior to
the year of such drug publication date), with respect to
such year, for which data are available, with the
negotiation-eligible drugs with the highest total
expenditures being ranked the highest.
✂️✂️(B) Select from such ranked drugs with respect to
such year the negotiation-eligible drugs with the
highest such rankings.
✂️✂️(2) <<NOTE: Applicability.>> High spend part d drugs for
2026 and 2027.—With respect to the initial price applicability
year 2026 and with
[[Page 136 STAT. 1837]]
respect to the initial price applicability year 2027, the
Secretary shall apply paragraph (1) as if the reference to
✂️negotiation-eligible drugs described in subsection (d)(1)’ were
a reference to ✂️negotiation-eligible drugs described in
subsection (d)(1)(A)’ and as if the reference to ✂️total
expenditures for such drugs under parts B and D of title XVIII’
were a reference to ✂️total expenditures for such drugs under
part D of title XVIII’.
✂️✂️(c) Selected Drug.—
✂️✂️(1) <<NOTE: Time period. Determination.>> In general.—
For purposes of this part, in accordance with subsection (e)(2)
and subject to paragraph (2), each negotiation-eligible drug
included on the list published under subsection (a) with respect
to an initial price applicability year shall be referred to as a
✂️selected drug’ with respect to such year and each subsequent
year beginning before the first year that begins at least 9
months after the date on which the Secretary determines at least
one drug or biological product—
✂️✂️(A) is approved or licensed (as applicable)—
✂️✂️(i) under section 505(j) of the Federal
Food, Drug, and Cosmetic Act using such drug as
the listed drug; or
✂️✂️(ii) under section 351(k) of the Public
Health Service Act using such drug as the
reference product; and
✂️✂️(B) is marketed pursuant to such approval or
licensure.
✂️✂️(2) Clarification.—A negotiation-eligible drug—
✂️✂️(A) that is included on the list published under
subsection (a) with respect to an initial price
applicability year; and
✂️✂️(B) for which the Secretary makes a determination
described in paragraph (1) before or during the
negotiation period with respect to such initial price
applicability year;
shall not be subject to the negotiation process under section
1194 with respect to such negotiation period and shall continue
to be considered a selected drug under this part with respect to
the number of negotiation-eligible drugs published on the list
under subsection (a) with respect to such initial price
applicability year.
✂️✂️(d) <<NOTE: Determinations. Time periods.>> Negotiation-Eligible
Drug.—
✂️✂️(1) <<NOTE: Definition.>> In general.—For purposes of
this part, subject to paragraph (2), the term ✂️negotiation-
eligible drug’ means, with respect to the selected drug
publication date with respect to an initial price applicability
year, a qualifying single source drug, as defined in subsection
(e), that is described in either of the following subparagraphs
(or, with respect to the initial price applicability year 2026
or 2027, that is described in subparagraph (A)):
✂️✂️(A) Part d high spend drugs.—The qualifying
single source drug is, determined in accordance with
subsection (e)(2), among the 50 qualifying single source
drugs with the highest total expenditures under part D
of title XVIII, as determined by the Secretary in
accordance with paragraph (3), during the most recent
12-month period for which data are available prior to
such selected drug publication date (but ending no later
than October 31 of the year prior to the year of such
drug publication date).
[[Page 136 STAT. 1838]]
✂️✂️(B) Part b high spend drugs.—The qualifying
single source drug is, determined in accordance with
subsection (e)(2), among the 50 qualifying single source
drugs with the highest total expenditures under part B
of title XVIII, as determined by the Secretary in
accordance with paragraph (3), during such most recent
12-month period, as described in subparagraph (A).
✂️✂️(2) Exception for small biotech drugs.—
✂️✂️(A) In general.—Subject to subparagraph (C), the
term ✂️negotiation-eligible drug’ shall not include, with
respect to the initial price applicability years 2026,
2027, and 2028, a qualifying single source drug that
meets either of the following:
✂️✂️(i) Part d drugs.—The total expenditures
for the qualifying single source drug under part D
of title XVIII, as determined by the Secretary in
accordance with paragraph (3)(B), during 2021—
✂️✂️(I) are equal to or less than 1
percent of the total expenditures under
such part D, as so determined, for all
covered part D drugs (as defined in
section 1860D-2(e)) during such year;
and
✂️✂️(II) are equal to at least 80
percent of the total expenditures under
such part D, as so determined, for all
covered part D drugs for which the
manufacturer of the drug has an
agreement in effect under section 1860D-
14A during such year.
✂️✂️(ii) Part b drugs.—The total expenditures
for the qualifying single source drug under part B
of title XVIII, as determined by the Secretary in
accordance with paragraph (3)(B), during 2021—
✂️✂️(I) are equal to or less than 1
percent of the total expenditures under
such part B, as so determined, for all
qualifying single source drugs for which
payment may be made under such part B
during such year; and
✂️✂️(II) are equal to at least 80
percent of the total expenditures under
such part B, as so determined, for all
qualifying single source drugs of the
manufacturer for which payment may be
made under such part B during such year.
✂️✂️(B) Clarifications relating to manufacturers.—
✂️✂️(i) Aggregation rule.—All persons treated
as a single employer under subsection (a) or (b)
of section 52 of the Internal Revenue Code of 1986
shall be treated as one manufacturer for purposes
of this paragraph.
✂️✂️(ii) <<NOTE: Effective dates.>>
Limitation.—A drug shall not be considered to be
a qualifying single source drug described in
clause (i) or (ii) of subparagraph (A) if the
manufacturer of such drug is acquired after 2021
by another manufacturer that does not meet the
definition of a specified manufacturer under
section 1860D-14C(g)(4)(B)(ii), effective at the
beginning of the plan year immediately following
such acquisition or, in the case of an acquisition
before 2025, effective January 1, 2025.
[[Page 136 STAT. 1839]]
✂️✂️(C) Drugs not included as small biotech drugs.—A
new formulation, such as an extended release
formulation, of a qualifying single source drug shall
not be considered a qualifying single source drug
described in subparagraph (A).
✂️✂️(3) Clarifications and determinations.—
✂️✂️(A) Previously selected drugs and small biotech
drugs excluded.—In applying subparagraphs (A) and (B)
of paragraph (1), the Secretary shall not consider or
count—
✂️✂️(i) drugs that are already selected drugs;
and
✂️✂️(ii) for initial price applicability years
2026, 2027, and 2028, qualifying single source
drugs described in paragraph (2)(A).
✂️✂️(B) Use of data.—In determining whether a
qualifying single source drug satisfies any of the
criteria described in paragraph (1) or (2), the
Secretary shall use data that is aggregated across
dosage forms and strengths of the drug, including new
formulations of the drug, such as an extended release
formulation, and not based on the specific formulation
or package size or package type of the drug.
✂️✂️(e) Qualifying Single Source Drug.—
✂️✂️(1) <<NOTE: Definition.>> In general.—For purposes of
this part, the term ✂️qualifying single source drug’ means, with
respect to an initial price applicability year, subject to
paragraphs (2) and (3), a covered part D drug (as defined in
section 1860D-2(e)) that is described in any of the following or
a drug or biological product for which payment may be made under
part B of title XVIII that is described in any of the following:
✂️✂️(A) <<NOTE: Time periods.>> Drug products.—A
drug—
✂️✂️(i) that is approved under section 505(c) of
the Federal Food, Drug, and Cosmetic Act and is
marketed pursuant to such approval;
✂️✂️(ii) for which, as of the selected drug
publication date with respect to such initial
price applicability year, at least 7 years will
have elapsed since the date of such approval; and
✂️✂️(iii) that is not the listed drug for any
drug that is approved and marketed under section
505(j) of such Act.
✂️✂️(B) Biological products.—A biological product—
✂️✂️(i) that is licensed under section 351(a) of
the Public Health Service Act and is marketed
under section 351 of such Act;
✂️✂️(ii) for which, as of the selected drug
publication date with respect to such initial
price applicability year, at least 11 years will
have elapsed since the date of such licensure; and
✂️✂️(iii) that is not the reference product for
any biological product that is licensed and
marketed under section 351(k) of such Act.
✂️✂️(2) Treatment of authorized generic drugs.—
✂️✂️(A) In general.—In the case of a qualifying
single source drug described in subparagraph (A) or (B)
of paragraph (1) that is the listed drug (as such term
is used in section 505(j) of the Federal Food, Drug, and
Cosmetic Act) or a product described in clause (ii) of
subparagraph
[[Page 136 STAT. 1840]]
(B), with respect to an authorized generic drug, in
applying the provisions of this part, such authorized
generic drug and such listed drug or such product shall
be treated as the same qualifying single source drug.
✂️✂️(B) Authorized generic drug defined.—For purposes
of this paragraph, the term ✂️authorized generic drug’
means—
✂️✂️(i) in the case of a drug, an authorized
generic drug (as such term is defined in section
505(t)(3) of the Federal Food, Drug, and Cosmetic
Act); and
✂️✂️(ii) in the case of a biological product, a
product that—
✂️✂️(I) has been licensed under
section 351(a) of such Act; and
✂️✂️(II) is marketed, sold, or
distributed directly or indirectly to
retail class of trade under a different
labeling, packaging (other than
repackaging as the reference product in
blister packs, unit doses, or similar
packaging for use in institutions),
product code, labeler code, trade name,
or trade mark than the reference
product.
✂️✂️(3) Exclusions.—In this part, the term ✂️qualifying single
source drug’ does not include any of the following:
✂️✂️(A) Certain orphan drugs.—A drug that is
designated as a drug for only one rare disease or
condition under section 526 of the Federal Food, Drug,
and Cosmetic Act and for which the only approved
indication (or indications) is for such disease or
condition.
✂️✂️(B) <<NOTE: Time periods. Determination.>> Low
spend medicare drugs.—A drug or biological product with
respect to which the total expenditures under parts B
and D of title XVIII, as determined by the Secretary in
accordance with subsection (d)(3)(B)—
✂️✂️(i) with respect to initial price
applicability year 2026, is less than, during the
period beginning on June 1, 2022, and ending on
May 31, 2023, $200,000,000;
✂️✂️(ii) with respect to initial price
applicability year 2027, is less than, during the
most recent 12-month period applicable under
subparagraphs (A) and (B) of subsection (d)(1) for
such year, the dollar amount specified in clause
(i) increased by the annual percentage increase in
the consumer price index for all urban consumers
(all items; United States city average) for the
period beginning on June 1, 2023, and ending on
September 30, 2024; or
✂️✂️(iii) with respect to a subsequent initial
price applicability year, is less than, during the
most recent 12-month period applicable under
subparagraphs (A) and (B) of subsection (d)(1) for
such year, the dollar amount specified in this
subparagraph for the previous initial price
applicability year increased by the annual
percentage increase in such consumer price index
for the 12-month period ending on September 30 of
the year prior to the year of the selected drug
publication date with respect to such subsequent
initial price applicability year.
[[Page 136 STAT. 1841]]
✂️✂️(C) Plasma-derived products.—A biological product
that is derived from human whole blood or plasma.
✂️✂️SEC. 1193. <<NOTE: 42 USC 1320f-2.>> MANUFACTURER AGREEMENTS.
✂️✂️(a) <<NOTE: Deadline.>> In General.—For purposes of section
1191(a)(2), the Secretary shall enter into agreements with manufacturers
of selected drugs with respect to a price applicability period, by not
later than February 28 following the selected drug publication date with
respect to such selected drug, under which—
✂️✂️(1) <<NOTE: Determination. Deadline.>> during the
negotiation period for the initial price applicability year for
the selected drug, the Secretary and the manufacturer, in
accordance with section 1194, negotiate to determine (and, by
not later than the last date of such period, agree to) a maximum
fair price for such selected drug of the manufacturer in order
for the manufacturer to provide access to such price—
✂️✂️(A) to maximum fair price eligible individuals who
with respect to such drug are described in subparagraph
(A) of section 1191(c)(2) and are dispensed such drug
(and to pharmacies, mail order services, and other
dispensers, with respect to such maximum fair price
eligible individuals who are dispensed such drugs)
during, subject to paragraph (2), the price
applicability period; and
✂️✂️(B) to hospitals, physicians, and other providers
of services and suppliers with respect to maximum fair
price eligible individuals who with respect to such drug
are described in subparagraph (B) of such section and
are furnished or administered such drug during, subject
to paragraph (2), the price applicability period;
✂️✂️(2) <<NOTE: Deadline.>> the Secretary and the
manufacturer shall, in accordance with section 1194, renegotiate
(and, by not later than the last date of the period of
renegotiation, agree to) the maximum fair price for such drug,
in order for the manufacturer to provide access to such maximum
fair price (as so renegotiated)—
✂️✂️(A) to maximum fair price eligible individuals who
with respect to such drug are described in subparagraph
(A) of section 1191(c)(2) and are dispensed such drug
(and to pharmacies, mail order services, and other
dispensers, with respect to such maximum fair price
eligible individuals who are dispensed such drugs)
during any year during the price applicability period
(beginning after such renegotiation) with respect to
such selected drug; and
✂️✂️(B) to hospitals, physicians, and other providers
of services and suppliers with respect to maximum fair
price eligible individuals who with respect to such drug
are described in subparagraph (B) of such section and
are furnished or administered such drug during any year
described in subparagraph (A);
✂️✂️(3) subject to subsection (d), access to the maximum fair
price (including as renegotiated pursuant to paragraph (2)),
with respect to such a selected drug, shall be provided by the
manufacturer to—
✂️✂️(A) maximum fair price eligible individuals, who
with respect to such drug are described in subparagraph
(A) of section 1191(c)(2), at the pharmacy, mail order
service, or other dispenser at the point-of-sale of such
drug (and
[[Page 136 STAT. 1842]]
shall be provided by the manufacturer to the pharmacy,
mail order service, or other dispenser, with respect to
such maximum fair price eligible individuals who are
dispensed such drugs), as described in paragraph (1)(A)
or (2)(A), as applicable; and
✂️✂️(B) hospitals, physicians, and other providers of
services and suppliers with respect to maximum fair
price eligible individuals who with respect to such drug
are described in subparagraph (B) of such section and
are furnished or administered such drug, as described in
paragraph (1)(B) or (2)(B), as applicable;
✂️✂️(4) the manufacturer submits to the Secretary, in a form
and manner specified by the Secretary, for the negotiation
period for the price applicability period (and, if applicable,
before any period of renegotiation pursuant to section 1194(f))
with respect to such drug—
✂️✂️(A) information on the non-Federal average
manufacturer price (as defined in section 8126(h)(5) of
title 38, United States Code) for the drug for the
applicable year or period; and
✂️✂️(B) <<NOTE: Requirement.>> information that the
Secretary requires to carry out the negotiation (or
renegotiation process) under this part; and
✂️✂️(5) <<NOTE: Compliance. Requirements. Determination.>>
the manufacturer complies with requirements determined by the
Secretary to be necessary for purposes of administering the
program and monitoring compliance with the program.
✂️✂️(b) Agreement in Effect Until Drug Is No Longer a Selected Drug.—
An agreement entered into under this section shall be effective, with
respect to a selected drug, until such drug is no longer considered a
selected drug under section 1192(c).
✂️✂️(c) <<NOTE: Determination.>> Confidentiality of Information.—
Information submitted to the Secretary under this part by a manufacturer
of a selected drug that is proprietary information of such manufacturer
(as determined by the Secretary) shall be used only by the Secretary or
disclosed to and used by the Comptroller General of the United States
for purposes of carrying out this part.
✂️✂️(d) Nonduplication With 340B Ceiling Price.—Under an agreement
entered into under this section, the manufacturer of a selected drug—
✂️✂️(1) shall not be required to provide access to the maximum
fair price under subsection (a)(3), with respect to such
selected drug and maximum fair price eligible individuals who
are eligible to be furnished, administered, or dispensed such
selected drug at a covered entity described in section
340B(a)(4) of the Public Health Service Act, to such covered
entity if such selected drug is subject to an agreement
described in section 340B(a)(1) of such Act and the ceiling
price (defined in section 340B(a)(1) of such Act) is lower than
the maximum fair price for such selected drug; and
✂️✂️(2) <<NOTE: Requirement.>> shall be required to provide
access to the maximum fair price to such covered entity with
respect to maximum fair price eligible individuals who are
eligible to be furnished, administered, or dispensed such
selected drug at such entity at such ceiling price in a
nonduplicated amount to the ceiling price if such maximum fair
price is below the ceiling price for such selected drug.
[[Page 136 STAT. 1843]]
✂️✂️SEC. 1194. <<NOTE: 42 USC 1320f-3.>> NEGOTIATION AND
RENEGOTIATION PROCESS.
✂️✂️(a) In General.—For purposes of this part, under an agreement
under section 1193 between the Secretary and a manufacturer of a
selected drug (or selected drugs), with respect to the period for which
such agreement is in effect and in accordance with subsections (b), (c),
and (d), the Secretary and the manufacturer—
✂️✂️(1) shall during the negotiation period with respect to
such drug, in accordance with this section, negotiate a maximum
fair price for such drug for the purpose described in section
1193(a)(1); and
✂️✂️(2) renegotiate, in accordance with the process specified
pursuant to subsection (f), such maximum fair price for such
drug for the purpose described in section 1193(a)(2) if such
drug is a renegotiation-eligible drug under such subsection.
✂️✂️(b) Negotiation Process Requirements.—
✂️✂️(1) Methodology and process.—The Secretary shall develop
and use a consistent methodology and process, in accordance with
paragraph (2), for negotiations under subsection (a) that aims
to achieve the lowest maximum fair price for each selected drug.
✂️✂️(2) <<NOTE: Applicability. Deadlines.>> Specific elements
of negotiation process.—As part of the negotiation process
under this section, with respect to a selected drug and the
negotiation period with respect to the initial price
applicability year with respect to such drug, the following
shall apply:
✂️✂️(A) Submission of information.—Not later than
March 1 of the year of the selected drug publication
date, with respect to the selected drug, the
manufacturer of the drug shall submit to the Secretary,
in accordance with section 1193(a)(4), the information
described in such section.
✂️✂️(B) <<NOTE: Proposal.>> Initial offer by
secretary.—Not later than the June 1 following the
selected drug publication date, the Secretary shall
provide the manufacturer of the selected drug with a
written initial offer that contains the Secretary’s
proposal for the maximum fair price of the drug and a
concise justification based on the factors described in
section 1194(e) that were used in developing such offer.
✂️✂️(C) <<NOTE: Proposal.>> Response to initial
offer.—
✂️✂️(i) In general.—Not later than 30 days
after the date of receipt of an initial offer
under subparagraph (B), the manufacturer shall
either accept such offer or propose a counteroffer
to such offer.
✂️✂️(ii) Counteroffer requirements.—If a
manufacturer proposes a counteroffer, such
counteroffer—
✂️✂️(I) shall be in writing; and
✂️✂️(II) shall be justified based on
the factors described in subsection (e).
✂️✂️(D) Response to counteroffer.—After receiving a
counteroffer under subparagraph (C), the Secretary shall
respond in writing to such counteroffer.
✂️✂️(E) Deadline.—All negotiations between the
Secretary and the manufacturer of the selected drug
shall end prior to the first day of November following
the selected drug publication date, with respect to the
initial price applicability year.
[[Page 136 STAT. 1844]]
✂️✂️(F) Limitations on offer amount.—In negotiating
the maximum fair price of a selected drug, with respect
to the initial price applicability year for the selected
drug, and, as applicable, in renegotiating the maximum
fair price for such drug, with respect to a subsequent
year during the price applicability period for such
drug, the Secretary shall not offer (or agree to a
counteroffer for) a maximum fair price for the selected
drug that—
✂️✂️(i) exceeds the ceiling determined under
subsection (c) for the selected drug and year; or
✂️✂️(ii) as applicable, is less than the floor
determined under subsection (d) for the selected
drug and year.
✂️✂️(c) Ceiling for Maximum Fair Price.—
✂️✂️(1) General ceiling.—
✂️✂️(A) In general.—The maximum fair price negotiated
under this section for a selected drug, with respect to
the first initial price applicability year of the price
applicability period with respect to such drug, shall
not exceed the lower of the amount under subparagraph
(B) or the amount under subparagraph (C).
✂️✂️(B) Subparagraph (B) amount.—An amount equal to
the following:
✂️✂️(i) Covered part d drug.—In the case of a
covered part D drug (as defined in section 1860D-
2(e)), the sum of the plan specific enrollment
weighted amounts for each prescription drug plan
or MA-PD plan (as determined under paragraph (2)).
✂️✂️(ii) Part b drug or biological.—In the case
of a drug or biological product for which payment
may be made under part B of title XVIII, the
payment amount under section 1847A(b)(4) for the
drug or biological product for the year prior to
the year of the selected drug publication date
with respect to the initial price applicability
year for the drug or biological product.
✂️✂️(C) Subparagraph (C) amount.—An amount equal to
the applicable percent described in paragraph (3), with
respect to such drug, of the following:
✂️✂️(i) Initial price applicability year 2026.—
In the case of a selected drug with respect to
which such initial price applicability year is
2026, the average non-Federal average manufacturer
price for such drug for 2021 (or, in the case that
there is not an average non-Federal average
manufacturer price available for such drug for
2021, for the first full year following the market
entry for such drug), increased by the percentage
increase in the consumer price index for all urban
consumers (all items; United States city average)
from September 2021 (or December of such first
full year following the market entry), as
applicable, to September of the year prior to the
year of the selected drug publication date with
respect to such initial price applicability year.
✂️✂️(ii) Initial price applicability year 2027
and subsequent years.—In the case of a selected
drug with respect to which such initial price
applicability year is 2027 or a subsequent year,
the lower of—
[[Page 136 STAT. 1845]]
✂️✂️(I) the average non-Federal
average manufacturer price for such drug
for 2021 (or, in the case that there is
not an average non-Federal average
manufacturer price available for such
drug for 2021, for the first full year
following the market entry for such
drug), increased by the percentage
increase in the consumer price index for
all urban consumers (all items; United
States city average) from September 2021
(or December of such first full year
following the market entry), as
applicable, to September of the year
prior to the year of the selected drug
publication date with respect to such
initial price applicability year; or
✂️✂️(II) the average non-Federal
average manufacturer price for such drug
for the year prior to the selected drug
publication date with respect to such
initial price applicability year.
✂️✂️(2) Plan specific enrollment weighted amount.—For
purposes of paragraph (1)(B)(i), the plan specific enrollment
weighted amount for a prescription drug plan or an MA-PD plan
with respect to a covered Part D drug is an amount equal to the
product of—
✂️✂️(A) the negotiated price of the drug under such
plan under part D of title XVIII, net of all price
concessions received by such plan or pharmacy benefit
managers on behalf of such plan, for the most recent
year for which data is available; and
✂️✂️(B) a fraction—
✂️✂️(i) the numerator of which is the total
number of individuals enrolled in such plan in
such year; and
✂️✂️(ii) the denominator of which is the total
number of individuals enrolled in a prescription
drug plan or an MA-PD plan in such year.
✂️✂️(3) Applicable percent described.—For purposes of this
subsection, the applicable percent described in this paragraph
is the following:
✂️✂️(A) Short-monopoly drugs and vaccines.—With
respect to a selected drug (other than an extended-
monopoly drug and a long-monopoly drug), 75 percent.
✂️✂️(B) Extended-monopoly drugs.—With respect to an
extended-monopoly drug, 65 percent.
✂️✂️(C) Long-monopoly drugs.—With respect to a long-
monopoly drug, 40 percent.
✂️✂️(4) Extended-monopoly drug defined.—
✂️✂️(A) <<NOTE: Time period.>> In general.—In this
part, subject to subparagraph (B), the term ✂️extended-
monopoly drug’ means, with respect to an initial price
applicability year, a selected drug for which at least
12 years, but fewer than 16 years, have elapsed since
the date of approval of such drug under section 505(c)
of the Federal Food, Drug, and Cosmetic Act or since the
date of licensure of such drug under section 351(a) of
the Public Health Service Act, as applicable.
✂️✂️(B) Exclusions.—The term ✂️extended-monopoly drug’
shall not include any of the following:
[[Page 136 STAT. 1846]]
✂️✂️(i) A vaccine that is licensed under section
351 of the Public Health Service Act and marketed
pursuant to such section.
✂️✂️(ii) A selected drug for which a
manufacturer had an agreement under this part with
the Secretary with respect to an initial price
applicability year that is before 2030.
✂️✂️(C) Clarification.—Nothing in subparagraph
(B)(ii) shall limit the transition of a selected drug
described in paragraph (3)(A) to a long-monopoly drug if
the selected drug meets the definition of a long-
monopoly drug.
✂️✂️(5) Long-monopoly drug defined.—
✂️✂️(A) <<NOTE: Time period.>> In general.—In this
part, subject to subparagraph (B), the term ✂️long-
monopoly drug’ means, with respect to an initial price
applicability year, a selected drug for which at least
16 years have elapsed since the date of approval of such
drug under section 505(c) of the Federal Food, Drug, and
Cosmetic Act or since the date of licensure of such drug
under section 351(a) of the Public Health Service Act,
as applicable.
✂️✂️(B) Exclusion.—The term ✂️long-monopoly drug’
shall not include a vaccine that is licensed under
section 351 of the Public Health Service Act and
marketed pursuant to such section.
✂️✂️(6) <<NOTE: Time period.>> Average non-federal average
manufacturer price.—In this part, the term ✂️average non-Federal
average manufacturer price’ means the average of the non-Federal
average manufacturer price (as defined in section 8126(h)(5) of
title 38, United States Code) for the 4 calendar quarters of the
year involved.
✂️✂️(d) <<NOTE: Time periods.>> Temporary Floor for Small Biotech
Drugs.—In the case of a selected drug that is a qualifying single
source drug described in section 1192(d)(2) and with respect to which
the first initial price applicability year of the price applicability
period with respect to such drug is 2029 or 2030, the maximum fair price
negotiated under this section for such drug for such initial price
applicability year may not be less than 66 percent of the average non-
Federal average manufacturer price for such drug (as defined in
subsection (c)(6)) for 2021 (or, in the case that there is not an
average non-Federal average manufacturer price available for such drug
for 2021, for the first full year following the market entry for such
drug), increased by the percentage increase in the consumer price index
for all urban consumers (all items; United States city average) from
September 2021 (or December of such first full year following the market
entry), as applicable, to September of the year prior to the selected
drug publication date with respect to the initial price applicability
year.
✂️✂️(e) Factors.—For purposes of negotiating the maximum fair price
of a selected drug under this part with the manufacturer of the drug,
the Secretary shall consider the following factors, as applicable to the
drug, as the basis for determining the offers and counteroffers under
subsection (b) for the drug:
✂️✂️(1) Manufacturer-specific data.—The following data, with
respect to such selected drug, as submitted by the manufacturer:
[[Page 136 STAT. 1847]]
✂️✂️(A) Research and development costs of the
manufacturer for the drug and the extent to which the
manufacturer has recouped research and development
costs.
✂️✂️(B) Current unit costs of production and
distribution of the drug.
✂️✂️(C) Prior Federal financial support for novel
therapeutic discovery and development with respect to
the drug.
✂️✂️(D) Data on pending and approved patent
applications, exclusivities recognized by the Food and
Drug Administration, and applications and approvals
under section 505(c) of the Federal Food, Drug, and
Cosmetic Act or section 351(a) of the Public Health
Service Act for the drug.
✂️✂️(E) Market data and revenue and sales volume data
for the drug in the United States.
✂️✂️(2) Evidence about alternative treatments.—The following
evidence, as available, with respect to such selected drug and
therapeutic alternatives to such drug:
✂️✂️(A) The extent to which such drug represents a
therapeutic advance as compared to existing therapeutic
alternatives and the costs of such existing therapeutic
alternatives.
✂️✂️(B) Prescribing information approved by the Food
and Drug Administration for such drug and therapeutic
alternatives to such drug.
✂️✂️(C) Comparative effectiveness of such drug and
therapeutic alternatives to such drug, taking into
consideration the effects of such drug and therapeutic
alternatives to such drug on specific populations, such
as individuals with disabilities, the elderly, the
terminally ill, children, and other patient populations.
✂️✂️(D) The extent to which such drug and therapeutic
alternatives to such drug address unmet medical needs
for a condition for which treatment or diagnosis is not
addressed adequately by available therapy.
In using evidence described in subparagraph (C), the Secretary
shall not use evidence from comparative clinical effectiveness
research in a manner that treats extending the life of an
elderly, disabled, or terminally ill individual as of lower
value than extending the life of an individual who is younger,
nondisabled, or not terminally ill.
✂️✂️(f) Renegotiation Process.—
✂️✂️(1) <<NOTE: Effective date.>> In general.—In the case of
a renegotiation-eligible drug (as defined in paragraph (2)) that
is selected under paragraph (3), the Secretary shall provide for
a process of renegotiation (for years (beginning with 2028)
during the price applicability period, with respect to such
drug) of the maximum fair price for such drug consistent with
paragraph (4).
✂️✂️(2) Renegotiation-eligible drug defined.—In this section,
the term ✂️renegotiation-eligible drug’ means a selected drug
that is any of the following:
✂️✂️(A) Addition of new indication.—A selected drug
for which a new indication is added to the drug.
✂️✂️(B) Change of status to an extended-monopoly
drug.—A selected drug that—
✂️✂️(i) is not an extended-monopoly or a long-
monopoly drug; and
[[Page 136 STAT. 1848]]
✂️✂️(ii) for which there is a change in status
to that of an extended-monopoly drug.
✂️✂️(C) Change of status to a long-monopoly drug.—A
selected drug that—
✂️✂️(i) is not a long-monopoly drug; and
✂️✂️(ii) for which there is a change in status
to that of a long-monopoly drug.
✂️✂️(D) <<NOTE: Determination.>> Material changes.—A
selected drug for which the Secretary determines there
has been a material change of any of the factors
described in paragraph (1) or (2) of subsection (e).
✂️✂️(3) <<NOTE: Effective date.>> Selection of drugs for
renegotiation.—For each year (beginning with 2028), the
Secretary shall select among renegotiation-eligible drugs for
renegotiation as follows:
✂️✂️(A) All extended-monopoly negotiation-eligible
drugs.—The Secretary shall select all renegotiation-
eligible drugs described in paragraph (2)(B).
✂️✂️(B) All long-monopoly negotiation-eligible
drugs.—The Secretary shall select all renegotiation-
eligible drugs described in paragraph (2)(C).
✂️✂️(C) Remaining drugs.—Among the remaining
renegotiation-eligible drugs described in subparagraphs
(A) and (D) of paragraph (2), the Secretary shall select
renegotiation-eligible drugs for which the Secretary
expects renegotiation is likely to result in a
significant change in the maximum fair price otherwise
negotiated.
✂️✂️(4) Renegotiation process.—
✂️✂️(A) In general.—The Secretary shall specify the
process for renegotiation of maximum fair prices with
the manufacturer of a renegotiation-eligible drug
selected for renegotiation under this subsection.
✂️✂️(B) Consistent with negotiation process.—The
process specified under subparagraph (A) shall, to the
extent practicable, be consistent with the methodology
and process established under subsection (b) and in
accordance with subsections (c), (d), and (e), and for
purposes of applying subsections (c)(1)(A) and (d), the
reference to the first initial price applicability year
of the price applicability period with respect to such
drug shall be treated as the first initial price
applicability year of such period for which the maximum
fair price established pursuant to such renegotiation
applies, including for applying subsection (c)(3)(B) in
the case of renegotiation-eligible drugs described in
paragraph (3)(A) of this subsection and subsection
(c)(3)(C) in the case of renegotiation-eligible drugs
described in paragraph (3)(B) of this subsection.
✂️✂️(5) Clarification.—A renegotiation-eligible drug for
which the Secretary makes a determination described in section
1192(c)(1) before or during the period of renegotiation shall
not be subject to the renegotiation process under this section.
✂️✂️(g) <<NOTE: Effective date.>> Clarification.—The maximum fair
price for a selected drug described in subparagraph (A) or (B) of
paragraph (1) shall take effect no later than the first day of the first
calendar quarter that begins after the date described in subparagraph
(A) or (B), as applicable.
[[Page 136 STAT. 1849]]
✂️✂️SEC. 1195. <<NOTE: Deadlines. Time periods. 42 USC 1320f-4.>>
PUBLICATION OF MAXIMUM FAIR PRICES.
✂️✂️(a) In General.—With respect to an initial price applicability
year and a selected drug with respect to such year—
✂️✂️(1) not later than November 30 of the year that is 2 years
prior to such initial price applicability year, the Secretary
shall publish the maximum fair price for such drug negotiated
with the manufacturer of such drug under this part; and
✂️✂️(2) not later than March 1 of the year prior to such
initial price applicability year, the Secretary shall publish,
subject to section 1193(c), the explanation for the maximum fair
price with respect to the factors as applied under section
1194(e) for such drug described in paragraph (1).
✂️✂️(b) Updates.—
✂️✂️(1) Subsequent year maximum fair prices.—For a selected
drug, for each year subsequent to the first initial price
applicability year of the price applicability period with
respect to such drug, with respect to which an agreement for
such drug is in effect under section 1193, not later than
November 30 of the year that is 2 years prior to such subsequent
year, the Secretary shall publish the maximum fair price
applicable to such drug and year, which shall be—
✂️✂️(A) subject to subparagraph (B), the amount equal
to the maximum fair price published for such drug for
the previous year, increased by the annual percentage
increase in the consumer price index for all urban
consumers (all items; United States city average) for
the 12-month period ending with the July immediately
preceding such November 30; or
✂️✂️(B) in the case the maximum fair price for such
drug was renegotiated, for the first year for which such
price as so renegotiated applies, such renegotiated
maximum fair price.
✂️✂️(2) <<NOTE: Determination.>> Prices negotiated after
deadline.—In the case of a selected drug with respect to an
initial price applicability year for which the maximum fair
price is determined under this part after the date of
publication under this section, the Secretary shall publish such
maximum fair price by not later than 30 days after the date such
maximum price is so determined.
✂️✂️SEC. 1196. <<NOTE: 42 USC 1320f-5.>> ADMINISTRATIVE DUTIES AND
COMPLIANCE MONITORING.
✂️✂️(a) Administrative Duties.—For purposes of section 1191(a)(4),
the administrative duties described in this section are the following:
✂️✂️(1) The establishment of procedures to ensure that the
maximum fair price for a selected drug is applied before—
✂️✂️(A) any coverage or financial assistance under
other health benefit plans or programs that provide
coverage or financial assistance for the purchase or
provision of prescription drug coverage on behalf of
maximum fair price eligible individuals; and
✂️✂️(B) any other discounts.
✂️✂️(2) The establishment of procedures to compute and apply
the maximum fair price across different strengths and dosage
forms of a selected drug and not based on the specific
formulation or package size or package type of such drug.
[[Page 136 STAT. 1850]]
✂️✂️(3) The establishment of procedures to carry out the
provisions of this part, as applicable, with respect to—
✂️✂️(A) maximum fair price eligible individuals who
are enrolled in a prescription drug plan under part D of
title XVIII or an MA-PD plan under part C of such title;
and
✂️✂️(B) maximum fair price eligible individuals who
are enrolled under part B of such title, including who
are enrolled in an MA plan under part C of such title.
✂️✂️(4) The establishment of a negotiation process and
renegotiation process in accordance with section 1194.
✂️✂️(5) The establishment of a process for manufacturers to
submit information described in section 1194(b)(2)(A).
✂️✂️(6) The sharing with the Secretary of the Treasury of such
information as is necessary to determine the tax imposed by
section 5000D of the Internal Revenue Code of 1986, including
the application of such tax to a manufacturer, producer, or
importer or the determination of any date described in section
5000D(c)(1) of such Code. For purposes of the preceding
sentence, such information shall include—
✂️✂️(A) the date on which the Secretary receives
notification of any termination of an agreement under
the Medicare coverage gap discount program under section
1860D-14A and the date on which any subsequent agreement
under such program is entered into;
✂️✂️(B) the date on which the Secretary receives
notification of any termination of an agreement under
the manufacturer discount program under section 1860D-
14C and the date on which any subsequent agreement under
such program is entered into; and
✂️✂️(C) the date on which the Secretary receives
notification of any termination of a rebate agreement
described in section 1927(b) and the date on which any
subsequent rebate agreement described in such section is
entered into.
✂️✂️(7) The establishment of procedures for purposes of
applying section 1192(d)(2)(B).
✂️✂️(b) Compliance Monitoring.—The Secretary shall monitor compliance
by a manufacturer with the terms of an agreement under section 1193 and
establish a mechanism through which violations of such terms shall be
reported.
✂️✂️SEC. 1197. <<NOTE: 42 USC 1320f-6.>> CIVIL MONETARY PENALTIES.
✂️✂️(a) Violations Relating to Offering of Maximum Fair Price.—Any
manufacturer of a selected drug that has entered into an agreement under
section 1193, with respect to a year during the price applicability
period with respect to such drug, that does not provide access to a
price that is equal to or less than the maximum fair price for such drug
for such year—
✂️✂️(1) to a maximum fair price eligible individual who with
respect to such drug is described in subparagraph (A) of section
1191(c)(2) and who is dispensed such drug during such year (and
to pharmacies, mail order services, and other dispensers, with
respect to such maximum fair price eligible individuals who are
dispensed such drugs); or
✂️✂️(2) to a hospital, physician, or other provider of
services or supplier with respect to maximum fair price eligible
individuals who with respect to such drug is described in
subparagraph (B) of such section and is furnished or
administered such drug
[[Page 136 STAT. 1851]]
by such hospital, physician, or provider or supplier during such
year;
shall be subject to a civil monetary penalty equal to ten times the
amount equal to the product of the number of units of such drug so
furnished, dispensed, or administered during such year and the
difference between the price for such drug made available for such year
by such manufacturer with respect to such individual or hospital,
physician, provider of services, or supplier and the maximum fair price
for such drug for such year.
✂️✂️(b) Violations of Certain Terms of Agreement.—Any manufacturer of
a selected drug that has entered into an agreement under section 1193,
with respect to a year during the price applicability period with
respect to such drug, that is in violation of a requirement imposed
pursuant to section 1193(a)(5), including the requirement to submit
information pursuant to section 1193(a)(4), shall be subject to a civil
monetary penalty equal to $1,000,000 for each day of such violation.
✂️✂️(c) False Information.—Any manufacturer that knowingly provides
false information pursuant to section 1196(a)(7) shall be subject to a
civil monetary penalty equal to $100,000,000 for each item of such false
information.
✂️✂️(d) Application.—The provisions of section 1128A (other than
subsections (a) and (b)) shall apply to a civil monetary penalty under
this section in the same manner as such provisions apply to a penalty or
proceeding under section 1128A(a).
✂️✂️SEC. 1198. <<NOTE: 42 USC 1320f-7.>> LIMITATION ON
ADMINISTRATIVE AND JUDICIAL REVIEW.
✂️✂️There shall be no administrative or judicial review of any of the
following:
✂️✂️(1) The determination of a unit, with respect to a drug or
biological product, pursuant to section 1191(c)(6).
✂️✂️(2) The selection of drugs under section 1192(b), the
determination of negotiation-eligible drugs under section
1192(d), and the determination of qualifying single source drugs
under section 1192(e).
✂️✂️(3) The determination of a maximum fair price under
subsection (b) or (f) of section 1194.
✂️✂️(4) The determination of renegotiation-eligible drugs
under section 1194(f)(2) and the selection of renegotiation-
eligible drugs under section 1194(f)(3).’'.
(b) Application of Maximum Fair Prices and Conforming Amendments.—
(1) Under medicare.—
(A) Application to payments under part b.—Section
1847A(b)(1)(B) of the Social Security Act (42 U.S.C.
1395w-3a(b)(1)(B)) is amended by inserting ✂️✂️or in the
case of such a drug or biological product that is a
selected drug (as referred to in section 1192(c)), with
respect to a price applicability period (as defined in
section 1191(b)(2)), 106 percent of the maximum fair
price (as defined in section 1191(c)(3)) applicable for
such drug and a year during such period’' after
✂️✂️paragraph (4)’'.
(B) Application under ma of cost-sharing for part b
drugs based off of negotiated price.—Section
1852(a)(1)(B)(iv) of the Social Security Act (42 U.S.C.
1395w-22(a)(1)(B)(iv)) is amended—
[[Page 136 STAT. 1852]]
(i) by redesignating subclause (VII) as
subclause (VIII); and
(ii) by inserting after subclause (VI) the
following subclause:
✂️✂️(VII) A drug or biological product
that is a selected drug (as referred to
in section 1192(c)).’'.
(C) Exception to part D non-interference.—Section
1860D-11(i) of the Social Security Act (42 U.S.C. 1395w-
111(i)) is amended—
(i) in paragraph (1), by striking ✂️✂️and’' at
the end;
(ii) in paragraph (2), by striking ✂️✂️or
institute a price structure for the reimbursement
of covered part D drugs.’' and inserting ✂️✂️,
except as provided under section 1860D-4(b)(3)(l);
and’'; and
(iii) by adding at the end the following new
paragraph:
✂️✂️(3) may not institute a price structure for the
reimbursement of covered part D drugs, except as provided under
part E of title XI.’'.
(D) Application as negotiated price under part d.—
Section 1860D-2(d)(1) of the Social Security Act (42
U.S.C. 1395w-102(d)(1)) is amended—
(i) in subparagraph (B), by inserting ✂️✂️,
subject to subparagraph (D),’' after ✂️✂️negotiated
prices’'; and
(ii) by adding at the end the following new
subparagraph:
✂️✂️(D) Application of maximum fair price for selected
drugs.—In applying this section, in the case of a
covered part D drug that is a selected drug (as referred
to in section 1192(c)), with respect to a price
applicability period (as defined in section 1191(b)(2)),
the negotiated prices used for payment (as described in
this subsection) shall be no greater than the maximum
fair price (as defined in section 1191(c)(3)) for such
drug and for each year during such period plus any
dispensing fees for such drug.’'.
(E) Coverage of selected drugs.—Section 1860D-
4(b)(3) of the Social Security Act (42 U.S.C. 1395w-
104(b)(3)) is amended by adding at the end the following
new subparagraph:
✂️✂️(I) Required inclusion of selected drugs.—
✂️✂️(i) <<NOTE: Time periods.>> In general.—
For 2026 and each subsequent year, the PDP sponsor
offering a prescription drug plan shall include
each covered part D drug that is a selected drug
under section 1192 for which a maximum fair price
(as defined in section 1191(c)(3)) is in effect
with respect to the year.
✂️✂️(ii) Clarification.—Nothing in clause (i)
shall be construed as prohibiting a PDP sponsor
from removing such a selected drug from a
formulary if such removal would be permitted under
section 423.120(b)(5)(iv) of title 42, Code of
Federal Regulations (or any successor
regulation).’'.
(F) Information from prescription drug plans and ma-
pd plans required.—
(i) Prescription drug plans.—Section 1860D-
12(b) of the Social Security Act (42 U.S.C. 1395w-
[[Page 136 STAT. 1853]]
112(b)) is amended by adding at the end the
following new paragraph:
✂️✂️(8) Provision of information related to maximum fair
prices. <<NOTE: Contracts. Requirement.>> —Each contract
entered into with a PDP sponsor under this part with respect to
a prescription drug plan offered by such sponsor shall require
the sponsor to provide information to the Secretary as requested
by the Secretary for purposes of carrying out section 1194.’'.
(ii) MA-PD plans.—Section 1857(f)(3) of the
Social Security Act (42 U.S.C. 1395w-27(f)(3)) is
amended by adding at the end the following new
subparagraph:
✂️✂️(E) Provision of information related to maximum
fair prices.—Section 1860D-12(b)(8).’'.
(G) Conditions for coverage.—
(i) Medicare part d.—Section 1860D-43(c) of
the Social Security Act (42 U.S.C. 1395w-153(c))
is amended—
(I) by redesignating paragraphs (1)
and (2) as subparagraphs (A) and (B),
respectively;
(II) by striking ✂️✂️Agreements.—
Subsection’' and inserting the
following: ✂️✂️Agreements.—
✂️✂️(1) In general.—Subject to paragraph (2), subsection’';
and
(III) by adding at the end the
following new paragraph:
✂️✂️(2) Exception.—Paragraph (1)(A) shall not apply to a
covered part D drug of a manufacturer for any period described
in section 5000D(c)(1) of the Internal Revenue Code of 1986 with
respect to the manufacturer.’'.
(ii) Medicaid and medicare part b.—Section
1927(a)(3) of the Social Security Act (42 U.S.C.
1396r-8(a)(3)) is amended by adding at the end the
following new sentence: ✂️✂️The preceding sentence
shall not apply to a single source drug or
innovator multiple source drug of a manufacturer
for any period described in section 5000D(c)(1) of
the Internal Revenue Code of 1986 with respect to
the manufacturer.’'.
(H) Disclosure of information under medicare part
d.—
(i) Contract requirements.—Section 1860D-
12(b)(3)(D)(i) of the Social Security Act (42
U.S.C. 1395w-112(b)(3)(D)(i)) is amended by
inserting ✂️✂️, or carrying out part E of title XI’'
after ✂️✂️appropriate)’'.
(ii) Subsidies.—Section 1860D-15(f)(2)(A)(i)
of the Social Security Act (42 U.S.C. 1395w-
115(f)(2)(A)(i)) is amended by inserting ✂️✂️or part
E of title XI’' after ✂️✂️this section’'.
(2) Drug price negotiation program prices included in best
price.—Section 1927(c)(1)(C) of the Social Security Act (42
U.S.C. 1396r-8(c)(1)(C)) is amended—
(A) in clause (i)(VI), by striking ✂️✂️any prices
charged’' and inserting ✂️✂️subject to clause (ii)(V), any
prices charged’'; and
(B) in clause (ii)—
(i) in subclause (III), by striking ✂️✂️; and’'
at the end;
[[Page 136 STAT. 1854]]
(ii) in subclause (IV), by striking the period
at the end and inserting ✂️✂️; and’'; and
(iii) by adding at the end the following new
subclause:
✂️✂️(V) in the case of a rebate period
and a covered outpatient drug that is a
selected drug (as referred to in section
1192(c)) during such rebate period,
shall be inclusive of the maximum fair
price (as defined in section 1191(c)(3))
for such drug with respect to such
period.’'.
(3) Maximum fair prices excluded from average manufacturer
price.—Section 1927(k)(1)(B)(i) of the Social Security Act (42
U.S.C. 1396r-8(k)(1)(B)(i)) is amended—
(A) in subclause (IV) by striking ✂️✂️; and’' at the
end;
(B) in subclause (V) by striking the period at the
end and inserting ✂️✂️; and’'; and
(C) by adding at the end the following new
subclause:
✂️✂️(VI) any reduction in price paid
during the rebate period to the
manufacturer for a drug by reason of
application of part E of title XI.’'.
(c) <<NOTE: 42 USC 1320f note.>> Implementation for 2026 Through
2028.—The Secretary of Health and Human Services shall implement this
section, including the amendments made by this section, for 2026, 2027,
and 2028 by program instruction or other forms of program guidance.
1.5.SEC11002. SPECIAL RULE TO DELAY SELECTION AND NEGOTIATION OF BIOLOGICS FOR BIOSIMILAR MARKET ENTRY.
(a) In General.—Part E of title XI of the Social Security Act, as
added by section 11001, is amended—
(1) <<NOTE: 42 USC 1320f-1.>> in section 1192—
(A) in subsection (a), in the flush matter following
paragraph (4), by inserting ✂️✂️and subsection (b)(3)’'
after ✂️✂️the previous sentence’';
(B) in subsection (b)—
(i) in paragraph (1), by adding at the end the
following new subparagraph:
✂️✂️(C) In the case of a biological product for which
the inclusion of the biological product as a selected
drug on a list published under subsection (a) has been
delayed under subsection (f)(2), remove such biological
product from the rankings under subparagraph (A) before
making the selections under subparagraph (B).’'; and
(ii) by adding at the end the following new
paragraph:
✂️✂️(3) Inclusion of delayed biological products.—Pursuant to
subparagraphs (B)(ii)(I) and (C)(i) of subsection (f)(2), the
Secretary shall select and include on the list published under
subsection (a) the biological products described in such
subparagraphs. Such biological products shall count towards the
required number of drugs to be selected under subsection
(a)(1).’'; and
(C) by adding at the end the following new
subsection:
✂️✂️(f) Special Rule To Delay Selection and Negotiation of Biologics
for Biosimilar Market Entry.—
✂️✂️(1) Application.—
[[Page 136 STAT. 1855]]
✂️✂️(A) <<NOTE: Determination. Time period.>> In
general.—Subject to subparagraph (B), in the case of a
biological product that would (but for this subsection)
be an extended-monopoly drug (as defined in section
1194(c)(4)) included as a selected drug on the list
published under subsection (a) with respect to an
initial price applicability year, the rules described in
paragraph (2) shall apply if the Secretary determines
that there is a high likelihood (as described in
paragraph (3)) that a biosimilar biological product (for
which such biological product will be the reference
product) will be licensed and marketed under section
351(k) of the Public Health Service Act before the date
that is 2 years after the selected drug publication date
with respect to such initial price applicability year.
✂️✂️(B) Request required.—
✂️✂️(i) In general.—The Secretary shall not
provide for a delay under—
✂️✂️(I) paragraph (2)(A) unless a
request is made for such a delay by a
manufacturer of a biosimilar biological
product prior to the selected drug
publication date for the list published
under subsection (a) with respect to the
initial price applicability year for
which the biological product may have
been included as a selected drug on such
list but for subparagraph (2)(A); or
✂️✂️(II) <<NOTE: Time period.>>
paragraph (2)(B)(iii) unless a request
is made for such a delay by such a
manufacturer prior to the selected drug
publication date for the list published
under subsection (a) with respect to the
initial price applicability year that is
1 year after the initial price
applicability year for which the
biological product described in
subsection (a) would have been included
as a selected drug on such list but for
paragraph (2)(A).
✂️✂️(ii) Information and documents.—
✂️✂️(I) In general.—A request made
under clause (i) shall be submitted to
the Secretary by such manufacturer at a
time and in a form and manner specified
by the Secretary, and contain—
✂️✂️(aa) information and
documents necessary for the
Secretary to make determinations
under this subsection, as
specified by the Secretary and
including, to the extent
available, items described in
subclause (III); and
✂️✂️(bb) all agreements
related to the biosimilar
biological product filed with
the Federal Trade Commission or
the Assistant Attorney General
pursuant to subsections (a) and
(c) of section 1112 of the
Medicare Prescription Drug,
Improvement, and Modernization
Act of 2003.
✂️✂️(II) Additional information and
documents.—After the Secretary has
reviewed the request and materials
submitted under subclause (I), the
manufacturer shall submit any additional
[[Page 136 STAT. 1856]]
information and documents requested by
the Secretary necessary to make
determinations under this subsection.
✂️✂️(III) Items described.—The items
described in this clause are the
following:
✂️✂️(aa) The manufacturing
schedule for such biosimilar
biological product submitted to
the Food and Drug Administration
during its review of the
application under such section
351(k).
✂️✂️(bb) <<NOTE: Time
period.>> Disclosures (in
filings by the manufacturer of
such biosimilar biological
product with the Securities and
Exchange Commission required
under section 12(b), 12(g),
13(a), or 15(d) of the
Securities Exchange Act of 1934
about capital investment,
revenue expectations, and
actions taken by the
manufacturer that are typical of
the normal course of business in
the year (or the 2 years, as
applicable) before marketing of
a biosimilar biological product)
that pertain to the marketing of
such biosimilar biological
product, or comparable
documentation that is
distributed to the shareholders
of privately held companies.
✂️✂️(C) Aggregation rule.—
✂️✂️(i) In general.—All persons treated as a
single employer under subsection (a) or (b) of
section 52 of the Internal Revenue Code of 1986,
or in a partnership, shall be treated as one
manufacturer for purposes of paragraph (2)(D)(iv).
✂️✂️(ii) Partnership defined.—In clause (i),
the term ✂️partnership’ means a syndicate, group,
pool, joint venture, or other organization through
or by means of which any business, financial
operation, or venture is carried on by the
manufacturer of the biological product and the
manufacturer of the biosimilar biological product.
✂️✂️(2) <<NOTE: Time periods. Determination.>> Rules
described.—The rules described in this paragraph are the
following:
✂️✂️(A) Delayed selection and negotiation for 1
year.—If a determination of high likelihood is made
under paragraph (3), the Secretary shall delay the
inclusion of the biological product as a selected drug
on the list published under subsection (a) until such
list is published with respect to the initial price
applicability year that is 1 year after the initial
price applicability year for which the biological
product would have been included as a selected drug on
such list.
✂️✂️(B) If not licensed and marketed during the
initial delay.—
✂️✂️(i) In general.—If, during the time period
between the selected drug publication date on
which the biological product would have been
included on the list as a selected drug pursuant
to subsection (a) but for subparagraph (A) and the
selected drug publication date with respect to the
initial price applicability year that is 1 year
after the initial price applicability
[[Page 136 STAT. 1857]]
year for which such biological product would have
been included as a selected drug on such list, the
Secretary determines that the biosimilar
biological product for which the manufacturer
submitted the request under paragraph
(1)(B)(i)(II) (and for which the Secretary
previously made a high likelihood determination
under paragraph (3)) has not been licensed and
marketed under section 351(k) of the Public Health
Service Act, the Secretary shall, at the request
of such manufacturer—
✂️✂️(I) reevaluate whether there is a
high likelihood (as described in
paragraph (3)) that such biosimilar
biological product will be licensed and
marketed under such section 351(k)
before the date that is 2 years after
the selected drug publication date for
which such biological product would have
been included as a selected drug on such
list published but for subparagraph (A);
and
✂️✂️(II) <<NOTE: Evaluation.>>
evaluate whether, on the basis of clear
and convincing evidence, the
manufacturer of such biosimilar
biological product has made a
significant amount of progress (as
determined by the Secretary) towards
both such licensure and the marketing of
such biosimilar biological product
(based on information from items
described in subclauses (I)(bb) and (II)
of paragraph (1)(B)(ii)) since the
receipt by the Secretary of the request
made by such manufacturer under
paragraph (1)(B)(i)(I).
✂️✂️(ii) Selection and negotiation.—If the
Secretary determines that there is not a high
likelihood that such biosimilar biological product
will be licensed and marketed as described in
clause (i)(I) or there has not been a significant
amount of progress as described in clause
(i)(II)—
✂️✂️(I) the Secretary shall include
the biological product as a selected
drug on the list published under
subsection (a) with respect to the
initial price applicability year that is
1 year after the initial price
applicability year for which such
biological product would have been
included as a selected drug on such list
but for subparagraph (A); and
✂️✂️(II) the manufacturer of such
biological product shall pay a rebate
under paragraph (4) with respect to the
year for which such manufacturer would
have provided access to a maximum fair
price for such biological product but
for subparagraph (A).
✂️✂️(iii) Second 1-year delay.—If the Secretary
determines that there is a high likelihood that
such biosimilar biological product will be
licensed and marketed (as described in clause
(i)(I)) and a significant amount of progress has
been made by the manufacturer of such biosimilar
biological product towards such licensure and
marketing (as described in clause (i)(II)), the
Secretary shall delay the inclusion of the
biological product as a selected drug on the list
published under
[[Page 136 STAT. 1858]]
subsection (a) until the selected drug publication
date of such list with respect to the initial
price applicability year that is 2 years after the
initial price applicability year for which such
biological product would have been included as a
selected drug on such list but for this
subsection.
✂️✂️(C) If not licensed and marketed during the year
two delay.—If, during the time period between the
selected drug publication date of the list for which the
biological product would have been included as a
selected drug but for subparagraph (B)(iii) and the
selected drug publication date with respect to the
initial price applicability year that is 2 years after
the initial price applicability year for which such
biological product would have been included as a
selected drug on such list but for this subsection, the
Secretary determines that such biosimilar biological
product has not been licensed and marketed—
✂️✂️(i) the Secretary shall include such
biological product as a selected drug on such list
with respect to the initial price applicability
year that is 2 years after the initial price
applicability year for which such biological
product would have been included as a selected
drug on such list; and
✂️✂️(ii) the manufacturer of such biological
product shall pay a rebate under paragraph (4)
with respect to the years for which such
manufacturer would have provided access to a
maximum fair price for such biological product but
for this subsection.
✂️✂️(D) Limitations on delays.—
✂️✂️(i) Limited to 2 years.—In no case shall
the Secretary delay the inclusion of a biological
product on the list published under subsection (a)
for more than 2 years.
✂️✂️(ii) Exclusion of biological products that
transitioned to a long-monopoly drug during the
delay.—In the case of a biological product for
which the inclusion on the list published pursuant
to subsection (a) was delayed by 1 year under
subparagraph (A) and for which there would have
been a change in status to a long-monopoly drug
(as defined in section 1194(c)(5)) if such
biological product had been a selected drug, in no
case may the Secretary provide for a second 1-year
delay under subparagraph (B)(iii).
✂️✂️(iii) Exclusion of biological products if
more than 1 year since licensure.—In no case
shall the Secretary delay the inclusion of a
biological product on the list published under
subsection (a) if more than 1 year has elapsed
since the biosimilar biological product has been
licensed under section 351(k) of the Public Health
Service Act and marketing has not commenced for
such biosimilar biological product.
✂️✂️(iv) Certain manufacturers of biosimilar
biological products excluded.—In no case shall
the Secretary delay the inclusion of a biological
product
[[Page 136 STAT. 1859]]
as a selected drug on the list published under
subsection (a) if Secretary determined that the
manufacturer of the biosimilar biological product
described in paragraph (1)(A)—
✂️✂️(I) is the same as the
manufacturer of the reference product
described in such paragraph or is
treated as being the same pursuant to
paragraph (1)(C); or
✂️✂️(II) has, based on information
from items described in paragraph
(1)(B)(ii)(I)(bb), entered into any
agreement described in such paragraph
with the manufacturer of the reference
product described in paragraph (1)(A)
that—
✂️✂️(aa) requires or
incentivizes the manufacturer of
the biosimilar biological
product to submit a request
described in paragraph (1)(B);
or
✂️✂️(bb) restricts the
quantity (either directly or
indirectly) of the biosimilar
biological product that may be
sold in the United States over a
specified period of time.
✂️✂️(3) High likelihood.—For purposes of this subsection,
there is a high likelihood described in paragraph (1) or
paragraph (2), as applicable, if the Secretary finds that—
✂️✂️(A) an application for licensure under section
351(k) of the Public Health Service Act for the
biosimilar biological product has been accepted for
review or approved by the Food and Drug Administration;
and
✂️✂️(B) information from items described in sub
clauses (I)(bb) and (III) of paragraph (1)(B)(ii)
submitted to the Secretary by the manufacturer
requesting a delay under such paragraph provides clear
and convincing evidence that such biosimilar biological
product will, within the time period specified under
paragraph (1)(A) or (2)(B)(i)(I), be marketed.
✂️✂️(4) Rebate.—
✂️✂️(A) In general.—For purposes of subparagraphs
(B)(ii)(II) and (C)(ii) of paragraph (2), in the case of
a biological product for which the inclusion on the list
under subsection (a) was delayed under this subsection
and for which the Secretary has negotiated and entered
into an agreement under section 1193 with respect to
such biological product, the manufacturer shall be
required to pay a rebate to the Secretary at such time
and in such manner as determined by the Secretary.
✂️✂️(B) <<NOTE: Estimate.>> Amount.—Subject to
subparagraph (C), the amount of the rebate under
subparagraph (A) with respect to a biological product
shall be equal to the estimated amount—
✂️✂️(i) in the case of a biological product that
is a covered part D drug (as defined in section
1860D-2(e)), that is the sum of the products of—
✂️✂️(I) 75 percent of the amount by
which—
✂️✂️(aa) the average
manufacturer price, as reported
by the manufacturer of such
covered part D drug under
section 1927 (or, if not
reported by such manufacturer
under section
[[Page 136 STAT. 1860]]
1927, as reported by such
manufacturer to the Secretary
pursuant to the agreement under
section 1193(a)) for such
biological product, with respect
to each of the calendar quarters
of the price applicability
period that would have applied
but for this subsection; exceeds
✂️✂️(bb) in the initial price
applicability year that would
have applied but for a delay
under—
✂️✂️(AA) paragraph (2)(A),
the maximum fair price
negotiated under section
1194 for such biological
product under such
agreement; or
✂️✂️(BB) paragraph
(2)(B)(iii), such maximum
fair price, increased as
described in section
1195(b)(1)(A); and
✂️✂️(II) the number of units dispensed
under part D of title XVIII for such
covered part D drug during each such
calendar quarter of such price
applicability period; and
✂️✂️(ii) in the case of a biological product for
which payment may be made under part B of title
XVIII, that is the sum of the products of—
✂️✂️(I) 80 percent of the amount by
which—
✂️✂️(aa) the payment amount
for such biological product
under section 1847A(b), with
respect to each of the calendar
quarters of the price
applicability period that would
have applied but for this
subsection; exceeds
✂️✂️(bb) in the initial price
applicability year that would
have applied but for a delay
under—
✂️✂️(AA) paragraph (2)(A),
the maximum fair price
negotiated under section
1194 for such biological
product under such
agreement; or
✂️✂️(BB) paragraph
(2)(B)(iii), such maximum
fair price, increased as
described in section
1195(b)(1)(A); and
✂️✂️(II) the number of units
(excluding units that are packaged into
the payment amount for an item or
service and are not separately payable
under such part B) of the billing and
payment code of such biological product
administered or furnished under such
part B during each such calendar quarter
of such price applicability period.
✂️✂️(C) Special rule for delayed biological products
that are long-monopoly drugs.—
✂️✂️(i) <<NOTE: Determination.>> In general.—
In the case of a biological product with respect
to which a rebate is required to be paid under
this paragraph, if such biological product
qualifies as a long-monopoly drug (as defined in
section 1194(c)(5)) at the time of its inclusion
on the list published under subsection (a), in
determining the amount of the rebate for such
biological product under subparagraph (B), the
amount described in clause (ii) shall
[[Page 136 STAT. 1861]]
be substituted for the maximum fair price
described in clause (i)(I) or (ii)(I) of such
subparagraph (B), as applicable.
✂️✂️(ii) <<NOTE: Time periods.>> Amount
described.—The amount described in this clause is
an amount equal to 65 percent of the average non-
Federal average manufacturer price for the
biological product for 2021 (or, in the case that
there is not an average non-Federal average
manufacturer price available for such biological
product for 2021, for the first full year
following the market entry for such biological
product), increased by the percentage increase in
the consumer price index for all urban consumers
(all items; United States city average) from
September 2021 (or December of such first full
year following the market entry), as applicable,
to September of the year prior to the selected
drug publication date with respect to the initial
price applicability year that would have applied
but for this subsection.
✂️✂️(D) Rebate deposits.—Amounts paid as rebates
under this paragraph shall be deposited into—
✂️✂️(i) in the case payment is made for such
biological product under part B of title XVIII,
the Federal Supplementary Medical Insurance Trust
Fund established under section 1841; and
✂️✂️(ii) in the case such biological product is
a covered part D drug (as defined in section
1860D-2(e)), the Medicare Prescription Drug
Account under section 1860D-16 in such Trust Fund.
✂️✂️(5) Definitions of biosimilar biological product.—In this
subsection, the term ✂️biosimilar biological product’ has the
meaning given such term in section 1847A(c)(6).’';
(2) in section 1193(a)(4) <<NOTE: 42 USC 1320f-2.>> —
(A) in the matter preceding subparagraph (A), by
inserting ✂️✂️, and for section 1192(f),’' after ✂️✂️section
1194(f))’';
(B) in subparagraph (A), by striking ✂️✂️and’' at the
end;
(C) by adding at the end the following new
subparagraph:
✂️✂️(C) information that the Secretary requires to
carry out section 1192(f), including rebates under
paragraph (4) of such section; and’';
(3) in section 1196(a)(7) <<NOTE: 42 USC 1320f-5.>> , by
striking ✂️✂️section 1192(d)(2)(B)’' and inserting ✂️✂️subsections
(d)(2)(B) and (f)(1)(C) of section 1192’';
(4) in section 1197 <<NOTE: 42 USC 1320f-6.>> —
(A) by redesignating subsections (b), (c), and (d)
as subsections (c), (d), and (e), respectively; and
(B) by inserting after subsection (a) the following
new subsection:
✂️✂️(b) <<NOTE: Penalties.>> Violations Relating to Providing
Rebates.—Any manufacturer that fails to comply with the rebate
requirements under section 1192(f)(4) shall be subject to a civil
monetary penalty equal to 10 times the amount of the rebate the
manufacturer failed to pay under such section.’'; and
(5) in section 1198(b)(2) <<NOTE: 42 USC 1320f-7.>> , by
inserting ✂️✂️the application of section 1192(f),’' after
✂️✂️section 1192(e)’'.
[[Page 136 STAT. 1862]]
(b) Conforming Amendments for Disclosure of Certain Information.—
Section 1927(b)(3)(D)(i) of the Social Security Act (42 U.S.C. 1396r-
8(b)(3)(D)(i)) is amended by striking ✂️✂️or to carry out section 1847B’'
and inserting ✂️✂️or to carry out section 1847B or section 1192(f),
including rebates under paragraph (4) of such section’'.
(c) <<NOTE: 42 USC 1320f-1 note.>> Implementation for 2026 Through
2028.—The Secretary of Health and Human Services shall implement this
section, including the amendments made by this section, for 2026, 2027,
and 2028 by program instruction or other forms of program guidance.
1.5.SEC11003. EXCISE TAX IMPOSED ON DRUG MANUFACTURERS DURING NONCOMPLIANCE PERIODS.
(a) In General.—Subtitle D of the Internal Revenue Code of 1986 is
amended by adding at the end the following new chapter:
✂️✂️CHAPTER 50A <<NOTE: 26 USC 5000D prec.>> —DESIGNATED DRUGS
✂️✂️Sec. 5000D. Designated drugs during noncompliance periods.
✂️✂️SEC. 5000D <<NOTE: 26 USC 5000D.>> . DESIGNATED DRUGS DURING
NONCOMPLIANCE PERIODS.
✂️✂️(a) In General.—There is hereby imposed on the sale by the
manufacturer, producer, or importer of any designated drug during a day
described in subsection (b) a tax in an amount such that the applicable
percentage is equal to the ratio of—
✂️✂️(1) such tax, divided by
✂️✂️(2) the sum of such tax and the price for which so sold.
✂️✂️(b) Noncompliance Periods.—A day is described in this subsection
with respect to a designated drug if it is a day during one of the
following periods:
✂️✂️(1) The period beginning on the March 1st (or, in the case
of initial price applicability year 2026, the October 2nd)
immediately following the date on which such drug is included on
the list published under section 1192(a) of the Social Security
Act and ending on the earlier of—
✂️✂️(A) the first date on which the manufacturer of
such designated drug has in place an agreement described
in section 1193(a) of such Act with respect to such
drug, or
✂️✂️(B) the date that the Secretary of Health and
Human Services has made a determination described in
section 1192(c)(1) of such Act with respect to such
designated drug.
✂️✂️(2) The period beginning on the November 2nd immediately
following the March 1st described in paragraph (1) (or, in the
case of initial price applicability year 2026, the August 2nd
immediately following the October 2nd described in such
paragraph) and ending on the earlier of—
✂️✂️(A) the first date on which the manufacturer of
such designated drug and the Secretary of Health and
Human Services have agreed to a maximum fair price under
an agreement described in section 1193(a) of the Social
Security Act, or
✂️✂️(B) the date that the Secretary of Health and
Human Services has made a determination described in
section 1192(c)(1) of such Act with respect to such
designated drug.
✂️✂️(3) In the case of any designated drug which is a selected
drug (as defined in section 1192(c) of the Social Security Act)
[[Page 136 STAT. 1863]]
that the Secretary of Health and Human Services has selected for
renegotiation under section 1194(f) of such Act, the period
beginning on the November 2nd of the year that begins 2 years
prior to the first initial price applicability year of the price
applicability period for which the maximum fair price
established pursuant to such renegotiation applies and ending on
the earlier of—
✂️✂️(A) the first date on which the manufacturer of
such designated drug has agreed to a renegotiated
maximum fair price under such agreement, or
✂️✂️(B) the date that the Secretary of Health and
Human Services has made a determination described in
section 1192(c)(1) of such Act with respect to such
designated drug.
✂️✂️(4) With respect to information that is required to be
submitted to the Secretary of Health and Human Services under an
agreement described in section 1193(a) of the Social Security
Act, the period beginning on the date on which such Secretary
certifies that such information is overdue and ending on the
date that such information is so submitted.
✂️✂️(c) Suspension of Tax.— <<NOTE: Contracts.>>
✂️✂️(1) In general.—A day shall not be taken into account as
a day during a period described in subsection (b) if such day is
also a day during the period—
✂️✂️(A) beginning on the first date on which—
✂️✂️(i) <<NOTE: Notice.>> the notice of
terminations of all applicable agreements of the
manufacturer have been received by the Secretary
of Health and Human Services, and
✂️✂️(ii) none of the drugs of the manufacturer
of the designated drug are covered by an agreement
under section 1860D-14A or 1860D-14C of the Social
Security Act, and
✂️✂️(B) ending on the last day of February following
the earlier of—
✂️✂️(i) the first day after the date described
in subparagraph (A) on which the manufacturer
enters into any subsequent applicable agreement,
or
✂️✂️(ii) the first date any drug of the
manufacturer of the designated drug is covered by
an agreement under section 1860D-14A or 1860D-14C
of the Social Security Act.
✂️✂️(2) <<NOTE: Definition.>> Applicable agreement.—For
purposes of this subsection, the term ✂️applicable agreement’
means the following:
✂️✂️(A) An agreement under—
✂️✂️(i) the Medicare coverage gap discount
program under section 1860D-14A of the Social
Security Act, or
✂️✂️(ii) the manufacturer discount program under
section 1860D-14C of such Act.
✂️✂️(B) A rebate agreement described in section
1927(b) of such Act.
✂️✂️(d) <<NOTE: Definition.>> Applicable Percentage.—For purposes of
this section, the term ✂️applicable percentage’ means—
✂️✂️(1) in the case of sales of a designated drug during the
first 90 days described in subsection (b) with respect to such
drug, 65 percent,
[[Page 136 STAT. 1864]]
✂️✂️(2) in the case of sales of such drug during the 91st day
through the 180th day described in subsection (b) with respect
to such drug, 75 percent,
✂️✂️(3) in the case of sales of such drug during the 181st day
through the 270th day described in subsection (b) with respect
to such drug, 85 percent, and
✂️✂️(4) in the case of sales of such drug during any
subsequent day, 95 percent.
✂️✂️(e) Definitions.—For purposes of this section—
✂️✂️(1) Designated drug.—The term ✂️designated drug’ means any
negotiation-eligible drug (as defined in section 1192(d) of the
Social Security Act) included on the list published under
section 1192(a) of such Act which is manufactured or produced in
the United States or entered into the United States for
consumption, use, or warehousing.
✂️✂️(2) United states.—The term ✂️United States’ has the
meaning given such term by section 4612(a)(4).
✂️✂️(3) Other terms.—The terms ✂️initial price applicability
year’, ✂️price applicability period’, and ✂️maximum fair price’
have the meaning given such terms in section 1191 of the Social
Security Act.
✂️✂️(f) Special Rules.—
✂️✂️(1) <<NOTE: Applicability.>> Coordination with rules for
possessions of the united states.—Rules similar to the rules of
paragraphs (2) and (4) of section 4132(c) shall apply for
purposes of this section.
✂️✂️(2) Anti-abuse rule.—In the case of a sale which was
timed for the purpose of avoiding the tax imposed by this
section, the Secretary may treat such sale as occurring during a
day described in subsection (b).
✂️✂️(g) <<NOTE: Applicability.>> Exports.—Rules similar to the rules
of section 4662(e) (other than section 4662(e)(2)(A)(ii)(II)) shall
apply for purposes of this chapter.
✂️✂️(h) <<NOTE: Guidelines.>> Regulations.—The Secretary shall
prescribe such regulations and other guidance as may be necessary to
carry out this section.’'.
(b) No Deduction for Excise Tax Payments.—Section 275(a)(6) of the
Internal Revenue Code of 1986 <<NOTE: 26 USC 275.>> is amended by
inserting ✂️✂️50A,’' after ✂️✂️46,’'.
(c) Clerical Amendment.—The table of chapters for subtitle D of the
Internal Revenue Code of 1986 <<NOTE: 26 USC 4001 prec.>> is amended by
adding at the end the following new item:
✂️✂️Chapter 50A—Designated Drugs’'.
(d) <<NOTE: 26 USC 5000D note.>> Effective Date.—The amendments
made by this section shall apply to sales after the date of the
enactment of this Act.
1.5.SEC11004. FUNDING.
In addition to amounts otherwise available, there is appropriated to
the Centers for Medicare & Medicaid Services, out of any money in the
Treasury not otherwise appropriated, $3,000,000,000 for fiscal year
2022, to remain available until expended, to carry out the provisions
of, including the amendments made by, this part.
[[Page 136 STAT. 1865]]
1.6PART 2—PRESCRIPTION DRUG INFLATION REBATES
1.6.SEC11101. MEDICARE PART B REBATE BY MANUFACTURERS.
(a) In General.—Section 1847A of the Social Security Act (42 U.S.C.
1395w-3a) is amended by redesignating subsection (i) as subsection (j)
and by inserting after subsection (h) the following subsection:
✂️✂️(i) Rebate by Manufacturers for Single Source Drugs and
Biologicals With Prices Increasing Faster Than Inflation.—
✂️✂️(1) <<NOTE: Deadlines. Effective dates. Time periods.>>
Requirements.—
✂️✂️(A) <<NOTE: Reports.>> Secretarial provision of
information.—Not later than 6 months after the end of
each calendar quarter beginning on or after January 1,
2023, the Secretary shall, for each part B rebatable
drug, report to each manufacturer of such part B
rebatable drug the following for such calendar quarter:
✂️✂️(i) Information on the total number of units
of the billing and payment code described in
subparagraph (A)(i) of paragraph (3) with respect
to such drug and calendar quarter.
✂️✂️(ii) Information on the amount (if any) of
the excess average sales price increase described
in subparagraph (A)(ii) of such paragraph for such
drug and calendar quarter.
✂️✂️(iii) The rebate amount specified under such
paragraph for such part B rebatable drug and
calendar quarter.
✂️✂️(B) Manufacturer requirement.—For each calendar
quarter beginning on or after January 1, 2023, the
manufacturer of a part B rebatable drug shall, for such
drug, not later than 30 days after the date of receipt
from the Secretary of the information described in
subparagraph (A) for such calendar quarter, provide to
the Secretary a rebate that is equal to the amount
specified in paragraph (3) for such drug for such
calendar quarter.
✂️✂️(C) Transition rule for reporting.—The Secretary
may, for each part B rebatable drug, delay the timeframe
for reporting the information described in subparagraph
(A) for calendar quarters beginning in 2023 and 2024
until not later than September 30, 2025.
✂️✂️(2) Part b rebatable drug defined.—
✂️✂️(A) In general.—In this subsection, the term
✂️part B rebatable drug’ means a single source drug or
biological (as defined in subparagraph (D) of subsection
(c)(6)), including a biosimilar biological product (as
defined in subparagraph (H) of such subsection) but
excluding a qualifying biosimilar biological product (as
defined in subsection (b)(8)(B)(iii)), for which payment
is made under this part, except such term shall not
include such a drug or biological—
✂️✂️(i) <<NOTE: Determination.>> if, as
determined by the Secretary, the average total
allowed charges for such drug or biological under
this part for a year per individual that uses such
[[Page 136 STAT. 1866]]
a drug or biological are less than, subject to
subparagraph (B), $100; or
✂️✂️(ii) that is a vaccine described in
subparagraph (A) or (B) of section 1861(s)(10).
✂️✂️(B) <<NOTE: Time periods.>> Increase.—The dollar
amount applied under subparagraph (A)(i)—
✂️✂️(i) for 2024, shall be the dollar amount
specified under such subparagraph for 2023,
increased by the percentage increase in the
consumer price index for all urban consumers
(United States city average) for the 12-month
period ending with June of the previous year; and
✂️✂️(ii) for a subsequent year, shall be the
dollar amount specified in this clause (or clause
(i)) for the previous year (without application of
subparagraph (C)), increased by the percentage
increase in the consumer price index for all urban
consumers (United States city average) for the 12-
month period ending with June of the previous
year.
✂️✂️(C) Rounding.—Any dollar amount determined under
subparagraph (B) that is not a multiple of $10 shall be
rounded to the nearest multiple of $10.
✂️✂️(3) <<NOTE: Time periods.>> Rebate amount.—
✂️✂️(A) <<NOTE: Estimate.>> In general.—For purposes
of paragraph (1), the amount specified in this paragraph
for a part B rebatable drug assigned to a billing and
payment code for a calendar quarter is, subject to
subparagraphs (B) and (G) and paragraph (4), the
estimated amount equal to the product of—
✂️✂️(i) the total number of units determined
under subparagraph (B) for the billing and payment
code of such drug; and
✂️✂️(ii) the amount (if any) by which—
✂️✂️(I) the amount equal to—
✂️✂️(aa) in the case of a part
B rebatable drug described in
paragraph (1)(B) of subsection
(b), 106 percent of the amount
determined under paragraph (4)
of such section for such drug
during the calendar quarter; or
✂️✂️(bb) in the case of a part
B rebatable drug described in
paragraph (1)(C) of such
subsection, the payment amount
under such paragraph for such
drug during the calendar
quarter; exceeds
✂️✂️(II) the inflation-adjusted
payment amount determined under
subparagraph (C) for such part B
rebatable drug during the calendar
quarter.
✂️✂️(B) Total number of units.—For purposes of
subparagraph (A)(i), the total number of units for the
billing and payment code with respect to a part B
rebatable drug furnished during a calendar quarter
described in subparagraph (A) is equal to—
✂️✂️(i) the number of units for the billing and
payment code of such drug furnished during such
calendar quarter, minus
[[Page 136 STAT. 1867]]
✂️✂️(ii) the number of units for such billing
and payment code of such drug furnished during
such calendar quarter—
✂️✂️(I) with respect to which the
manufacturer provides a discount under
the program under section 340B of the
Public Health Service Act or a rebate
under section 1927; or
✂️✂️(II) that are packaged into the
payment amount for an item or service
and are not separately payable.
✂️✂️(C) Determination of inflation-adjusted payment
amount.—The inflation-adjusted payment amount
determined under this subparagraph for a part B
rebatable drug for a calendar quarter is—
✂️✂️(i) the payment amount for the billing and
payment code for such drug in the payment amount
benchmark quarter (as defined in subparagraph
(D)); increased by
✂️✂️(ii) the percentage by which the rebate
period CPI-U (as defined in subparagraph (F)) for
the calendar quarter exceeds the benchmark period
CPI-U (as defined in subparagraph (E)).
✂️✂️(D) <<NOTE: Definition.>> Payment amount
benchmark quarter.—The term ✂️payment amount benchmark
quarter’ means the calendar quarter beginning July 1,
2021.
✂️✂️(E) <<NOTE: Definition.>> Benchmark period cpi-
u.—The term ✂️benchmark period CPI-U’ means the consumer
price index for all urban consumers (United States city
average) for January 2021.
✂️✂️(F) Rebate period cpi-u.—The term ✂️rebate period
CPI-U’ means, with respect to a calendar quarter
described in subparagraph (C), the greater of the
benchmark period CPI-U and the consumer price index for
all urban consumers (United States city average) for the
first month of the calendar quarter that is two calendar
quarters prior to such described calendar quarter.
✂️✂️(G) Reduction or waiver for shortages and severe
supply chain disruptions.—The Secretary shall reduce or
waive the amount under subparagraph (A) with respect to
a part B rebatable drug and a calendar quarter—
✂️✂️(i) in the case of a part B rebatable drug
that is described as currently in shortage on the
shortage list in effect under section 506E of the
Federal Food, Drug, and Cosmetic Act at any point
during the calendar quarter; or
✂️✂️(ii) <<NOTE: Determination.>> in the case
of a biosimilar biological product, when the
Secretary determines there is a severe supply
chain disruption during the calendar quarter, such
as that caused by a natural disaster or other
unique or unexpected event.
✂️✂️(4) <<NOTE: Effective dates. Applicability. Time
periods.>> Special treatment of certain drugs and exemption.—
✂️✂️(A) Subsequently approved drugs.—In the case of a
part B rebatable drug first approved or licensed by the
Food and Drug Administration after December 1, 2020,
clause (i) of paragraph (3)(C) shall be applied as if
the term ✂️payment amount benchmark quarter’ were defined
[[Page 136 STAT. 1868]]
under paragraph (3)(D) as the third full calendar
quarter after the day on which the drug was first
marketed and clause (ii) of paragraph (3)(C) shall be
applied as if the term ✂️benchmark period CPI-U’ were
defined under paragraph (3)(E) as if the reference to
✂️January 2021’ under such paragraph were a reference to
✂️the first month of the first full calendar quarter
after the day on which the drug was first marketed’.
✂️✂️(B) Timeline for provision of rebates for
subsequently approved drugs.—In the case of a part B
rebatable drug first approved or licensed by the Food
and Drug Administration after December 1, 2020,
paragraph (1)(B) shall be applied as if the reference to
✂️January 1, 2023’ under such paragraph were a reference
to ✂️the later of the 6th full calendar quarter after the
day on which the drug was first marketed or January 1,
2023’.
✂️✂️(C) Selected drugs.—In the case of a part B
rebatable drug that is a selected drug (as defined in
section 1192(c)) with respect to a price applicability
period (as defined in section 1191(b)(2)), in the case
such drug is no longer considered to be a selected drug
under section 1192(c), for each applicable period (as
defined under subsection (g)(7)) beginning after the
price applicability period with respect to such drug,
clause (i) of paragraph (3)(C) shall be applied as if
the term ✂️payment amount benchmark quarter’ were defined
under paragraph (3)(D) as the calendar quarter beginning
January 1 of the last year during such price
applicability period with respect to such selected drug
and clause (ii) of paragraph (3)(C) shall be applied as
if the term ✂️benchmark period CPI-U’ were defined under
paragraph (3)(E) as if the reference to ✂️January 2021’
under such paragraph were a reference to ✂️the July of
the year preceding such last year’.
✂️✂️(5) <<NOTE: Effective date. Time period.>> Application to
beneficiary coinsurance.—In the case of a part B rebatable drug
furnished on or after April 1, 2023, if the payment amount
described in paragraph (3)(A)(ii)(I) (or, in the case of a part
B rebatable drug that is a selected drug (as defined in section
1192(c)), the payment amount described in subsection (b)(1)(B)
for such drug) for a calendar quarter exceeds the inflation
adjusted payment for such quarter—
✂️✂️(A) in computing the amount of any coinsurance
applicable under this part to an individual to whom such
drug is furnished, the computation of such coinsurance
shall be equal to 20 percent of the inflation-adjusted
payment amount determined under paragraph (3)(C) for
such part B rebatable drug; and
✂️✂️(B) <<NOTE: Applicability. Determination.>> the
amount of such coinsurance for such calendar quarter, as
computed under subparagraph (A), shall be applied as a
percent, as determined by the Secretary, to the payment
amount that would otherwise apply under subparagraphs
(B) or (C) of subsection (b)(1).
✂️✂️(6) Rebate deposits.—Amounts paid as rebates under
paragraph (1)(B) shall be deposited into the Federal
Supplementary Medical Insurance Trust Fund established under
section 1841.
[[Page 136 STAT. 1869]]
✂️✂️(7) <<NOTE: Time period.>> Civil money penalty.—If a
manufacturer of a part B rebatable drug has failed to comply
with the requirements under paragraph (1)(B) for such drug for a
calendar quarter, the manufacturer shall be subject to, in
accordance with a process established by the Secretary pursuant
to regulations, a civil money penalty in an amount equal to at
least 125 percent of the amount specified in paragraph (3) for
such drug for such calendar quarter.
The <<NOTE: Applicability.>> provisions of section 1128A (other
than subsections (a) (with respect to amounts of penalties or
additional assessments) and (b)) shall apply to a civil money
penalty under this paragraph in the same manner as such
provisions apply to a penalty or proceeding under section
1128A(a).
✂️✂️(8) Limitation on administrative or judicial review.—
There shall be no administrative or judicial review of any of
the following:
✂️✂️(A) The determination of units under this
subsection.
✂️✂️(B) The determination of whether a drug is a part
B rebatable drug under this subsection.
✂️✂️(C) The calculation of the rebate amount under
this subsection.
✂️✂️(D) The computation of coinsurance under paragraph
(5) of this subsection.
✂️✂️(E) The computation of amounts paid under section
1833(a)(1)(EE).’'.
(b) Amounts Payable; Cost-Sharing.—Section 1833 of the Social
Security Act (42 U.S.C. 1395l) is amended—
(1) in subsection (a)(1)—
(A) in subparagraph (G), by inserting ✂️✂️, subject to
subsection (i)(9),’' after ✂️✂️the amounts paid’';
(B) in subparagraph (S), by striking ✂️✂️with respect
to’' and inserting ✂️✂️subject to subparagraph (EE), with
respect to’';
(C) by striking ✂️✂️and (DD)’' and inserting ✂️✂️(DD)’';
and
(D) <<NOTE: Effective date. Time
period. Applicability.>> by inserting before the
semicolon at the end the following: ✂️✂️, and (EE) with
respect to a part B rebatable drug (as defined in
paragraph (2) of section 1847A(i)) furnished on or after
April 1, 2023, for which the payment amount for a
calendar quarter under paragraph (3)(A)(ii)(I) of such
section (or, in the case of a part B rebatable drug that
is a selected drug (as defined in section 1192(c) for
which, the payment amount described in section
1847A(b)(1)(B)) for such drug for such quarter exceeds
the inflation-adjusted payment under paragraph
(3)(A)(ii)(II) of such section for such quarter, the
amounts paid shall be equal to the percent of the
payment amount under paragraph (3)(A)(ii)(I) of such
section or section 1847A(b)(1)(B), as applicable, that
equals the difference between (i) 100 percent, and (ii)
the percent applied under section 1847A(i)(5)(B)’';
(2) in subsection (i), by adding at the end the following
new paragraph:
✂️✂️(9) <<NOTE: Effective date. Determination. Applicability.>> In
the case of a part B rebatable drug (as defined in paragraph (2) of
section 1847A(i)) for which payment under this subsection is not
packaged into a payment for a service furnished on or after April 1,
2023, under the revised payment system under this subsection, in lieu of
calculation of coinsurance and the amount
[[Page 136 STAT. 1870]]
of payment otherwise applicable under this subsection, the provisions of
section 1847A(i)(5) and paragraph (1)(EE) of subsection (a), shall, as
determined appropriate by the Secretary, apply under this subsection in
the same manner as such provisions of section 1847A(i)(5) and subsection
(a) apply under such section and subsection.’'; and
(3) in subsection (t)(8), by adding at the end the following
new subparagraph:
✂️✂️(F) <<NOTE: Effective date. Time
period. Determination. Applicability.>> Part b
rebatable drugs.—In the case of a part B rebatable drug
(as defined in paragraph (2) of section 1847A(i), except
if such drug does not have a copayment amount as a
result of application of subparagraph (E)) for which
payment under this part is not packaged into a payment
for a covered OPD service (or group of services)
furnished on or after April 1, 2023, and the payment for
such drug under this subsection is the same as the
amount for a calendar quarter under paragraph
(3)(A)(ii)(I) of section 1847A(i), under the system
under this subsection, in lieu of calculation of the
copayment amount and the amount of payment otherwise
applicable under this subsection (other than the
application of the limitation described in subparagraph
(C)), the provisions of section 1847A(i)(5) and
paragraph (1)(EE) of subsection (a), shall, as
determined appropriate by the Secretary, apply under
this subsection in the same manner as such provisions of
section 1847A(i)(5) and subsection (a) apply under such
section and subsection.’'.
(c) Conforming Amendments.—
(1) To part b asp calculation.—Section 1847A(c)(3) of the
Social Security Act (42 U.S.C. 1395w-3a(c)(3)) is amended by
inserting ✂️✂️subsection (i) or’' before ✂️✂️section 1927’'.
(2) Excluding part b drug inflation rebate from best
price.—Section 1927(c)(1)(C)(ii)(I) of the Social Security Act
(42 U.S.C. 1396r-8(c)(1)(C)(ii)(I)) is amended by inserting ✂️✂️or
section 1847A(i)’' after ✂️✂️this section’'.
(3) Coordination with medicaid rebate information
disclosure.—Section 1927(b)(3)(D)(i) of the Social Security Act
(42 U.S.C. 1396r-8(b)(3)(D)(i)) is amended by inserting ✂️✂️and
the rebate’' after ✂️✂️the payment amount’'.
(4) Excluding part b drug inflation rebates from average
manufacturer price.—Section 1927(k)(1)(B)(i) of the Social
Security Act (42 U.S.C. 1396r-8(k)(1)(B)(i)), as amended by
section 11001(b)(3), is amended—
(A) in subclause (V), by striking ✂️✂️and’' at the
end;
(B) in subclause (VI), by striking the period at the
end and inserting a semicolon; and
(C) by adding at the end the following new
subclause:
✂️✂️(VII) rebates paid by
manufacturers under section 1847A(i);
and’'.
(d) <<NOTE: Time period.>> Funding.—In addition to amounts
otherwise available, there are appropriated to the Centers for Medicare
& Medicaid Services, out of any money in the Treasury not otherwise
appropriated, $80,000,000 for fiscal year 2022, including $12,500,000 to
carry out the provisions of, including the amendments made by, this
section in fiscal year 2022, and $7,500,000 to carry out the provisions
of, including the amendments made by, this section
[[Page 136 STAT. 1871]]
in each of fiscal years 2023 through 2031, to remain available until
expended.
1.6.SEC11102. MEDICARE PART D REBATE BY MANUFACTURERS.
(a) In General.—Part D of title XVIII of the Social Security Act is
amended by inserting after section 1860D-14A (42 U.S.C. 1395w-114a) the
following new section:
✂️✂️SEC. 1860D-14B. <<NOTE: 42 USC 1395w-114b.>> MANUFACTURER
REBATE FOR CERTAIN DRUGS WITH PRICES
INCREASING FASTER THAN INFLATION.
✂️✂️(a) Requirements.—
✂️✂️(1) <<NOTE: Reports.>> Secretarial provision of
information.—Not later than 9 months after the end of each
applicable period (as defined in subsection (g)(7)), subject to
paragraph (3), the Secretary shall, for each part D rebatable
drug, report to each manufacturer of such part D rebatable drug
the following for such period:
✂️✂️(A) The amount (if any) of the excess annual
manufacturer price increase described in subsection
(b)(1)(A)(ii) for each dosage form and strength with
respect to such drug and period.
✂️✂️(B) The rebate amount specified under subsection
(b) for each dosage form and strength with respect to
such drug and period.
✂️✂️(2) <<NOTE: Deadline.>> Manufacturer requirements.—For
each applicable period, the manufacturer of a part D rebatable
drug, for each dosage form and strength with respect to such
drug, not later than 30 days after the date of receipt from the
Secretary of the information described in paragraph (1) for such
period, shall provide to the Secretary a rebate that is equal to
the amount specified in subsection (b) for such dosage form and
strength with respect to such drug for such period.
✂️✂️(3) <<NOTE: Time period. Effective date.>> Transition
rule for reporting.—The Secretary may, for each rebatable
covered part D drug, delay the timeframe for reporting the
information and rebate amount described in subparagraphs (A) and
(B) of such paragraph for the applicable periods beginning
October 1, 2022, and October 1, 2023, until not later than
December 31, 2025.
✂️✂️(b) <<NOTE: Determinations.>> Rebate Amount.—
✂️✂️(1) In general.—
✂️✂️(A) Calculation.—For purposes of this section,
the amount specified in this subsection for a dosage
form and strength with respect to a part D rebatable
drug and applicable period is, subject to subparagraph
(C), paragraph (5)(B), and paragraph (6), the estimated
amount equal to the product of—
✂️✂️(i) subject to subparagraph (B) of this
paragraph, the total number of units of such
dosage form and strength for each rebatable
covered part D drug dispensed under this part
during the applicable period; and
✂️✂️(ii) the amount (if any) by which—
✂️✂️(I) the annual manufacturer price
(as determined in paragraph (2)) paid
for such dosage form and strength with
respect to such part D rebatable drug
for the period; exceeds
✂️✂️(II) the inflation-adjusted
payment amount determined under
paragraph (3) for such dosage
[[Page 136 STAT. 1872]]
form and strength with respect to such
part D rebatable drug for the period.
✂️✂️(B) <<NOTE: Effective date.>> Excluded units.—
For purposes of subparagraph (A)(i), beginning with plan
year 2026, the Secretary shall exclude from the total
number of units for a dosage form and strength with
respect to a part D rebatable drug, with respect to an
applicable period, units of each dosage form and
strength of such part D rebatable drug for which the
manufacturer provides a discount under the program under
section 340B of the Public Health Service Act.
✂️✂️(C) Reduction or waiver for shortages and severe
supply chain disruptions.—The Secretary shall reduce or
waive the amount under subparagraph (A) with respect to
a part D rebatable drug and an applicable period—
✂️✂️(i) in the case of a part D rebatable drug
that is described as currently in shortage on the
shortage list in effect under section 506E of the
Federal Food, Drug, and Cosmetic Act at any point
during the applicable period;
✂️✂️(ii) in the case of a generic part D
rebatable drug (described in subsection
(g)(1)(C)(ii)) or a biosimilar (defined as a
biological product licensed under section 351(k)
of the Public Health Service Act), when the
Secretary determines there is a severe supply
chain disruption during the applicable period,
such as that caused by a natural disaster or other
unique or unexpected event; and
✂️✂️(iii) in the case of a generic Part D
rebatable drug (as so described), if the Secretary
determines that without such reduction or waiver,
the drug is likely to be described as in shortage
on such shortage list during a subsequent
applicable period.
✂️✂️(2) Determination of annual manufacturer price.—The
annual manufacturer price determined under this paragraph for a
dosage form and strength, with respect to a part D rebatable
drug and an applicable period, is the sum of the products of—
✂️✂️(A) the average manufacturer price (as defined in
subsection (g)(6)) of such dosage form and strength, as
calculated for a unit of such drug, with respect to each
of the calendar quarters of such period; and
✂️✂️(B) the ratio of—
✂️✂️(i) the total number of units of such dosage
form and strength reported under section 1927 with
respect to each such calendar quarter of such
period; to
✂️✂️(ii) the total number of units of such
dosage form and strength reported under section
1927 with respect to such period, as determined by
the Secretary.
✂️✂️(3) Determination of inflation-adjusted payment amount.—
The inflation-adjusted payment amount determined under this
paragraph for a dosage form and strength with respect to a part
D rebatable drug for an applicable period, subject to paragraph
(5), is—
✂️✂️(A) the benchmark period manufacturer price
determined under paragraph (4) for such dosage form and
strength with respect to such drug and period; increased
by
[[Page 136 STAT. 1873]]
✂️✂️(B) the percentage by which the applicable period
CPI-U (as defined in subsection (g)(5)) for the period
exceeds the benchmark period CPI-U (as defined in
subsection (g)(4)).
✂️✂️(4) Determination of benchmark period manufacturer
price.—The benchmark period manufacturer price determined under
this paragraph for a dosage form and strength, with respect to a
part D rebatable drug and an applicable period, is the sum of
the products of—
✂️✂️(A) the average manufacturer price (as defined in
subsection (g)(6)) of such dosage form and strength, as
calculated for a unit of such drug, with respect to each
of the calendar quarters of the payment amount benchmark
period (as defined in subsection (g)(3)); and
✂️✂️(B) the ratio of—
✂️✂️(i) the total number of units reported under
section 1927 of such dosage form and strength with
respect to each such calendar quarter of such
payment amount benchmark period; to
✂️✂️(ii) the total number of units reported
under section 1927 of such dosage form and
strength with respect to such payment amount
benchmark period.
✂️✂️(5) Special treatment of certain drugs and exemption.—
✂️✂️(A) <<NOTE: Effective dates. Applicability. Time
period.>> Subsequently approved drugs.—In the case of
a part D rebatable drug first approved or licensed by
the Food and Drug Administration after October 1, 2021,
subparagraphs (A) and (B) of paragraph (4) shall be
applied as if the term ✂️payment amount benchmark period’
were defined under subsection (g)(3) as the first
calendar year beginning after the day on which the drug
was first marketed and subparagraph (B) of paragraph (3)
shall be applied as if the term ✂️benchmark period CPI-U’
were defined under subsection (g)(4) as if the reference
to ✂️January 2021’ under such subsection were a reference
to ✂️January of the first year beginning after the date
on which the drug was first marketed’.
✂️✂️(B) Treatment of new formulations.—
✂️✂️(i) In general.—In the case of a part D
rebatable drug that is a line extension of a part
D rebatable drug that is an oral solid dosage
form, the Secretary shall establish a formula for
determining the rebate amount under paragraph (1)
and the inflation adjusted payment amount under
paragraph (3) with respect to such part D
rebatable drug and an applicable period,
consistent with the formula applied under
subsection (c)(2)(C) of section 1927 for
determining a rebate obligation for a rebate
period under such section.
✂️✂️(ii) Line extension defined.—In this
subparagraph, the term ✂️line extension’ means,
with respect to a part D rebatable drug, a new
formulation of the drug, such as an extended
release formulation, but does not include an
abuse-deterrent formulation of the drug (as
determined by the Secretary), regardless of
whether such abuse-deterrent formulation is an
extended release formulation.
[[Page 136 STAT. 1874]]
✂️✂️(C) <<NOTE: Effective date. Applicability.>>
Selected drugs.—In the case of a part D rebatable drug
that is a selected drug (as defined in section 1192(c))
with respect to a price applicability period (as defined
in section 1191(b)(2)), in the case such drug is no
longer considered to be a selected drug under section
1192(c), for each applicable period (as defined under
subsection (g)(7)) beginning after the price
applicability period with respect to such drug,
subparagraphs (A) and (B) of paragraph (4) shall be
applied as if the term ✂️payment amount benchmark period’
were defined under subsection (g)(3) as the last year
beginning during such price applicability period with
respect to such selected drug and subparagraph (B) of
paragraph (3) shall be applied as if the term ✂️benchmark
period CPI-U’ were defined under subsection (g)(4) as if
the reference to ✂️January 2021’ under such subsection
were a reference to ✂️January of the last year beginning
during such price applicability period with respect to
such drug’.
✂️✂️(6) Reconciliation in case of revised information.—The
Secretary shall provide for a method and process under which, in
the case where a PDP sponsor of a prescription drug plan or an
MA organization offering an MA-PD plan submits revisions to the
number of units of a rebatable covered part D drug dispensed,
the Secretary determines, pursuant to such revisions,
adjustments, if any, to the calculation of the amount specified
in this subsection for a dosage form and strength with respect
to such part D rebatable drug and an applicable period and
reconciles any overpayments or underpayments in amounts paid as
rebates under this subsection. <<NOTE: Deadline.>> Any
identified underpayment shall be rectified by the manufacturer
not later than 30 days after the date of receipt from the
Secretary of information on such underpayment.
✂️✂️(c) Rebate Deposits.—Amounts paid as rebates under subsection (b)
shall be deposited into the Medicare Prescription Drug Account in the
Federal Supplementary Medical Insurance Trust Fund established under
section 1841.
✂️✂️(d) Information.—For purposes of carrying out this section, the
Secretary shall use information submitted by—
✂️✂️(1) manufacturers under section 1927(b)(3);
✂️✂️(2) States under section 1927(b)(2)(A); and
✂️✂️(3) PDP sponsors of prescription drug plans and MA
organization offering MA-PD plans under this part.
✂️✂️(e) Civil Money Penalty.—If a manufacturer of a part D rebatable
drug has failed to comply with the requirement under subsection (a)(2)
with respect to such drug for an applicable period, the manufacturer
shall be subject to a civil money penalty in an amount equal to 125
percent of the amount specified in subsection (b) for such drug for such
period. The <<NOTE: Applicability.>> provisions of section 1128A (other
than subsections (a) (with respect to amounts of penalties or additional
assessments) and (b)) shall apply to a civil money penalty under this
subsection in the same manner as such provisions apply to a penalty or
proceeding under section 1128A(a).
✂️✂️(f) Limitation on Administrative or Judicial Review.—There shall
be no administrative or judicial review of any of the following:
✂️✂️(1) The determination of units under this section.
[[Page 136 STAT. 1875]]
✂️✂️(2) The determination of whether a drug is a part D
rebatable drug under this section.
✂️✂️(3) The calculation of the rebate amount under this
section.
✂️✂️(g) Definitions.—In this section:
✂️✂️(1) Part d rebatable drug.—
✂️✂️(A) In general.—Except as provided in
subparagraph (B), the term ✂️part D rebatable drug’
means, with respect to an applicable period, a drug or
biological described in subparagraph (C) that is a
covered part D drug (as such term is defined under
section 1860D-2(e)).
✂️✂️(B) Exclusion.—
✂️✂️(i) <<NOTE: Determinations. Estimate.>> In
general.—Such term shall, with respect to an
applicable period, not include a drug or
biological if the average annual total cost under
this part for such period per individual who uses
such a drug or biological, as determined by the
Secretary, is less than, subject to clause (ii),
$100, as determined by the Secretary using the
most recent data available or, if data is not
available, as estimated by the Secretary.
✂️✂️(ii) <<NOTE: Time periods. Effective
dates.>> Increase.—The dollar amount applied
under clause (i)—
✂️✂️(I) for the applicable period
beginning October 1, 2023, shall be the
dollar amount specified under such
clause for the applicable period
beginning October 1, 2022, increased by
the percentage increase in the consumer
price index for all urban consumers
(United States city average) for the 12-
month period beginning with October of
2023; and
✂️✂️(II) for a subsequent applicable
period, shall be the dollar amount
specified in this clause for the
previous applicable period, increased by
the percentage increase in the consumer
price index for all urban consumers
(United States city average) for the 12-
month period beginning with October of
the previous period.
Any dollar amount specified under this clause that
is not a multiple of $10 shall be rounded to the
nearest multiple of $10.
✂️✂️(C) Drug or biological described.—A drug or
biological described in this subparagraph is a drug or
biological that, as of the first day of the applicable
period involved, is—
✂️✂️(i) a drug approved under a new drug
application under section 505(c) of the Federal
Food, Drug, and Cosmetic Act;
✂️✂️(ii) a drug approved under an abbreviated
new drug application under section 505(j) of the
Federal Food, Drug, and Cosmetic Act, in the case
where—
✂️✂️(I) the reference listed drug
approved under section 505(c) of the
Federal Food, Drug, and Cosmetic Act,
including any ✂️authorized generic drug’
(as that term is defined in section
505(t)(3) of the Federal Food, Drug, and
Cosmetic Act), is not being marketed, as
identified in the Food and Drug
Administration’s National Drug Code
Directory;
[[Page 136 STAT. 1876]]
✂️✂️(II) there is no other drug
approved under section 505(j) of the
Federal Food, Drug, and Cosmetic Act
that is rated as therapeutically
equivalent (under the Food and Drug
Administration’s most recent publication
of ✂️Approved Drug Products with
Therapeutic Equivalence Evaluations’)
and that is being marketed, as
identified in the Food and Drug
Administration’s National Drug Code
Directory;
✂️✂️(III) <<NOTE: Time period.>> the
manufacturer is not a ✂️first applicant’
during the ✂️180-day exclusivity period’,
as those terms are defined in section
505(j)(5)(B)(iv) of the Federal Food,
Drug, and Cosmetic Act; and
✂️✂️(IV) the manufacturer is not a
✂️first approved applicant’ for a
competitive generic therapy, as that
term is defined in section
505(j)(5)(B)(v) of the Federal Food,
Drug, and Cosmetic Act; or
✂️✂️(iii) a biological licensed under section
351 of the Public Health Service Act.
✂️✂️(2) Unit.—The term ✂️unit’ means, with respect to a part D
rebatable drug, the lowest dispensable amount (such as a capsule
or tablet, milligram of molecules, or grams) of the part D
rebatable drug, as reported under section 1927.
✂️✂️(3) Payment amount benchmark period.—The term ✂️payment
amount benchmark period’ means the period beginning January 1,
2021, and ending in the month immediately prior to October 1,
2021.
✂️✂️(4) Benchmark period cpi-u.—The term ✂️benchmark period
CPI-U’ means the consumer price index for all urban consumers
(United States city average) for January 2021.
✂️✂️(5) Applicable period cpi-u.—The term ✂️applicable period
CPI-U’ means, with respect to an applicable period, the consumer
price index for all urban consumers (United States city average)
for the first month of such applicable period.
✂️✂️(6) Average manufacturer price.—The term ✂️average
manufacturer price’ has the meaning, with respect to a part D
rebatable drug of a manufacturer, given such term in section
1927(k)(1), with respect to a covered outpatient drug of a
manufacturer for a rebate period under section 1927.
✂️✂️(7) Applicable period.—The term ✂️applicable period’ means
a 12-month period beginning with October 1 of a year (beginning
with October 1, 2022).
✂️✂️(h) Implementation for 2022, 2023, and 2024.—The Secretary shall
implement this section for 2022, 2023, and 2024 by program instruction
or other forms of program guidance.’'.
(b) Conforming Amendments.—
(1) To part b asp calculation.—Section 1847A(c)(3) of the
Social Security Act (42 U.S.C. 1395w-3a(c)(3)), as amended by
section 11101(c)(1), is amended by striking ✂️✂️subsection (i) or
section 1927’' and inserting ✂️✂️subsection (i), section 1927, or
section 1860D-14B’'.
(2) Excluding part d drug inflation rebate from best
price.—Section 1927(c)(1)(C)(ii)(I) of the Social Security Act
(42 U.S.C. 1396r-8(c)(1)(C)(ii)(I)), as amended by section
11101(c)(2), is amended by striking ✂️✂️or section 1847A(i)’' and
inserting ✂️✂️, section 1847A(i), or section 1860D-14B’'.
[[Page 136 STAT. 1877]]
(3) Coordination with medicaid rebate information
disclosure.—Section 1927(b)(3)(D)(i) of the Social Security Act
(42 U.S.C. 1396r-8(b)(3)(D)(i)), as amended by sections 11002(b)
and 11101(c)(3), is amended by striking ✂️✂️or section 1192(f),
including rebates under paragraph (4) of such section’' and
inserting ✂️✂️, section 1192(f), including rebates under paragraph
(4) of such section, or section 1860D-14B’'.
(4) Excluding part d drug inflation rebates from average
manufacturer price.—Section 1927(k)(1)(B)(i) of the Social
Security Act (42 U.S.C. 1396r-8(k)(1)(B)(i)), as amended by
section 11001(b)(3) and section 11101(c)(4), is amended by
adding at the end the following new subclause:
(A) in subclause (VI), by striking ✂️✂️and’' at the
end;
(B) in subclause (VII), by striking the period at
the end and inserting a semicolon; and
(C) by adding at the end the following new
subclause:
✂️✂️(VIII) rebates paid by
manufacturers under section 1860D-
14B.’'.
(c) <<NOTE: Time periods.>> Funding.—In addition to amounts
otherwise available, there are appropriated to the Centers for Medicare
& Medicaid Services, out of any money in the Treasury not otherwise
appropriated, $80,000,000 for fiscal year 2022, including $12,500,000 to
carry out the provisions of, including the amendments made by, this
section in fiscal year 2022, and $7,500,000 to carry out the provisions
of, including the amendments made by, this section in each of fiscal
years 2023 through 2031, to remain available until expended.
1.7PART 3—PART D IMPROVEMENTS AND MAXIMUM OUT-OF-POCKET CAP FOR MEDICARE
BENEFICIARIES
1.7.SEC11201. <<NOTE: Time periods.>> MEDICARE PART D BENEFIT REDESIGN.
(a) Benefit Structure Redesign.—Section 1860D-2(b) of the Social
Security Act (42 U.S.C. 1395w-102(b)) is amended—
(1) in paragraph (2)—
(A) in subparagraph (A), in the matter preceding
clause (i), by inserting ✂️✂️for a year preceding 2025 and
for costs above the annual deductible specified in
paragraph (1) and up to the annual out-of-pocket
threshold specified in paragraph (4)(B) for 2025 and
each subsequent year’' after ✂️✂️paragraph (3)’';
(B) in subparagraph (C)—
(i) in clause (i), in the matter preceding
subclause (I), by inserting ✂️✂️for a year preceding
2025,’' after ✂️✂️paragraph (4),’'; and
(ii) in clause (ii)(III), by striking ✂️✂️and
each subsequent year’' and inserting ✂️✂️through
2024’'; and
(C) in subparagraph (D)—
(i) in clause (i)—
(I) in the matter preceding
subclause (I), by inserting ✂️✂️for a year
preceding 2025,’' after ✂️✂️paragraph
(4),’'; and
(II) in subclause (I)(bb), by
striking ✂️✂️a year after 2018’' and
inserting ✂️✂️each of years 2019 through
2024’'; and
[[Page 136 STAT. 1878]]
(ii) in clause (ii)(V), by striking ✂️✂️2019 and
each subsequent year’' and inserting ✂️✂️each of
years 2019 through 2024’';
(2) in paragraph (3)(A)—
(A) in the matter preceding clause (i), by inserting
✂️✂️for a year preceding 2025,’' after ✂️✂️and (4),’'; and
(B) in clause (ii), by striking ✂️✂️for a subsequent
year’' and inserting ✂️✂️for each of years 2007 through
2024’'; and
(3) in paragraph (4)—
(A) in subparagraph (A)—
(i) in clause (i)—
(I) by redesignating subclauses (I)
and (II) as items (aa) and (bb),
respectively, and moving the margin of
each such redesignated item 2 ems to the
right;
(II) in the matter preceding item
(aa), as redesignated by subclause (I),
by striking ✂️✂️is equal to the greater
of—’' and inserting ✂️✂️is equal to—
✂️✂️(I) for a year preceding 2024, the
greater of—’';
(III) by striking the period at the
end of item (bb), as redesignated by
subclause (I), and inserting ✂️✂️; and’';
and
(IV) by adding at the end the
following:
✂️✂️(II) for 2024 and each succeeding
year, $0.’'; and
(ii) in clause (ii)—
(I) by striking ✂️✂️clause (i)(I)’'
and inserting ✂️✂️clause (i)(I)(aa)’'; and
(II) by adding at the end the
following new sentence: ✂️✂️The Secretary
shall continue to calculate the dollar
amounts specified in clause (i)(I)(aa),
including with the adjustment under this
clause, after 2023 for purposes of
section 1860D-14(a)(1)(D)(iii).’';
(B) in subparagraph (B)—
(i) in clause (i)—
(I) in subclause (V), by striking
✂️✂️or’' at the end;
(II) in subclause (VI)—
(aa) by striking ✂️✂️for a
subsequent year’' and inserting
✂️✂️for each of years 2021 through
2024’'; and
(bb) by striking the period
at the end and inserting a
semicolon; and
(III) by adding at the end the
following new subclauses:
✂️✂️(VII) for 2025, is equal to
$2,000; or
✂️✂️(VIII) for a subsequent year, is
equal to the amount specified in this
subparagraph for the previous year,
increased by the annual percentage
increase described in paragraph (6) for
the year involved.’'; and
(ii) in clause (ii), by striking ✂️✂️clause
(i)(II)’' and inserting ✂️✂️clause (i)’';
(C) in subparagraph (C)—
[[Page 136 STAT. 1879]]
(i) in clause (i), by striking ✂️✂️and for
amounts’' and inserting ✂️✂️and, for a year
preceding 2025, for amounts’'; and
(ii) in clause (iii)—
(I) by redesignating subclauses (I)
through (IV) as items (aa) through (dd)
and indenting appropriately;
(II) by striking ✂️✂️if such costs are
borne or paid’' and inserting ✂️✂️if such
costs—
✂️✂️(I) are borne or paid—’'; and
(III) in item (dd), by striking the
period at the end and inserting ✂️✂️;
or’'; and
(IV) by adding at the end the
following new subclause:
✂️✂️(II) for 2025 and subsequent
years, are reimbursed through insurance,
a group health plan, or certain other
third party payment arrangements, but
not including the coverage provided by a
prescription drug plan or an MA-PD plan
that is basic prescription drug coverage
(as defined in subsection (a)(3)) or any
payments by a manufacturer under the
manufacturer discount program under
section 1860D-14C.’'; and
(D) in subparagraph (E), by striking ✂️✂️In applying’'
and inserting ✂️✂️For each of years 2011 through 2024, in
applying’'.
(b) Reinsurance Payment Amount.—Section 1860D-15(b) of the Social
Security Act (42 U.S.C. 1395w-115(b)) is amended—
(1) in paragraph (1)—
(A) by striking ✂️✂️equal to 80 percent’' and
inserting ✂️✂️equal to—
✂️✂️(A) for a year preceding 2025, 80 percent’';
(B) in subparagraph (A), as added by subparagraph
(A), by striking the period at the end and inserting ✂️✂️;
and’'; and
(C) by adding at the end the following new
subparagraph:
✂️✂️(B) for 2025 and each subsequent year, the sum
of—
✂️✂️(i) with respect to applicable drugs (as
defined in section 1860D-14C(g)(2)), an amount
equal to 20 percent of such allowable reinsurance
costs attributable to that portion of gross
covered prescription drug costs as specified in
paragraph (3) incurred in the coverage year after
such individual has incurred costs that exceed the
annual out-of-pocket threshold specified in
section 1860D-2(b)(4)(B); and
✂️✂️(ii) with respect to covered part D drugs
that are not applicable drugs (as so defined), an
amount equal to 40 percent of such allowable
reinsurance costs attributable to that portion of
gross covered prescription drug costs as specified
in paragraph (3) incurred in the coverage year
after such individual has incurred costs that
exceed the annual out-of-pocket threshold
specified in section 1860D-2(b)(4)(B).’';
(2) in paragraph (2)—
(A) by striking ✂️✂️COSTS.—For purposes’' and
inserting ✂️✂️Costs.—
[[Page 136 STAT. 1880]]
✂️✂️(A) In general.—Subject to subparagraph (B), for
purposes’'; and
(B) by adding at the end the following new
subparagraph:
✂️✂️(B) Inclusion of manufacturer discounts on
applicable drugs. <<NOTE: Definition.>> —For purposes
of applying subparagraph (A), the term ✂️allowable
reinsurance costs’ shall include the portion of the
negotiated price (as defined in section 1860D-14C(g)(6))
of an applicable drug (as defined in section 1860D-
14C(g)(2)) that was paid by a manufacturer under the
manufacturer discount program under section 1860D-
14C.’'; and
(3) in paragraph (3)—
(A) in the first sentence, by striking ✂️✂️For
purposes’' and inserting ✂️✂️Subject to paragraph (2)(B),
for purposes’'; and
(B) in the second sentence, by inserting ✂️✂️(or, with
respect to 2025 and subsequent years, in the case of an
applicable drug, as defined in section 1860D-14C(g)(2),
by a manufacturer)’' after ✂️✂️by the individual or under
the plan’'.
(c) Manufacturer Discount Program.—
(1) In general.—Part D of title XVIII of the Social
Security Act (42 U.S.C. 1395w-101 through 42 U.S.C. 1395w-153),
as amended by section 11102, is amended by inserting after
section 1860D-14B the following new sections:
✂️✂️SEC. 1860D-14C. <<NOTE: 42 USC 1395w-114c.>> MANUFACTURER
DISCOUNT PROGRAM.
✂️✂️(a) Establishment.—The Secretary shall establish a manufacturer
discount program (in this section referred to as the ✂️program’). Under
the program, the Secretary shall enter into agreements described in
subsection (b) with manufacturers and provide for the performance of the
duties described in subsection (c).
✂️✂️(b) Terms of Agreement.—
✂️✂️(1) In general.—
✂️✂️(A) <<NOTE: Effective date.>> Agreement.—An
agreement under this section shall require the
manufacturer to provide, in accordance with this
section, discounted prices for applicable drugs of the
manufacturer that are dispensed to applicable
beneficiaries on or after January 1, 2025.
✂️✂️(B) Clarification.—Nothing in this section shall
be construed as affecting—
✂️✂️(i) the application of a coinsurance of 25
percent of the negotiated price, as applied under
paragraph (2)(A) of section 1860D-2(b), for costs
described in such paragraph; or
✂️✂️(ii) the application of the copayment amount
described in paragraph (4)(A) of such section,
with respect to costs described in such paragraph.
✂️✂️(C) <<NOTE: Deadlines.>> Timing of agreement.—
✂️✂️(i) Special rule for 2025.—In order for an
agreement with a manufacturer to be in effect
under this section with respect to the period
beginning on January 1, 2025, and ending on
December 31, 2025, the manufacturer shall enter
into such agreement not later than March 1, 2024.
[[Page 136 STAT. 1881]]
✂️✂️(ii) 2026 and subsequent years.—In order
for an agreement with a manufacturer to be in
effect under this section with respect to plan
year 2026 or a subsequent plan year, the
manufacturer shall enter into such agreement not
later than a calendar quarter or semi-annual
deadline established by the Secretary.
✂️✂️(2) <<NOTE: Determination.>> Provision of appropriate
data.—Each manufacturer with an agreement in effect under this
section shall collect and have available appropriate data, as
determined by the Secretary, to ensure that it can demonstrate
to the Secretary compliance with the requirements under the
program.
✂️✂️(3) Compliance with requirements for administration of
program.—Each manufacturer with an agreement in effect under
this section shall comply with requirements imposed by the
Secretary, as applicable, for purposes of administering the
program, including any determination under subparagraph (A) of
subsection (c)(1) or procedures established under such
subsection (c)(1).
✂️✂️(4) Length of agreement.—
✂️✂️(A) In general.—An agreement under this section
shall be effective for an initial period of not less
than 12 months and shall be automatically renewed for a
period of not less than 1 year unless terminated under
subparagraph (B).
✂️✂️(B) Termination.—
✂️✂️(i) By the secretary.—The Secretary shall
provide for termination of an agreement under this
section for a knowing and willful violation of the
requirements of the agreement or other good cause
shown. <<NOTE: Time period.>> Such termination
shall not be effective earlier than 30 days after
the date of notice to the manufacturer of such
termination. <<NOTE: Hearings.>> The Secretary
shall provide, upon request, a manufacturer with a
hearing concerning such a termination, and such
hearing shall take place prior to the effective
date of the termination with sufficient time for
such effective date to be repealed if the
Secretary determines appropriate.
✂️✂️(ii) By a manufacturer.—A manufacturer may
terminate an agreement under this section for any
reason. <<NOTE: Effective dates.>> Any such
termination shall be effective, with respect to a
plan year—
✂️✂️(I) if the termination occurs
before January 31 of a plan year, as of
the day after the end of the plan year;
and
✂️✂️(II) if the termination occurs on
or after January 31 of a plan year, as
of the day after the end of the
succeeding plan year.
✂️✂️(iii) Effectiveness of termination.—Any
termination under this subparagraph shall not
affect discounts for applicable drugs of the
manufacturer that are due under the agreement
before the effective date of its termination.
✂️✂️(5) Effective date of agreement.—An agreement under this
section shall take effect at the start of a calendar quarter or
another date specified by the Secretary.
✂️✂️(c) Duties Described.—The duties described in this subsection are
the following:
[[Page 136 STAT. 1882]]
✂️✂️(1) Administration of program.—Administering the program,
including—
✂️✂️(A) the determination of the amount of the
discounted price of an applicable drug of a
manufacturer;
✂️✂️(B) the establishment of procedures to ensure
that, not later than the applicable number of calendar
days after the dispensing of an applicable drug by a
pharmacy or mail order service, the pharmacy or mail
order service is reimbursed for an amount equal to the
difference between—
✂️✂️(i) the negotiated price of the applicable
drug; and
✂️✂️(ii) the discounted price of the applicable
drug;
✂️✂️(C) the establishment of procedures to ensure that
the discounted price for an applicable drug under this
section is applied before any coverage or financial
assistance under other health benefit plans or programs
that provide coverage or financial assistance for the
purchase or provision of prescription drug coverage on
behalf of applicable beneficiaries as specified by the
Secretary; and
✂️✂️(D) providing a reasonable dispute resolution
mechanism to resolve disagreements between
manufacturers, prescription drug plans and MA-PD plans,
and the Secretary.
✂️✂️(2) Monitoring compliance.—The Secretary shall monitor
compliance by a manufacturer with the terms of an agreement
under this section.
✂️✂️(3) Collection of data from prescription drug plans and
ma-pd plans.—The Secretary may collect appropriate data from
prescription drug plans and MA-PD plans in a timeframe that
allows for discounted prices to be provided for applicable drugs
under this section.
✂️✂️(d) Administration.—
✂️✂️(1) In general.—Subject to paragraph (2), the Secretary
shall provide for the implementation of this section, including
the performance of the duties described in subsection (c).
✂️✂️(2) Limitation.—In providing for the implementation of
this section, the Secretary shall not receive or distribute any
funds of a manufacturer under the program.
✂️✂️(e) Civil Money Penalty.—
✂️✂️(1) <<NOTE: Determination.>> In general.—A manufacturer
that fails to provide discounted prices for applicable drugs of
the manufacturer dispensed to applicable beneficiaries in
accordance with an agreement in effect under this section shall
be subject to a civil money penalty for each such failure in an
amount the Secretary determines is equal to the sum of—
✂️✂️(A) the amount that the manufacturer would have
paid with respect to such discounts under the agreement,
which will then be used to pay the discounts which the
manufacturer had failed to provide; and
✂️✂️(B) 25 percent of such amount.
✂️✂️(2) Application.—The provisions of section 1128A (other
than subsections (a) and (b)) shall apply to a civil money
penalty under this subsection in the same manner as such
provisions apply to a penalty or proceeding under section
1128A(a).
[[Page 136 STAT. 1883]]
✂️✂️(f) Clarification Regarding Availability of Other Covered Part D
Drugs.—Nothing in this section shall prevent an applicable beneficiary
from purchasing a covered part D drug that is not an applicable drug
(including a generic drug or a drug that is not on the formulary of the
prescription drug plan or MA-PD plan that the applicable beneficiary is
enrolled in).
✂️✂️(g) Definitions.—In this section:
✂️✂️(1) Applicable beneficiary.—The term ✂️applicable
beneficiary’ means an individual who, on the date of dispensing
a covered part D drug—
✂️✂️(A) is enrolled in a prescription drug plan or an
MA-PD plan;
✂️✂️(B) is not enrolled in a qualified retiree
prescription drug plan; and
✂️✂️(C) has incurred costs, as determined in
accordance with section 1860D-2(b)(4)(C), for covered
part D drugs in the year that exceed the annual
deductible specified in section 1860D-2(b)(1).
✂️✂️(2) Applicable drug.—The term ✂️applicable drug’, with
respect to an applicable beneficiary—
✂️✂️(A) means a covered part D drug—
✂️✂️(i) approved under a new drug application
under section 505(c) of the Federal Food, Drug,
and Cosmetic Act or, in the case of a biologic
product, licensed under section 351 of the Public
Health Service Act; and
✂️✂️(ii)(I) if the PDP sponsor of the
prescription drug plan or the MA organization
offering the MA-PD plan uses a formulary, which is
on the formulary of the prescription drug plan or
MA-PD plan that the applicable beneficiary is
enrolled in;
✂️✂️(II) if the PDP sponsor of the prescription
drug plan or the MA organization offering the MA-
PD plan does not use a formulary, for which
benefits are available under the prescription drug
plan or MA-PD plan that the applicable beneficiary
is enrolled in; or
✂️✂️(III) is provided through an exception or
appeal; and
✂️✂️(B) does not include a selected drug (as referred
to under section 1192(c)) during a price applicability
period (as defined in section 1191(b)(2)) with respect
to such drug.
✂️✂️(3) Applicable number of calendar days.—The term
✂️applicable number of calendar days’ means—
✂️✂️(A) with respect to claims for reimbursement
submitted electronically, 14 days; and
✂️✂️(B) with respect to claims for reimbursement
submitted otherwise, 30 days.
✂️✂️(4) Discounted price.—
✂️✂️(A) In general.—The term ✂️discounted price’
means, subject to subparagraphs (B) and (C), with
respect to an applicable drug of a manufacturer
dispensed during a year to an applicable beneficiary—
✂️✂️(i) who has not incurred costs, as
determined in accordance with section 1860D-
2(b)(4)(C), for covered part D drugs in the year
that are equal to or exceed the annual out-of-
pocket threshold specified in section 1860D-
2(b)(4)(B)(i) for the year, 90 percent of the
negotiated price of such drug; and
[[Page 136 STAT. 1884]]
✂️✂️(ii) who has incurred such costs, as so
determined, in the year that are equal to or
exceed such threshold for the year, 80 percent of
the negotiated price of such drug.
✂️✂️(B) Phase-in for certain drugs dispensed to lis
beneficiaries.—
✂️✂️(i) In general.—In the case of an
applicable drug of a specified manufacturer (as
defined in clause (ii)) that is marketed as of the
date of enactment of this subparagraph and
dispensed for an applicable beneficiary who is a
subsidy eligible individual (as defined in section
1860D-14(a)(3)), the term ✂️discounted price’ means
the specified LIS percent (as defined in clause
(iii)) of the negotiated price of the applicable
drug of the manufacturer.
✂️✂️(ii) Specified manufacturer.—
✂️✂️(I) In general.—In this
subparagraph, subject to subclause (II),
the term ✂️specified manufacturer’ means
a manufacturer of an applicable drug for
which, in 2021—
✂️✂️(aa) the manufacturer had
a coverage gap discount
agreement under section 1860D-
14A;
✂️✂️(bb) the total
expenditures for all of the
specified drugs of the
manufacturer covered by such
agreement or agreements for such
year and covered under this part
during such year represented
less than 1.0 percent of the
total expenditures under this
part for all covered Part D
drugs during such year; and
✂️✂️(cc) the total
expenditures for all of the
specified drugs of the
manufacturer that are single
source drugs and biological
products for which payment may
be made under part B during such
year represented less than 1.0
percent of the total
expenditures under part B for
all drugs or biological products
for which payment may be made
under such part during such
year.
✂️✂️(II) Specified drugs.—
✂️✂️(aa) In general.—For
purposes of this clause, the
term ✂️specified drug’ means,
with respect to a specified
manufacturer, for 2021, an
applicable drug that is
produced, prepared, propagated,
compounded, converted, or
processed by the manufacturer.
✂️✂️(bb) Aggregation rule.—
All persons treated as a single
employer under subsection (a) or
(b) of section 52 of the
Internal Revenue Code of 1986
shall be treated as one
manufacturer for purposes of
this
subparagraph. <<NOTE: Determinati
on. Requirement. Attestation.>>
For purposes of making a
determination pursuant to the
previous sentence, an agreement
under this section shall require
that a manufacturer provide and
attest to such information as
specified by the Secretary as
necessary.
✂️✂️(III) <<NOTE: Time
periods. Effective dates.>>
Limitation.—The term ✂️specified
manufacturer’ shall not include a
manufacturer
[[Page 136 STAT. 1885]]
described in subclause (I) if such
manufacturer is acquired after 2021 by
another manufacturer that is not a
specified manufacturer, effective at the
beginning of the plan year immediately
following such acquisition or, in the
case of an acquisition before 2025,
effective January 1, 2025.
✂️✂️(iii) Specified lis percent.—In this
subparagraph, the ✂️specified LIS percent’ means,
with respect to a year—
✂️✂️(I) for an applicable drug
dispensed for an applicable beneficiary
described in clause (i) who has not
incurred costs, as determined in
accordance with section 1860D-
2(b)(4)(C), for covered part D drugs in
the year that are equal to or exceed the
annual out-of-pocket threshold specified
in section 1860D-2(b)(4)(B)(i) for the
year—
✂️✂️(aa) for 2025, 99 percent;
✂️✂️(bb) for 2026, 98 percent;
✂️✂️(cc) for 2027, 95 percent;
✂️✂️(dd) for 2028, 92 percent;
and
✂️✂️(ee) for 2029 and each
subsequent year, 90 percent; and
✂️✂️(II) for an applicable drug
dispensed for an applicable beneficiary
described in clause (i) who has incurred
costs, as determined in accordance with
section 1860D-2(b)(4)(C), for covered
part D drugs in the year that are equal
to or exceed the annual out-of-pocket
threshold specified in section 1860D-
2(b)(4)(B)(i) for the year—
✂️✂️(aa) for 2025, 99 percent;
✂️✂️(bb) for 2026, 98 percent;
✂️✂️(cc) for 2027, 95 percent;
✂️✂️(dd) for 2028, 92 percent;
✂️✂️(ee) for 2029, 90 percent;
✂️✂️(ff) for 2030, 85 percent;
and
✂️✂️(gg) for 2031 and each
subsequent year, 80 percent.
✂️✂️(C) Phase-in for specified small manufacturers.—
✂️✂️(i) In general.—In the case of an
applicable drug of a specified small manufacturer
(as defined in clause (ii)) that is marketed as of
the date of enactment of this subparagraph and
dispensed for an applicable beneficiary, the term
✂️discounted price’ means the specified small
manufacturer percent (as defined in clause (iii))
of the negotiated price of the applicable drug of
the manufacturer.
✂️✂️(ii) Specified small manufacturer.—
✂️✂️(I) In general.—In this
subparagraph, subject to subclause
(III), the term ✂️specified small
manufacturer’ means a manufacturer of an
applicable drug for which, in 2021—
✂️✂️(aa) the manufacturer is a
specified manufacturer (as
defined in subparagraph
(B)(ii)); and
[[Page 136 STAT. 1886]]
✂️✂️(bb) the total
expenditures under part D for
any one of the specified small
manufacturer drugs of the
manufacturer that are covered by
the agreement or agreements
under section 1860D-14A of such
manufacturer for such year and
covered under this part during
such year are equal to or more
than 80 percent of the total
expenditures under this part for
all specified small manufacturer
drugs of the manufacturer that
are covered by such agreement or
agreements for such year and
covered under this part during
such year.
✂️✂️(II) Specified small manufacturer
drugs.—
✂️✂️(aa) In general.—For
purposes of this clause, the
term ✂️specified small
manufacturer drugs’ means, with
respect to a specified small
manufacturer, for 2021, an
applicable drug that is
produced, prepared, propagated,
compounded, converted, or
processed by the manufacturer.
✂️✂️(bb) Aggregation rule.—
All persons treated as a single
employer under subsection (a) or
(b) of section 52 of the
Internal Revenue Code of 1986
shall be treated as one
manufacturer for purposes of
this subparagraph. For purposes
of making a determination
pursuant to the previous
sentence, an agreement under
this section shall require that
a manufacturer provide and
attest to such information as
specified by the Secretary as
necessary.
✂️✂️(III) Limitation.—The term
✂️specified small manufacturer’ shall not
include a manufacturer described in
subclause (I) if such manufacturer is
acquired after 2021 by another
manufacturer that is not a specified
small manufacturer, effective at the
beginning of the plan year immediately
following such acquisition or, in the
case of an acquisition before 2025,
effective January 1, 2025.
✂️✂️(iii) Specified small manufacturer
percent.—In this subparagraph, the term
✂️specified small manufacturer percent’ means, with
respect to a year—
✂️✂️(I) for an applicable drug
dispensed for an applicable beneficiary
who has not incurred costs, as
determined in accordance with section
1860D-2(b)(4)(C), for covered part D
drugs in the year that are equal to or
exceed the annual out-of-pocket
threshold specified in section 1860D-
2(b)(4)(B)(i) for the year—
✂️✂️(aa) for 2025, 99 percent;
✂️✂️(bb) for 2026, 98 percent;
✂️✂️(cc) for 2027, 95 percent;
✂️✂️(dd) for 2028, 92 percent;
and
✂️✂️(ee) for 2029 and each
subsequent year, 90 percent; and
✂️✂️(II) for an applicable drug
dispensed for an applicable beneficiary
who has incurred costs, as
[[Page 136 STAT. 1887]]
determined in accordance with section
1860D-2(b)(4)(C), for covered part D
drugs in the year that are equal to or
exceed the annual out-of-pocket
threshold specified in section 1860D-
2(b)(4)(B)(i) for the year—
✂️✂️(aa) for 2025, 99 percent;
✂️✂️(bb) for 2026, 98 percent;
✂️✂️(cc) for 2027, 95 percent;
✂️✂️(dd) for 2028, 92 percent;
✂️✂️(ee) for 2029, 90 percent;
✂️✂️(ff) for 2030, 85 percent;
and
✂️✂️(gg) for 2031 and each
subsequent year, 80 percent.
✂️✂️(D) Total expenditures.—For purposes of this
paragraph, the term ✂️total expenditures’ includes, in
the case of expenditures with respect to part D, the
total gross covered prescription drug costs as defined
in section 1860D-15(b)(3). The term ✂️total expenditures’
excludes, in the case of expenditures with respect to
part B, expenditures for a drug or biological that are
bundled or packaged into the payment for another
service.
✂️✂️(E) Special case for certain claims.—
✂️✂️(i) Claims spanning deductible.—In the case
where the entire amount of the negotiated price of
an individual claim for an applicable drug with
respect to an applicable beneficiary does not fall
above the annual deductible specified in section
1860D-2(b)(1) for the year, the manufacturer of
the applicable drug shall provide the discounted
price under this section on only the portion of
the negotiated price of the applicable drug that
falls above such annual deductible.
✂️✂️(ii) Claims spanning out-of-pocket
threshold.—In the case where the entire amount of
the negotiated price of an individual claim for an
applicable drug with respect to an applicable
beneficiary does not fall entirely below or
entirely above the annual out-of-pocket threshold
specified in section 1860D-2(b)(4)(B)(i) for the
year, the manufacturer of the applicable drug
shall provide the discounted price—
✂️✂️(I) in accordance with
subparagraph (A)(i) on the portion of
the negotiated price of the applicable
drug that falls below such threshold;
and
✂️✂️(II) in accordance with
subparagraph (A)(ii) on the portion of
such price of such drug that falls at or
above such threshold.
✂️✂️(5) Manufacturer.—The term ✂️manufacturer’ means any
entity which is engaged in the production, preparation,
propagation, compounding, conversion, or processing of
prescription drug products, either directly or indirectly by
extraction from substances of natural origin, or independently
by means of chemical synthesis, or by a combination of
extraction and chemical synthesis. Such term does not include a
wholesale distributor of drugs or a retail pharmacy licensed
under State law.
✂️✂️(6) Negotiated price.—The term ✂️negotiated price’ has the
meaning given such term for purposes of section 1860D-
[[Page 136 STAT. 1888]]
2(d)(1)(B), and, with respect to an applicable drug, such
negotiated price shall include any dispensing fee and, if
applicable, any vaccine administration fee for the applicable
drug.
✂️✂️(7) Qualified retiree prescription drug plan.—The term
✂️qualified retiree prescription drug plan’ has the meaning given
such term in section 1860D-22(a)(2).
✂️✂️SEC. 1860D-14D. <<NOTE: 42 USC 1395w-114d.>> SELECTED DRUG
SUBSIDY PROGRAM.
✂️✂️With respect to covered part D drugs that would be applicable
drugs (as defined in section 1860D-14C(g)(2)) but for the application of
subparagraph (B) of such section, the Secretary shall provide a process
whereby, in the case of an applicable beneficiary (as defined in section
1860D-14C(g)(1)) who, with respect to a year, is enrolled in a
prescription drug plan or is enrolled in an MA-PD plan, has not incurred
costs that are equal to or exceed the annual out-of-pocket threshold
specified in section 1860D-2(b)(4)(B)(i), and is dispensed such a drug,
the Secretary (periodically and on a timely basis) provides the PDP
sponsor or the MA organization offering the plan, a subsidy with respect
to such drug that is equal to 10 percent of the negotiated price (as
defined in section 1860D-14C(g)(6)) of such drug.’'.
(2) Sunset of medicare coverage gap discount program.—
Section 1860D-14A of the Social Security Act (42 U.S.C. 1395w-
114a) is amended—
(A) in subsection (a), in the first sentence, by
striking ✂️✂️The Secretary’' and inserting ✂️✂️Subject to
subsection (h), the Secretary’'; and
(B) by adding at the end the following new
subsection:
✂️✂️(h) Sunset of Program.—
✂️✂️(1) In general.—The program shall not apply with respect
to applicable drugs dispensed on or after January 1, 2025, and,
subject to paragraph (2), agreements under this section shall be
terminated as of such date.
✂️✂️(2) Continued application for applicable drugs dispensed
prior to sunset.—The provisions of this section (including all
responsibilities and duties) shall continue to apply on and
after January 1, 2025, with respect to applicable drugs
dispensed prior to such date.’'.
(3) Selected drug subsidy payments from medicare
prescription drug account.—Section 1860D-16(b)(1) of the Social
Security Act (42 U.S.C. 1395w-116(b)(1)) is amended—
(A) in subparagraph (C), by striking ✂️✂️and’' at the
end;
(B) in subparagraph (D), by striking the period at
the end and inserting ✂️✂️; and’'; and
(C) by adding at the end the following new
subparagraph:
✂️✂️(E) payments under section 1860D-14D (relating to
selected drug subsidy payments).’'.
(d) Medicare Part D Premium Stabilization.—
(1) 2024 through 2029.—Section 1860D-13 of the Social
Security Act (42 U.S.C. 1395w-113) is amended—
(A) in subsection (a)—
(i) in paragraph (1)(A), by inserting ✂️✂️or (8)
(as applicable)’' after ✂️✂️paragraph (2)’';
(ii) in paragraph (2), in the matter preceding
subparagraph (A), by striking ✂️✂️The base’' and
inserting ✂️✂️Subject to paragraph (8), the base’';
[[Page 136 STAT. 1889]]
(iii) in paragraph (7)—
(I) in subparagraph (B)(ii), by
inserting ✂️✂️or (8) (as applicable)’'
after ✂️✂️paragraph (2)’'; and
(II) in subparagraph (E)(i), by
inserting ✂️✂️or (8) (as applicable)’'
after ✂️✂️paragraph (2)’'; and
(iv) by adding at the end the following new
paragraph:
✂️✂️(8) <<NOTE: Time period.>> Premium stabilization.—
✂️✂️(A) In general.—The base beneficiary premium
under this paragraph for a prescription drug plan for a
month in 2024 through 2029 shall be computed as follows:
✂️✂️(i) 2024.—The base beneficiary premium for
a month in 2024 shall be equal to the lesser of—
✂️✂️(I) the base beneficiary premium
computed under paragraph (2) for a month
in 2023 increased by 6 percent; or
✂️✂️(II) the base beneficiary premium
computed under paragraph (2) for a month
in 2024 that would have applied if this
paragraph had not been enacted.
✂️✂️(ii) 2025.—The base beneficiary premium for
a month in 2025 shall be equal to the lesser of—
✂️✂️(I) the base beneficiary premium
computed under clause (i) for a month in
2024 increased by 6 percent; or
✂️✂️(II) the base beneficiary premium
computed under paragraph (2) for a month
in 2025 that would have applied if this
paragraph had not been enacted.
✂️✂️(iii) 2026.—The base beneficiary premium
for a month in 2026 shall be equal to the lesser
of—
✂️✂️(I) the base beneficiary premium
computed under clause (ii) for a month
in 2025 increased by 6 percent; or
✂️✂️(II) the base beneficiary premium
computed under paragraph (2) for a month
in 2026 that would have applied if this
paragraph had not been enacted.
✂️✂️(iv) 2027.—The base beneficiary premium for
a month in 2027 shall be equal to the lesser of—
✂️✂️(I) the base beneficiary premium
computed under clause (iii) for a month
in 2026 increased by 6 percent; or
✂️✂️(II) the base beneficiary premium
computed under paragraph (2) for a month
in 2027 that would have applied if this
paragraph had not been enacted.
✂️✂️(v) 2028.—The base beneficiary premium for
a month in 2028 shall be equal to the lesser of—
✂️✂️(I) the base beneficiary premium
computed under clause (iv) for a month
in 2027 increased by 6 percent; or
✂️✂️(II) the base beneficiary premium
computed under paragraph (2) for a month
in 2028 that would have applied if this
paragraph had not been enacted.
[[Page 136 STAT. 1890]]
✂️✂️(vi) 2029.—The base beneficiary premium for
a month in 2029 shall be equal to the lesser of—
✂️✂️(I) the base beneficiary premium
computed under clause (v) for a month in
2028 increased by 6 percent; or
✂️✂️(II) the base beneficiary premium
computed under paragraph (2) for a month
in 2029 that would have applied if this
paragraph had not been enacted.
✂️✂️(B) Clarification regarding 2030 and subsequent
years.—The base beneficiary premium for a month in 2030
or a subsequent year shall be computed under paragraph
(2) without regard to this paragraph.’'; and
(B) in subsection (b)(3)(A)(ii), by striking
✂️✂️subsection (a)(2)’' and inserting ✂️✂️paragraph (2) or
(8) of subsection (a) (as applicable)’'.
(2) Adjustment to beneficiary premium percentage for 2030
and subsequent years.—Section 1860D-13(a) of the Social
Security Act (42 U.S.C. 1395w-113(a)), as amended by paragraph
(1), is amended—
(A) in paragraph (3)(A), by inserting ✂️✂️(or, for
2030 and each subsequent year, the percent specified
under paragraph (9))’' after ✂️✂️25.5 percent’'; and
(B) by adding at the end the following new
paragraph:
✂️✂️(9) <<NOTE: Time periods.>> Percent specified.—
✂️✂️(A) <<NOTE: Determination.>> In general.—Subject
to subparagraph (B), for purposes of paragraph (3)(A),
the percent specified under this paragraph for 2030 and
each subsequent year is the percent that the Secretary
determines is necessary to ensure that the base
beneficiary premium computed under paragraph (2) for a
month in 2030 is equal to the lesser of—
✂️✂️(i) the base beneficiary premium computed
under paragraph (8)(A)(vi) for a month in 2029
increased by 6 percent; or
✂️✂️(ii) the base beneficiary premium computed
under paragraph (2) for a month in 2030 that would
have applied if this paragraph had not been
enacted.
✂️✂️(B) Floor.—The percent specified under
subparagraph (A) may not be less than 20 percent.’'.
(3) Conforming amendments.—
(A) Section 1854(b)(2)(B) of the Social Security Act
42 U.S.C. 1395w-24(b)(2)(B)) is amended by striking
✂️✂️section 1860D-13(a)(2)’' and inserting ✂️✂️paragraph (2)
or (8) (as applicable) of section 1860D-13(a)’'.
(B) Section 1860D-11(g)(6) of the Social Security
Act (42 U.S.C. 1395w-111(g)(6)) is amended by inserting
✂️✂️(or, for 2030 and each subsequent year, the percent
specified under section 1860D-13(a)(9))’' after ✂️✂️25.5
percent’'.
(C) Section 1860D-13(a)(7)(B)(i) of the Social
Security Act (42 U.S.C. 1395w-113(a)(7)(B)(i)) is
amended—
(i) in subclause (I), by inserting ✂️✂️(or, for
2030 and each subsequent year, the percent
specified under paragraph (9))’' after ✂️✂️25.5
percent’'; and
(ii) in subclause (II), by inserting ✂️✂️(or,
for 2030 and each subsequent year, the percent
specified under paragraph (9))’' after ✂️✂️25.5
percent’'.
[[Page 136 STAT. 1891]]
(D) Section 1860D-15(a) of the Social Security Act
(42 U.S.C. 1395w-115(a)) is amended—
(i) in the matter preceding paragraph (1), by
inserting ✂️✂️(or, for each of 2024 through 2029,
the percent applicable as a result of the
application of section 1860D-13(a)(8), or, for
2030 and each subsequent year, 100 percent minus
the percent specified under section 1860D-
13(a)(9))’' after ✂️✂️74.5 percent’'; and
(ii) in paragraph (1)(B), by striking
✂️✂️paragraph (2) of section 1860D-13(a)’' and
inserting ✂️✂️paragraph (2) or (8) of section 1860D-
13(a) (as applicable)’'.
(e) <<NOTE: Time periods.>> Conforming Amendments.—
(1) Section 1860D-2 of the Social Security Act (42 U.S.C.
1395w-102) is amended—
(A) in subsection (a)(2)(A)(i)(I), by striking ✂️✂️,
or an increase in the initial’' and inserting ✂️✂️or, for
a year preceding 2025, an increase in the initial’';
(B) in subsection (c)(1)(C)—
(i) in the subparagraph heading, by striking
✂️✂️at initial coverage limit’'; and
(ii) by inserting ✂️✂️for a year preceding 2025
or the annual out-of-pocket threshold specified in
subsection (b)(4)(B) for the year for 2025 and
each subsequent year’' after ✂️✂️subsection (b)(3)
for the year’' each place it appears; and
(C) in subsection (d)(1)(A), by striking ✂️✂️or an
initial’' and inserting ✂️✂️or, for a year preceding 2025,
an initial’'.
(2) Section 1860D-4(a)(4)(B)(i) of the Social Security Act
(42 U.S.C. 1395w-104(a)(4)(B)(i)) is amended by striking ✂️✂️the
initial’' and inserting ✂️✂️for a year preceding 2025, the
initial’'.
(3) Section 1860D-14(a) of the Social Security Act (42
U.S.C. 1395w-114(a)) is amended—
(A) in paragraph (1)—
(i) in subparagraph (C), by striking ✂️✂️The
continuation’' and inserting ✂️✂️For a year
preceding 2025, the continuation’';
(ii) in subparagraph (D)(iii), by striking
✂️✂️1860D-2(b)(4)(A)(i)(I)’' and inserting ✂️✂️1860D-
2(b)(4)(A)(i)(I)(aa)’'; and
(iii) in subparagraph (E), by striking ✂️✂️The
elimination’' and inserting ✂️✂️For a year preceding
2024, the elimination’'; and
(B) in paragraph (2)(E), by striking ✂️✂️1860D-
2(b)(4)(A)(i)(I)’' and inserting ✂️✂️1860D-
2(b)(4)(A)(i)(I)(aa)’'.
(4) Section 1860D-21(d)(7) of the Social Security Act (42
U.S.C. 1395w-131(d)(7)) is amended by striking ✂️✂️section 1860D-
2(b)(4)(B)(i)’' and inserting ✂️✂️section 1860D-2(b)(4)(C)(i)’'.
(5) Section 1860D-22(a)(2)(A) of the Social Security Act (42
U.S.C. 1395w-132(a)(2)(A)) is amended—
(A) by striking ✂️✂️the value of any discount’' and
inserting the following: ✂️✂️the value of—
✂️✂️(i) for years prior to 2025, any discount’';
(B) in clause (i), as inserted by subparagraph (A)
of this paragraph, by striking the period at the end and
inserting ✂️✂️; and’'; and
(C) by adding at the end the following new clause:
[[Page 136 STAT. 1892]]
✂️✂️(ii) for 2025 and each subsequent year, any
discount provided pursuant to section 1860D-
14C.’'.
(6) Section 1860D-41(a)(6) of the Social Security Act (42
U.S.C. 1395w-151(a)(6)) is amended—
(A) by inserting ✂️✂️for a year before 2025’' after
✂️✂️1860D-2(b)(3)’'; and
(B) by inserting ✂️✂️for such year’' before the
period.
(7) Section 1860D-43 of the Social Security Act (42 U.S.C.
1395w-153) is amended—
(A) in subsection (a)—
(i) by striking paragraph (1) and inserting
the following:
✂️✂️(1) participate in—
✂️✂️(A) for 2011 through 2024, the Medicare coverage
gap discount program under section 1860D-14A; and
✂️✂️(B) for 2025 and each subsequent year, the
manufacturer discount program under section 1860D-
14C;’';
(ii) by striking paragraph (2) and inserting
the following:
✂️✂️(2) have entered into and have in effect—
✂️✂️(A) for 2011 through 2024, an agreement described
in subsection (b) of section 1860D-14A with the
Secretary; and
✂️✂️(B) for 2025 and each subsequent year, an
agreement described in subsection (b) of section 1860D-
14C with the Secretary; and’'; and
(iii) in paragraph (3), by striking ✂️✂️such
section’' and inserting ✂️✂️section 1860D-14A’'; and
(B) by striking subsection (b) and inserting the
following:
✂️✂️(b) <<NOTE: Applicability.>> Effective Date.—Paragraphs (1)(A),
(2)(A), and (3) of subsection (a) shall apply to covered part D drugs
dispensed under this part on or after January 1, 2011, and before
January 1, 2025, and paragraphs (1)(B) and (2)(B) of such subsection
shall apply to covered part D drugs dispensed under this part on or
after January 1, 2025.’'.
(8) Section 1927 of the Social Security Act (42 U.S.C.
1396r-8) is amended—
(A) in subsection (c)(1)(C)(i)(VI), by inserting
before the period at the end the following: ✂️✂️or under
the manufacturer discount program under section 1860D-
14C’'; and
(B) in subsection (k)(1)(B)(i)(V), by inserting
before the period at the end the following: ✂️✂️or under
section 1860D-14C’'.
(f) <<NOTE: 42 USC 1395w-102 note.>> Implementation for 2024
Through 2026.—The Secretary shall implement this section, including the
amendments made by this section, for 2024, 2025, and 2026 by program
instruction or other forms of program guidance.
(g) <<NOTE: Time periods.>> Funding.—In addition to amounts
otherwise available, there are appropriated to the Centers for Medicare
& Medicaid Services, out of any money in the Treasury not otherwise
appropriated, $341,000,000 for fiscal year 2022, including $20,000,000
and $65,000,000 to carry out the provisions of, including the amendments
made by, this section in fiscal years 2022 and 2023, respectively, and
$32,000,000 to carry out the provisions of, including the amendments
made by, this section in each of fiscal years 2024 through 2031, to
remain available until expended.
[[Page 136 STAT. 1893]]
1.7.SEC11202. MAXIMUM MONTHLY CAP ON COST-SHARING PAYMENTS UNDER PRESCRIPTION DRUG PLANS AND MA-PD PLANS.
(a) In General.—Section 1860D-2(b) of the Social Security Act (42
U.S.C. 1395w-102(b)) is amended—
(1) in paragraph (2)—
(A) in subparagraph (A), by striking ✂️✂️and (D)’' and
inserting ✂️✂️, (D), and (E)’'; and
(B) by adding at the end the following new
subparagraph:
✂️✂️(E) Maximum monthly cap on cost-sharing
payments.—
✂️✂️(i) <<NOTE: Effective date.>> In general.—
For plan years beginning on or after January 1,
2025, each PDP sponsor offering a prescription
drug plan and each MA organization offering an MA-
PD plan shall provide to any enrollee of such
plan, including an enrollee who is a subsidy
eligible individual (as defined in paragraph (3)
of section 1860D-14(a)), the option to elect with
respect to a plan year to pay cost-sharing under
the plan in monthly amounts that are capped in
accordance with this subparagraph.
✂️✂️(ii) Determination of maximum monthly cap.—
For each month in the plan year for which an
enrollee in a prescription drug plan or an MA-PD
plan has made an election pursuant to clause (i),
the PDP sponsor or MA organization shall determine
a maximum monthly cap (as defined in clause (iv))
for such enrollee.
✂️✂️(iii) Beneficiary monthly payments.—With
respect to an enrollee who has made an election
pursuant to clause (i), for each month described
in clause (ii), the PDP sponsor or MA organization
shall bill such enrollee an amount (not to exceed
the maximum monthly cap) for the out-of-pocket
costs of such enrollee in such month.
✂️✂️(iv) Maximum monthly cap defined.—In this
subparagraph, the term ✂️maximum monthly cap’
means, with respect to an enrollee—
✂️✂️(I) for the first month for which
the enrollee has made an election
pursuant to clause (i), an amount
determined by calculating—
✂️✂️(aa) the annual out-of-
pocket threshold specified in
paragraph (4)(B) minus the
incurred costs of the enrollee
as described in paragraph
(4)(C); divided by
✂️✂️(bb) the number of months
remaining in the plan year; and
✂️✂️(II) for a subsequent month, an
amount determined by calculating—
✂️✂️(aa) the sum of any
remaining out-of-pocket costs
owed by the enrollee from a
previous month that have not yet
been billed to the enrollee and
any additional out-of-pocket
costs incurred by the enrollee;
divided by
✂️✂️(bb) the number of months
remaining in the plan year.
[[Page 136 STAT. 1894]]
✂️✂️(v) <<NOTE: Applicability.>> Additional
requirements.—The following requirements shall
apply with respect to the option to make an
election pursuant to clause (i) under this
subparagraph:
✂️✂️(I) Secretarial
responsibilities.—The Secretary shall
provide information to part D eligible
individuals on the option to make such
election through educational materials,
including through the notices provided
under section 1804(a).
✂️✂️(II) Timing of election.—An
enrollee in a prescription drug plan or
an MA-PD plan may make such an
election—
✂️✂️(aa) prior to the
beginning of the plan year; or
✂️✂️(bb) in any month during
the plan year.
✂️✂️(III) Pdp sponsor and ma
organization responsibilities.—Each PDP
sponsor offering a prescription drug
plan or MA organization offering an MA-
PD plan—
✂️✂️(aa) may not limit the
option for an enrollee to make
such an election to certain
covered part D drugs;
✂️✂️(bb) <<NOTE: Notification.>>
shall, prior to the plan year,
notify prospective enrollees of
the option to make such an
election in promotional
materials;
✂️✂️(cc) shall include
information on such option in
enrollee educational materials;
✂️✂️(dd) <<NOTE: Notification.>>
shall have in place a mechanism
to notify a pharmacy during the
plan year when an enrollee
incurs out-of-pocket costs with
respect to covered part D drugs
that make it likely the enrollee
may benefit from making such an
election;
✂️✂️(ee) shall provide that a
pharmacy, after receiving a
notification described in item
(dd) with respect to an
enrollee, informs the enrollee
of such notification;
✂️✂️(ff) shall ensure that
such an election by an enrollee
has no effect on the amount paid
to pharmacies (or the timing of
such payments) with respect to
covered part D drugs dispensed
to the enrollee; and
✂️✂️(gg) shall have in place a
financial reconciliation process
to correct inaccuracies in
payments made by an enrollee
under this subparagraph with
respect to covered part D drugs
during the plan year.
✂️✂️(IV) Failure to pay amount
billed.—If an enrollee fails to pay the
amount billed for a month as required
under this subparagraph—
✂️✂️(aa) the election of the
enrollee pursuant to clause (i)
shall be terminated and the
enrollee shall pay the cost-
sharing otherwise applicable for
any covered part D drugs
subsequently dispensed to the
enrollee up to the annual out-
of-pocket threshold specified in
paragraph (4)(B); and
[[Page 136 STAT. 1895]]
✂️✂️(bb) the PDP sponsor or MA
organization may preclude the
enrollee from making an election
pursuant to clause (i) in a
subsequent plan year.
✂️✂️(V) Clarification regarding past
due amounts.—Nothing in this
subparagraph shall be construed as
prohibiting a PDP sponsor or an MA
organization from billing an enrollee
for an amount owed under this
subparagraph.
✂️✂️(VI) Treatment of unsettled
balances.—Any unsettled balances with
respect to amounts owed under this
subparagraph shall be treated as plan
losses and the Secretary shall not be
liable for any such balances outside of
those assumed as losses estimated in
plan bids.’'; and
(2) in paragraph (4)—
(A) in subparagraph (C), by striking ✂️✂️subparagraph
(E)’' and inserting ✂️✂️subparagraph (E) or subparagraph
(F)’'; and
(B) by adding at the end the following new
subparagraph:
✂️✂️(F) Inclusion of costs paid under maximum monthly
cap option.—In applying subparagraph (A), with respect
to an enrollee who has made an election pursuant to
clause (i) of paragraph (2)(E), costs shall be treated
as incurred if such costs are paid by a PDP sponsor or
an MA organization under the option provided under such
paragraph.’'.
(b) Application to Alternative Prescription Drug Coverage.—Section
1860D-2(c) of the Social Security Act (42 U.S.C. 1395w-102(c)) is
amended by adding at the end the following new paragraph:
✂️✂️(4) Same maximum monthly cap on cost-sharing.—The maximum
monthly cap on cost-sharing payments shall apply to coverage
with respect to an enrollee who has made an election pursuant to
clause (i) of subsection (b)(2)(E) under the option provided
under such subsection.’'.
(c) <<NOTE: 42 USC 1395w-102 note.>> Implementation for 2025.—The
Secretary shall implement this section, including the amendments made by
this section, for 2025 by program instruction or other forms of program
guidance.
(d) <<NOTE: Time period.>> Funding.—In addition to amounts
otherwise available, there are appropriated to the Centers for Medicare
& Medicaid Services, out of any money in the Treasury not otherwise
appropriated, $10,000,000 for fiscal year 2023, to remain available
until expended, to carry out the provisions of, including the amendments
made by, this section.
[[Page 136 STAT. 1896]]
1.8PART 4—CONTINUED DELAY OF IMPLEMENTATION OF PRESCRIPTION DRUG REBATE
RULE
1.8.SEC11301. <<NOTE: [42 USC 1320](https://www.law.cornell.edu/uscode/text/42/1320)a-7b note.>> EXTENSION OF MORATORIUM ON IMPLEMENTATION OF RULE RELATING TO ELIMINATING THE ANTI- KICKBACK STATUTE SAFE HARBOR PROTECTION FOR PRESCRIPTION DRUG REBATES.
The <<NOTE: Effective date.>> Secretary of Health and Human
Services shall not, prior to January 1, 2032, implement, administer, or
enforce the provisions of the final rule published by the Office of the
Inspector General of the Department of Health and Human Services on
November 30, 2020, and titled ✂️✂️Fraud and Abuse; Removal of Safe Harbor
Protection for Rebates Involving Prescription Pharmaceuticals and
Creation of New Safe Harbor Protection for Certain Point-of-Sale
Reductions in Price on Prescription Pharmaceuticals and Certain Pharmacy
Benefit Manager Service Fees’' (85 Fed. Reg. 76666).
1.9PART 5—MISCELLANEOUS
1.9.SEC11401. COVERAGE OF ADULT VACCINES RECOMMENDED BY THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES UNDER MEDICARE PART D.
(a) Ensuring Treatment of Cost-sharing and Deductible Is Consistent
With Treatment of Vaccines Under Medicare Part B.—Section 1860D-2 of
the Social Security Act (42 U.S.C. 1395w-102), as amended by sections
11201 and 11202, is amended—
(1) in subsection (b)—
(A) in paragraph (1)(A), by striking ✂️✂️The
coverage’' and inserting ✂️✂️Subject to paragraph (8), the
coverage’';
(B) in paragraph (2)—
(i) in subparagraph (A), by inserting ✂️✂️and
paragraph (8)’' after ✂️✂️and (E)’';
(ii) in subparagraph (C)(i), in the matter
preceding subclause (I), by striking ✂️✂️paragraph
(4)’' and inserting ✂️✂️paragraphs (4) and (8)’';
and
(iii) in subparagraph (D)(i), in the matter
preceding subclause (I), by striking ✂️✂️paragraph
(4)’' and inserting ✂️✂️paragraphs (4) and (8)’';
(C) in paragraph (3)(A), in the matter preceding
clause (i), by striking ✂️✂️and (4)’' and inserting ✂️✂️(4),
and (8)’';
(D) in paragraph (4)(A)(i), by striking ✂️✂️The
coverage’' and inserting ✂️✂️Subject to paragraph (8), the
coverage’'; and
(E) by adding at the end the following new
paragraph:
✂️✂️(8) Treatment of cost-sharing for adult vaccines
recommended by the advisory committee on immunization practices
consistent with treatment of vaccines under part b.—
✂️✂️(A) <<NOTE: Effective date.>> In general.—For
plan years beginning on or after January 1, 2023, with
respect to an adult vaccine recommended by the Advisory
Committee on Immunization Practices (as defined in
subparagraph (B))—
✂️✂️(i) the deductible under paragraph (1) shall
not apply; and
[[Page 136 STAT. 1897]]
✂️✂️(ii) there shall be no coinsurance or other
cost-sharing under this part with respect to such
vaccine.
✂️✂️(B) Adult vaccines recommended by the advisory
committee on immunization
practices. <<NOTE: Definition.>> —For purposes of this
paragraph, the term ✂️adult vaccine recommended by the
Advisory Committee on Immunization Practices’ means a
covered part D drug that is a vaccine licensed under
section 351 of the Public Health Service Act for use by
adult populations and administered in accordance with
recommendations of the Advisory Committee on
Immunization Practices of the Centers for Disease
Control and Prevention.’'; and
(2) in subsection (c), by adding at the end the following
new paragraph:
✂️✂️(5) Treatment of cost-sharing for adult vaccines
recommended by the advisory committee on immunization
practices.—The coverage is in accordance with subsection
(b)(8).’'.
(b) Conforming Amendments to Cost-sharing for Low-income
Individuals.—Section 1860D-14(a) of the Social Security Act (42 U.S.C.
1395w-114(a)), as amended by section 11201, is amended—
(1) in paragraph (1)(D), in each of clauses (ii) and (iii),
by striking ✂️✂️In the case’' and inserting ✂️✂️Subject to paragraph
(6), in the case’';
(2) in paragraph (2)—
(A) in subparagraph (B), by striking ✂️✂️A reduction’'
and inserting ✂️✂️Subject to section 1860D-2(b)(8), a
reduction’';
(B) in subparagraph (D), by striking ✂️✂️The
substitution’' and inserting ✂️✂️Subject to paragraph (6),
the substitution’'; and
(C) in subparagraph (E), by striking ✂️✂️subsection
(c)’' and inserting ✂️✂️paragraph (6) of this subsection
and subsection (c)’'; and
(3) by adding at the end the following new paragraph:
✂️✂️(6) No application of cost-sharing or deductible for adult
vaccines recommended by the advisory committee on immunization
practices. <<NOTE: Effective date.>> —For plan years beginning
on or after January 1, 2023, with respect to an adult vaccine
recommended by the Advisory Committee on Immunization Practices
(as defined in section 1860D-2(b)(8)(B))—
✂️✂️(A) the deductible under section 1860D-2(b)(1)
shall not apply; and
✂️✂️(B) there shall be no cost-sharing under this
section with respect to such vaccine.’'.
(c) Temporary Retrospective Subsidy.—
(1) In general.—Section 1860D-15 of the Social Security Act
(42 U.S.C. 1395w-115) is amended by adding at the end the
following new subsection:
✂️✂️(h) Temporary Retrospective Subsidy for Reduction in Cost-sharing
and Deductible for Adult Vaccines Recommended by the Advisory Committee
on Immunization Practices During 2023.—
✂️✂️(1) In general.—In addition to amounts otherwise payable
under this section to a PDP sponsor of a prescription drug plan
or an MA organization offering an MA-PD plan, for plan year
2023, the Secretary shall provide the PDP sponsor
[[Page 136 STAT. 1898]]
or MA organization offering the plan subsidies in an amount
equal to the aggregate reduction in cost-sharing and deductible
by reason of the application of section 1860D-2(b)(8) for
individuals under the plan during the year.
✂️✂️(2) <<NOTE: Deadline.>> Timing.—The Secretary shall
provide a subsidy under paragraph (1), as applicable, not later
than 18 months following the end of the applicable plan year.’'.
(2) Treatment as incurred costs.—Section 1860D-
2(b)(4)(C)(iii)(I) of the Social Security Act (42 U.S.C. 1395w-
102(b)(4)(C)(iii)(I)), as amended by section 11201(a)(3)(C), is
amended—
(A) in item (cc), by striking ✂️✂️or’' at the end; and
(B) by adding at the end the following new item:
✂️✂️(dd) under section 1860D-
15(h); or’'.
(d) <<NOTE: 42 USC 1395w-102 note.>> Rule of Construction.—Nothing
in this section shall be construed as limiting coverage under part D of
title XVIII of the Social Security Act for vaccines that are not
recommended by the Advisory Committee on Immunization Practices.
(e) <<NOTE: 42 USC 1395w-102 note.>> Implementation for 2023
Through 2025.—The Secretary shall implement this section, including the
amendments made by this section, for 2023, 2024, and 2025, by program
instruction or other forms of program guidance.
1.9.SEC11402. PAYMENT FOR BIOSIMILAR BIOLOGICAL PRODUCTS DURING INITIAL PERIOD.
Section 1847A(c)(4) of the Social Security Act (42 U.S.C. 1395w-
3a(c)(4)) is amended—
(1) in each of subparagraphs (A) and (B), by redesignating
clauses (i) and (ii) as subclauses (I) and (II), respectively,
and moving such subclauses 2 ems to the right;
(2) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii) and moving such clauses 2 ems to the right;
(3) by striking ✂️✂️unavailable.—In the case’' and inserting
✂️✂️unavailable.—
✂️✂️(A) In general.—Subject to subparagraph (B), in
the case’'; and
(4) by adding at the end the following new subparagraph:
✂️✂️(B) Limitation on payment amount for biosimilar
biological products during initial
period. <<NOTE: Effective date.>> —In the case of a
biosimilar biological product furnished on or after July
1, 2024, during the initial period described in
subparagraph (A) with respect to the biosimilar
biological product, the amount payable under this
section for the biosimilar biological product is the
lesser of the following:
✂️✂️(i) The amount determined under clause (ii)
of such subparagraph for the biosimilar biological
product.
✂️✂️(ii) The amount determined under subsection
(b)(1)(B) for the reference biological product.’'.
1.9.SEC11403. TEMPORARY INCREASE IN MEDICARE PART B PAYMENT FOR CERTAIN BIOSIMILAR BIOLOGICAL PRODUCTS.
Section 1847A(b)(8) of the Social Security Act (42 U.S.C. 1395w-
3a(b)(8)) is amended—
(1) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii), respectively, and moving the margin of each such
redesignated clause 2 ems to the right;
[[Page 136 STAT. 1899]]
(2) by striking ✂️✂️product.—The amount’' and inserting the
following: ✂️✂️product.—
✂️✂️(A) In general.—Subject to subparagraph (B), the
amount’'; and
(3) by adding at the end the following new subparagraph:
✂️✂️(B) <<NOTE: Time periods.>> Temporary payment
increase.—
✂️✂️(i) In general.—In the case of a qualifying
biosimilar biological product that is furnished
during the applicable 5-year period for such
product, the amount specified in this paragraph
for such product with respect to such period is
the sum determined under subparagraph (A), except
that clause (ii) of such subparagraph shall be
applied by substituting ✂️8 percent’ for ✂️6
percent’.
✂️✂️(ii) Applicable 5-year period.—For purposes
of clause (i), the applicable 5-year period for a
qualifying biosimilar biological product is—
✂️✂️(I) <<NOTE: Effective date.>> in
the case of such a product for which
payment was made under this paragraph as
of September 30, 2022, the 5-year period
beginning on October 1, 2022; and
✂️✂️(II) in the case of such a product
for which payment is first made under
this paragraph during a calendar quarter
during the period beginning October 1,
2022, and ending December 31, 2027, the
5-year period beginning on the first day
of such calendar quarter during which
such payment is first made.
✂️✂️(iii) Qualifying biosimilar biological
product defined.—For purposes of this
subparagraph, the term ✂️qualifying biosimilar
biological product’ means a biosimilar biological
product described in paragraph (1)(C) with respect
to which—
✂️✂️(I) in the case of a product
described in clause (ii)(I), the average
sales price under paragraph (8)(A)(i)
for a calendar quarter during the 5-year
period described in such clause is not
more than the average sales price under
paragraph (4)(A) for such quarter for
the reference biological product; and
✂️✂️(II) in the case of a product
described in clause (ii)(II), the
average sales price under paragraph
(8)(A)(i) for a calendar quarter during
the 5-year period described in such
clause is not more than the average
sales price under paragraph (4)(A) for
such quarter for the reference
biological product.’'.
1.9.SEC11404. <<NOTE: Effective date.>> EXPANDING ELIGIBILITY FOR LOW-INCOME SUBSIDIES UNDER PART D OF THE MEDICARE PROGRAM.
Section 1860D-14(a) of the Social Security Act (42 U.S.C. 1395w-
114(a)), as amended by sections 11201 and 11401, is amended—
(1) in the subsection heading, by striking ✂️✂️Individuals’'
and all that follows through ✂️✂️Line’' and inserting ✂️✂️Certain
Individuals’';
(2) in paragraph (1)—
[[Page 136 STAT. 1900]]
(A) by striking the paragraph heading and inserting
✂️✂️Individuals with certain low incomes’'; and
(B) in the matter preceding subparagraph (A)—
(i) by inserting ✂️✂️(or, with respect to a plan
year beginning on or after January 1, 2024, 150
percent)’' after ✂️✂️135 percent’'; and
(ii) by inserting ✂️✂️(or, with respect to a
plan year beginning on or after January 1, 2024,
paragraph (3)(E))’' after ✂️✂️the resources
requirement described in paragraph (3)(D)’'; and
(3) in paragraph (2)—
(A) by striking the paragraph heading and inserting
✂️✂️Other low-income individuals’'; and
(B) in the matter preceding subparagraph (A), by
striking ✂️✂️In the case of a subsidy’' and inserting
✂️✂️With respect to a plan year beginning before January
1, 2024, in the case of a subsidy’'.
1.9.SEC11405. IMPROVING ACCESS TO ADULT VACCINES UNDER MEDICAID AND CHIP.
(a) Medicaid.—
(1) Requiring coverage of adult vaccinations.—
(A) In general.—Section 1902(a)(10)(A) of the
Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is
amended in the matter preceding clause (i) by inserting
✂️✂️(13)(B),’' after ✂️✂️(5),’'.
(B) Medically needy.—Section 1902(a)(10)(C)(iv) of
such Act (42 U.S.C. 1396a(a)(10)(C)(iv)) is amended by
inserting ✂️✂️, (13)(B),’' after ✂️✂️(5)’'.
(2) No cost sharing for vaccinations.—
(A) General cost-sharing limitations.—Section 1916
of the Social Security Act (42 U.S.C. 1396o) is
amended—
(i) in subsection (a)(2)—
(I) in subparagraph (G), by
inserting a comma after ✂️✂️State plan’';
(II) in subparagraph (H), by
striking ✂️✂️; or’' and inserting a comma;
(III) in subparagraph (I), by
striking ✂️✂️; and’' and inserting ✂️✂️,
or’'; and
(IV) by adding at the end the
following new subparagraph:
✂️✂️(J) vaccines described in section 1905(a)(13)(B)
and the administration of such vaccines; and’'; and
(ii) in subsection (b)(2)—
(I) in subparagraph (G), by
inserting a comma after ✂️✂️State plan’';
(II) in subparagraph (H), by
striking ✂️✂️; or’' and inserting a comma;
(III) in subparagraph (I), by
striking ✂️✂️; and’' and inserting ✂️✂️,
or’'; and
(IV) by adding at the end the
following new subparagraph:
✂️✂️(J) vaccines described in section 1905(a)(13)(B)
and the administration of such vaccines; and’'.
(B) Application to alternative cost sharing.—
Section 1916A(b)(3)(B) of the Social Security Act (42
U.S.C.
[[Page 136 STAT. 1901]]
1396o-1(b)(3)(B)) is amended by adding at the end the
following new clause:
✂️✂️(xiv) Vaccines described in section
1905(a)(13)(B) and the administration of such
vaccines.’'.
(3) Increased fmap for adult vaccines and their
administration.—Section 1905(b) of the Social Security Act (42
U.S.C. 1396d(b)) is amended—
(A) by striking ✂️✂️and (5)’' and inserting ✂️✂️(5)’';
(B) by striking ✂️✂️services and vaccines described in
subparagraphs (A) and (B) of subsection (a)(13), and
prohibits cost-sharing for such services and vaccines’'
and inserting ✂️✂️services described in subsection
(a)(13)(A), and prohibits cost-sharing for such
services’';
(C) by striking ✂️✂️medical assistance for such
services and vaccines’' and inserting ✂️✂️medical
assistance for such services’'; and
(D) <<NOTE: Time periods.>> by inserting ✂️✂️, and
(6) during the first 8 fiscal quarters beginning on or
after the effective date of this clause, in the case of
a State which, as of the date of enactment of the Act
titled ✂️An Act to provide for reconciliation pursuant to
title II of S. Con. Res. 14’, provides medical
assistance for vaccines described in subsection
(a)(13)(B) and their administration and prohibits cost-
sharing for such vaccines, the Federal medical
assistance percentage, as determined under this
subsection and subsection (y), shall be increased by 1
percentage point with respect to medical assistance for
such vaccines and their administration’' before the
first period.
(b) CHIP.—
(1) Requiring coverage of adult vaccinations.—Section
2103(c) of the Social Security Act (42 U.S.C. 1397cc(c)) is
amended by adding at the end the following paragraph:
✂️✂️(12) Required coverage of approved, recommended adult
vaccines and their administration.—Regardless of the type of
coverage elected by a State under subsection (a), if the State
child health plan or a waiver of such plan provides child health
assistance or pregnancy-related assistance (as defined in
section 2112) to an individual who is 19 years of age or older,
such assistance shall include coverage of vaccines described in
section 1905(a)(13)(B) and their administration.’'.
(2) No cost-sharing for vaccinations.—Section 2103(e)(2) of
such Act (42 U.S.C. 1397cc(e)(2)) is amended by inserting
✂️✂️vaccines described in subsection (c)(12) (and the
administration of such vaccines),’' after ✂️✂️in vitro diagnostic
products described in subsection (c)(10) (and administration of
such products),’'.
(c) <<NOTE: Applicability. 42 USC 1396a note.>> Effective Date.—
The amendments made by this section take effect on the 1st day of the
1st fiscal quarter that begins on or after the date that is 1 year after
the date of enactment of this Act and shall apply to expenditures made
under a State plan or waiver of such plan under title XIX of the Social
Security Act (42 U.S.C. 1396 through 1396w-6) or under a State child
health plan or waiver of such plan under title XXI of such Act (42
U.S.C. 1397aa through 1397mm) on or after such effective date.
[[Page 136 STAT. 1902]]
1.9.SEC11406. APPROPRIATE COST-SHARING FOR COVERED INSULIN PRODUCTS UNDER MEDICARE PART D.
(a) In General.—Section 1860D-2 of the Social Security Act (42
U.S.C. 1395w-102), as amended by sections 11201, 11202, and 11401, is
amended—
(1) in subsection (b)—
(A) in paragraph (1)(A), by striking ✂️✂️paragraph
(8)’' and inserting ✂️✂️paragraphs (8) and (9)’';
(B) in paragraph (2)—
(i) in subparagraph (A), by striking
✂️✂️paragraph (8)’' and inserting ✂️✂️paragraphs (8)
and (9)’';
(ii) in subparagraph (C)(i), in the matter
preceding subclause (I), by striking ✂️✂️and (8)’'
and inserting ✂️✂️, (8), and (9)’'; and
(iii) in subparagraph (D)(i), in the matter
preceding subclause (I), by striking ✂️✂️and (8)’'
and inserting ✂️✂️, (8), and (9)’';
(C) in paragraph (3)(A), in the matter preceding
clause (i), by striking ✂️✂️and (8)’' and inserting ✂️✂️(8),
and (9)’';
(D) in paragraph (4)(A)(i), by striking ✂️✂️paragraph
(8)’' and inserting ✂️✂️paragraphs (8) and (9)’'; and
(E) by adding at the end the following new
paragraph:
✂️✂️(9) Treatment of cost-sharing for covered insulin
products.—
✂️✂️(A) <<NOTE: Time periods.>> No application of
deductible.—For plan year 2023 and subsequent plan
years, the deductible under paragraph (1) shall not
apply with respect to any covered insulin product.
✂️✂️(B) Application of cost-sharing.—
✂️✂️(i) Plan years 2023 and 2024.—For plan
years 2023 and 2024, the coverage provides
benefits for any covered insulin product,
regardless of whether an individual has reached
the initial coverage limit under paragraph (3) or
the out-of-pocket threshold under paragraph (4),
with cost-sharing for a month’s supply that does
not exceed the applicable copayment amount.
✂️✂️(ii) Plan year 2025 and subsequent plan
years.—For a plan year beginning on or after
January 1, 2025, the coverage provides benefits
for any covered insulin product, prior to an
individual reaching the out-of-pocket threshold
under paragraph (4), with cost-sharing for a
month’s supply that does not exceed the applicable
copayment amount.
✂️✂️(C) <<NOTE: Definition.>> Covered insulin
product.—In this paragraph, the term ✂️covered insulin
product’ means an insulin product that is a covered part
D drug covered under the prescription drug plan or MA-PD
plan that is approved under section 505 of the Federal
Food, Drug, and Cosmetic Act or licensed under section
351 of the Public Health Service Act and marketed
pursuant to such approval or licensure, including any
covered insulin product that has been deemed to be
licensed under section 351 of the Public Health Service
Act pursuant to section 7002(e)(4) of the Biologics
Price Competition and Innovation Act of 2009 and
marketed pursuant to such section.
✂️✂️(D) <<NOTE: Definition.>> Applicable copayment
amount.—In this paragraph, the term ✂️applicable
copayment amount’ means, with
[[Page 136 STAT. 1903]]
respect to a covered insulin product under a
prescription drug plan or an MA-PD plan dispensed—
✂️✂️(i) during plan years 2023, 2024, and 2025,
$35; and
✂️✂️(ii) during plan year 2026 and each
subsequent plan year, the lesser of—
✂️✂️(I) $35;
✂️✂️(II) an amount equal to 25 percent
of the maximum fair price established
for the covered insulin product in
accordance with part E of title XI; or
✂️✂️(III) an amount equal to 25
percent of the negotiated price of the
covered insulin product under the
prescription drug plan or MA-PD plan.
✂️✂️(E) <<NOTE: Reimbursement. Deadline.>> Special
rule for first 3 months of 2023.—With respect to a
month’s supply of a covered insulin product dispensed
during the period beginning on January 1, 2023, and
ending on March 31, 2023, a PDP sponsor offering a
prescription drug plan or an MA organization offering an
MA-PD plan shall reimburse an enrollee within 30 days
for any cost-sharing paid by such enrollee that exceeds
the cost-sharing applied by the prescription drug plan
or MA-PD plan under subparagraph (B)(i) at the point-of-
sale for such month’s supply.’'; and
(2) in subsection (c), by adding at the end the following
new paragraph:
✂️✂️(6) Treatment of cost-sharing for covered insulin
products.—The coverage is provided in accordance with
subsection (b)(9).’'.
(b) Conforming Amendments to Cost-sharing for Low-income
Individuals.—Section 1860D-14(a) of the Social Security Act (42 U.S.C.
1395w-114(a)), as amended by sections 11201, 11401, and 11404, is
amended—
(1) <<NOTE: Time periods.>> in paragraph (1)—
(A) in subparagraph (D)(iii), by adding at the end
the following new sentence: ✂️✂️For plan year 2023 and
subsequent plan years, the copayment amount applicable
under the preceding sentence to a month’s supply of a
covered insulin product (as defined in section 1860D-
2(b)(9)(C)) dispensed to the individual may not exceed
the applicable copayment amount for the product under
the prescription drug plan or MA-PD plan in which the
individual is enrolled.’'; and
(B) in subparagraph (E), by inserting the following
before the period at the end: ✂️✂️or under section 1860D-
2(b)(9) in the case of a covered insulin product (as
defined in subparagraph (C) of such section)’'; and
(2) in paragraph (2)—
(A) in subparagraph (B), by striking ✂️✂️section
1860D-2(b)(8)’' and inserting ✂️✂️paragraphs (8) and (9)
of section 1860D-2(b)’';
(B) in subparagraph (D), by adding at the end the
following new sentence: ✂️✂️For plan year 2023, the amount
of the coinsurance applicable under the preceding
sentence to a month’s supply of a covered insulin
product (as defined in section 1860D-2(b)(9)(C))
dispensed to the individual may not exceed the
applicable copayment amount for the
[[Page 136 STAT. 1904]]
product under the prescription drug plan or MA-PD plan
in which the individual is enrolled.’'; and
(C) in subparagraph (E), by adding at the end the
following new sentence: ✂️✂️For plan year 2023, the amount
of the copayment or coinsurance applicable under the
preceding sentence to a month’s supply of a covered
insulin product (as defined in section 1860D-2(b)(9)(C))
dispensed to the individual may not exceed the
applicable copayment amount for the product under the
prescription drug plan or MA-PD plan in which the
individual is enrolled.’'.
(c) Temporary Retrospective Subsidy.—Section 1860D-15(h) of the
Social Security Act (42 U.S.C. 1395w-115(h)), as added by section
11401(c), is amended—
(1) in the subsection heading, by inserting ✂️✂️and Insulin’'
after ✂️✂️Practices’'; and
(2) in paragraph (1), by striking ✂️✂️section 1860D-2(b)(8)’'
and inserting ✂️✂️paragraph (8) or (9) of section 1860D-2(b)’'.
(d) <<NOTE: 42 USC 1395w-102 note.>> Implementation for 2023
Through 2025.—The Secretary shall implement this section for plan years
2023, 2024, and 2025 by program instruction or other forms of program
guidance.
(e) Funding.—In addition to amounts otherwise available, there is
appropriated to the Centers for Medicare & Medicaid Services, out of any
money in the Treasury not otherwise appropriated, $1,500,000 for fiscal
year 2022, to remain available until expended, to carry out the
provisions of, including the amendments made by, this section.
1.9.SEC11407. <<NOTE: Effective dates.>> LIMITATION ON MONTHLY COINSURANCE AND ADJUSTMENTS TO SUPPLIER PAYMENT UNDER MEDICARE PART B FOR INSULIN FURNISHED THROUGH DURABLE MEDICAL EQUIPMENT.
(a) Waiver of Deductible.—The first sentence of section 1833(b) of
the Social Security Act (42 U.S.C. 1395l(b)) is amended—
(1) by striking ✂️✂️and (12)’' and inserting ✂️✂️(12)’'; and
(2) by inserting before the period the following: ✂️✂️, and
(13) such deductible shall not apply with respect to insulin
furnished on or after July 1, 2023, through an item of durable
medical equipment covered under section 1861(n).’'.
(b) Coinsurance.—
(1) In general.—Section 1833(a)(1)(S) of the Social
Security Act (42 U.S.C. 1395l(a)(1)(S)) is amended—
(A) by inserting ✂️✂️(i) except as provided in clause
(ii),’' after ✂️✂️(S)’'; and
(B) by inserting after ✂️✂️or 1847B),’' the following:
✂️✂️and (ii) with respect to insulin furnished on or after
July 1, 2023, through an item of durable medical
equipment covered under section 1861(n), the amounts
paid shall be, subject to the fourth sentence of this
subsection, 80 percent of the payment amount established
under section 1847A (or section 1847B, if applicable)
for such insulin,’'.
(2) Adjustment to supplier payments; limitation on monthly
coinsurance.—Section 1833(a) of the Social Security Act (42
U.S.C. 1395l(a)) is amended, in the flush matter at the end, by
adding at the end the following new sentence: ✂️✂️The Secretary
shall make such adjustments as may be necessary to the amounts
paid as specified under paragraph (1)(S)(ii) for insulin
furnished on or after July 1, 2023, through
[[Page 136 STAT. 1905]]
an item of durable medical equipment covered under section
1861(n), such that the amount of coinsurance payable by an
individual enrolled under this part for a month’s supply of such
insulin does not exceed $35.’'.
(c) <<NOTE: 42 USC 1395l note.>> Implementation.—The Secretary of
Health and Human Services shall implement this section for 2023 by
program instruction or other forms of program guidance.
1.9.SEC11408. SAFE HARBOR FOR ABSENCE OF DEDUCTIBLE FOR INSULIN.
(a) In General.—Paragraph (2) of section 223(c) of the Internal
Revenue Code of 1986 <<NOTE: 26 USC 223.>> is amended by adding at the
end the following new subparagraph:
✂️✂️(G) Safe harbor for absence of deductible for
certain insulin products.—
✂️✂️(i) In general.—A plan shall not fail to be
treated as a high deductible health plan by reason
of failing to have a deductible for selected
insulin products.
✂️✂️(ii) <<NOTE: Definitions.>> Selected
insulin products.—For purposes of this
subparagraph—
✂️✂️(I) In general.—The term
✂️selected insulin products’ means any
dosage form (such as vial, pump, or
inhaler dosage forms) of any different
type (such as rapid-acting, short-
acting, intermediate-acting, long-
acting, ultra long-acting, and premixed)
of insulin.
✂️✂️(II) Insulin.—The term ✂️insulin’
means insulin that is licensed under
subsection (a) or (k) of section 351 of
the Public Health Service Act (42 U.S.C.
262) and continues to be marketed under
such section, including any insulin
product that has been deemed to be
licensed under section 351(a) of such
Act pursuant to section 7002(e)(4) of
the Biologics Price Competition and
Innovation Act of 2009 (Public Law 111-
148) and continues to be marketed
pursuant to such licensure.’'.
(b) <<NOTE: 26 USC 223 note.>> Effective Date.—The amendment made
by this section shall apply to plan years beginning after December 31,
2022.
Subtitle C—Affordable Care Act Subsidies
1.9.SEC12001. IMPROVE AFFORDABILITY AND REDUCE PREMIUM COSTS OF HEALTH INSURANCE FOR CONSUMERS.
(a) In General.—Clause (iii) of section 36B(b)(3)(A) of the
Internal Revenue Code of 1986 is amended—
(1) by striking ✂️✂️in 2021 or 2022’' and inserting ✂️✂️after
December 31, 2020, and before January 1, 2026’', and
(2) by striking ✂️✂️2021 and 2022’' in the heading and
inserting ✂️✂️2021 through 2025’'.
(b) Extension Through 2025 of Rule to Allow Credit to Taxpayers
Whose Household Income Exceeds 400 Percent of the Poverty Line.—Section
36B(c)(1)(E) of the Internal Revenue Code of 1986 is amended—
(1) by striking ✂️✂️in 2021 or 2022’' and inserting ✂️✂️after
December 31, 2020, and before January 1, 2026’', and
[[Page 136 STAT. 1906]]
(2) by striking ✂️✂️2021 and 2022’' in the heading and
inserting ✂️✂️2021 through 2025’'.
(c) <<NOTE: 26 USC 36B note.>> Effective Date.—The amendments made
by this section shall apply to taxable years beginning after December
31, 2022.
Subtitle D—Energy Security
1.9.SEC13001. AMENDMENT OF 1986 CODE.
Except as otherwise expressly provided, whenever in this subtitle an
amendment or repeal is expressed in terms of an amendment to, or repeal
of, a section or other provision, the reference shall be considered to
be made to a section or other provision of the Internal Revenue Code of
1986.
1.10PART 1—CLEAN ELECTRICITY AND REDUCING CARBON EMISSIONS
1.10.SEC13101. EXTENSION AND MODIFICATION OF CREDIT FOR ELECTRICITY PRODUCED FROM CERTAIN RENEWABLE RESOURCES.
(a) In General.—The following provisions of section
45(d) <<NOTE: 26 USC 45.>> are each amended by striking ✂️✂️January 1,
2022’' each place it appears and inserting ✂️✂️January 1, 2025’':
(1) Paragraph (2)(A).
(2) Paragraph (3)(A).
(3) Paragraph (6).
(4) Paragraph (7).
(5) Paragraph (9).
(6) Paragraph (11)(B).
(b) Base Credit Amount.—Section 45 is amended—
(1) in subsection (a)(1), by striking ✂️✂️1.5 cents’' and
inserting ✂️✂️0.3 cents’', and
(2) in subsection (b)(2), by striking ✂️✂️1.5 cent’' and
inserting ✂️✂️0.3 cent’'.
(c) Application of Extension to Geothermal and Solar.—Section
45(d)(4) is amended by striking ✂️✂️and which’' and all that follows
through ✂️✂️January 1, 2022’' and inserting ✂️✂️and the construction of
which begins before January 1, 2025’'.
(d) Extension of Election to Treat Qualified Facilities as Energy
Property.—Section 48(a)(5)(C)(ii) is amended by striking ✂️✂️January 1,
2022’' and inserting ✂️✂️January 1, 2025’'.
(e) Application of Extension to Wind Facilities.—
(1) In general.—Section 45(d)(1) is amended by striking
✂️✂️January 1, 2022’' and inserting ✂️✂️January 1, 2025’'.
(2) Application of phaseout percentage.—
(A) Renewable electricity production credit.—
Section 45(b)(5) is amended by inserting ✂️✂️which is
placed in service before January 1, 2022’' after ✂️✂️using
wind to produce electricity’'.
(B) Energy credit.—Section 48(a)(5)(E) is amended
by inserting ✂️✂️placed in service before January 1, 2022,
and’' before ✂️✂️treated as energy property’'.
(3) Qualified offshore wind facilities under energy
credit.—Section 48(a)(5)(F)(i) is amended by striking
✂️✂️offshore wind facility’' and all that follows and inserting
the following: ✂️✂️offshore wind facility, subparagraph (E) shall
not apply.’'.
[[Page 136 STAT. 1907]]
(f) Wage and Apprenticeship Requirements.—Section 45(b) <<NOTE: 26
USC 45.>> is amended by adding at the end the following new paragraphs:
✂️✂️(6) Increased credit amount for qualified facilities.—
✂️✂️(A) In general.—In the case of any qualified
facility which satisfies the requirements of
subparagraph (B), the amount of the credit determined
under subsection (a) (determined after the application
of paragraphs (1) through (5) and without regard to this
paragraph) shall be equal to such amount multiplied by
5.
✂️✂️(B) Qualified facility requirements.—A qualified
facility meets the requirements of this subparagraph if
it is one of the following:
✂️✂️(i) A facility with a maximum net output of
less than 1 megawatt (as measured in alternating
current).
✂️✂️(ii) <<NOTE: Time
period. Publication. Guidelines.>> A facility the
construction of which begins prior to the date
that is 60 days after the Secretary publishes
guidance with respect to the requirements of
paragraphs (7)(A) and (8).
✂️✂️(iii) A facility which satisfies the
requirements of paragraphs (7)(A) and (8).
✂️✂️(7) Prevailing wage requirements.—
✂️✂️(A) In general.—The requirements described in
this subparagraph with respect to any qualified facility
are that the taxpayer shall ensure that any laborers and
mechanics employed by the taxpayer or any contractor or
subcontractor in—
✂️✂️(i) the construction of such facility, and
✂️✂️(ii) <<NOTE: Determination.>> with respect
to any taxable year, for any portion of such
taxable year which is within the period described
in subsection (a)(2)(A)(ii), the alteration or
repair of such facility,
shall be paid wages at rates not less than the
prevailing rates for construction, alteration, or repair
of a similar character in the locality in which such
facility is located as most recently determined by the
Secretary of Labor, in accordance with subchapter IV of
chapter 31 of title 40, United States
Code. <<NOTE: Applicability.>> For purposes of
determining an increased credit amount under paragraph
(6)(A) for a taxable year, the requirement under clause
(ii) is applied to such taxable year in which the
alteration or repair of the qualified facility occurs.’'
✂️✂️(B) Correction and penalty related to failure to
satisfy wage requirements.—
✂️✂️(i) In general.—In the case of any taxpayer
which fails to satisfy the requirement under
subparagraph (A) with respect to the construction
of any qualified facility or with respect to the
alteration or repair of a facility in any year
during the period described in subparagraph
(A)(ii), such taxpayer shall be deemed to have
satisfied such requirement under such subparagraph
with respect to such facility for any year if,
with respect to any laborer or mechanic who was
paid wages at a rate below the rate described in
such subparagraph for any period during such year,
such taxpayer—
[[Page 136 STAT. 1908]]
✂️✂️(I) makes payment to such laborer
or mechanic in an amount equal to the
sum of—
✂️✂️(aa) an amount equal to
the difference between—
✂️✂️(AA) the amount of
wages paid to such laborer
or mechanic during such
period, and
✂️✂️(BB) the amount of
wages required to be paid to
such laborer or mechanic
pursuant to such
subparagraph during such
period, plus
✂️✂️(bb) interest on the
amount determined under item
(aa) at the underpayment rate
established under section 6621
(determined by substituting ✂️6
percentage points’ for ✂️3
percentage points’ in subsection
(a)(2) of such section) for the
period described in such item,
and
✂️✂️(II) makes payment to the
Secretary of a penalty in an amount
equal to the product of—
✂️✂️(aa) $5,000, multiplied by
✂️✂️(bb) the total number of
laborers and mechanics who were
paid wages at a rate below the
rate described in subparagraph
(A) for any period during such
year.
✂️✂️(ii) Deficiency procedures not to apply.—
Subchapter B of chapter 63 (relating to deficiency
procedures for income, estate, gift, and certain
excise taxes) shall not apply with respect to the
assessment or collection of any penalty imposed by
this paragraph.
✂️✂️(iii) <<NOTE: Determination. Applicability.>>
Intentional disregard.—If the Secretary
determines that any failure described in clause
(i) is due to intentional disregard of the
requirements under subparagraph (A), such clause
shall be applied—
✂️✂️(I) in subclause (I), by
substituting ✂️three times the sum’ for
✂️the sum’, and
✂️✂️(II) in subclause (II), by
substituting ✂️$10,000’ for ✂️5,000’ in
item (aa) thereof.
✂️✂️(iv) <<NOTE: Regulations. Deadline.>>
Limitation on period for payment.—Pursuant to
rules issued by the Secretary, in the case of a
final determination by the Secretary with respect
to any failure by the taxpayer to satisfy the
requirement under subparagraph (A), subparagraph
(B)(i) shall not apply unless the payments
described in subclauses (I) and (II) of such
subparagraph are made by the taxpayer on or before
the date which is 180 days after the date of such
determination.
✂️✂️(8) Apprenticeship requirements.—The requirements
described in this paragraph with respect to the construction of
any qualified facility are as follows:
✂️✂️(A) Labor hours.—
✂️✂️(i) Percentage of total labor hours.—
Taxpayers shall ensure that, with respect to the
construction of any qualified facility, not less
than the applicable percentage of the total labor
hours of the construction, alteration, or repair
work (including such work performed by any
contractor or subcontractor)
[[Page 136 STAT. 1909]]
with respect to such facility shall, subject to
subparagraph (B), be performed by qualified
apprentices.
✂️✂️(ii) <<NOTE: Effective dates.>> Applicable
percentage.—For purposes of clause (i), the
applicable percentage shall be—
✂️✂️(I) in the case of a qualified
facility the construction of which
begins before January 1, 2023, 10
percent,
&n