1 So in original. Probably should be followed by a comma.
is 15.1 percent; and
2 So in original. Probably should be followed by “is”.
23.1 percent.
3 So in original. Probably should be followed by a semicolon.
4 See References in Text note below.
of this title insofar as the entity provides the same type of services to the same type of populations as a covered entity described in such section provides, but does not receive funding under a provision of law referred to in such section;
5 So in original. The semicolon probably should be a comma.
and
6 See 1993 Amendment note below.
Establishment of upper payment limits
7 So in original. Probably should be “paragraph”.
(1)(B) as the source of standards for such assessment) including but not limited to monitoring for therapeutic appropriateness, overutilization and underutilization, appropriate use of generic products, therapeutic duplication, drug-disease contraindications, drug-drug interactions, incorrect drug dosage or duration of drug treatment, and clinical abuse/misuse and, as necessary, introduce remedial strategies, in order to improve the quality of care and to conserve program funds or personal expenditures.
8 So in original.
licensed and actively practicing pharmacists.
9 So in original. Probably should be “biological product”.
used for a medical indication which is not a medically accepted indication. Any drug, biological product, or insulin excluded from the definition of such term as a result of this paragraph shall be treated as a covered outpatient drug for purposes of determining the best price (as defined in subsection (c)(1)(C)) for such drug, biological product, or insulin.
Editorial Notes
References in Text

The amendments made by subsections (a)(1), (span), (c), and (d) of section 2501 of the Patient Protection and Affordable Care Act, referred to in subsec. (span)(1)(C)(i)(II), mean the amendments made by section 2501(a)(1), (span), (c), and (d) of Puspan. L. 111–148, which amended this section and section 1396span of this title.

The Internal Revenue Code of 1986, referred to in subsecs. (a)(3) and (c)(1)(D)(i)(IV)(aa), is classified generally to Title 26, Internal Revenue Code.

Section 256span(a)(4) of this title, referred to in subsec. (c)(1)(D)(i)(IV)(bspan), was in the original “section 340(B)(a)(4) of the Public Health Service Act”, and was translated as meaning section 340B(a)(4) of the Public Health Service Act, which defines “covered entity”, to reflect the probable intent of Congress.

The Federal Food, Drug, and Cosmetic Act, referred to in subsecs. (d)(4)(C) and (k)(6), is act June 25, 1938, ch. 675, 52 Stat. 1040, which is classified generally to chapter 9 (§ 301 et seq.) of Title 21, Food and Drugs. For complete classification of this Act to the Code, see section 301 of Title 21 and Tables.

Paragraph (4) and subsection (e)(4), referred to in subsecs. (e)(5) and (f)(1)(B), probably means text that was editorially designated as par. (4) of subsec. (e). See 1993 Amendment note below.

Section 507 of the Federal Food, Drug, and Cosmetic Act, referred to in subsec. (k)(2)(A)(i), was repealed by Puspan. L. 105–115, title I, § 125(span)(1), Nov. 21, 1997, 111 Stat. 2325.

Section 107(c)(3) of the Drug Amendments of 1962, referred to in subsec. (k)(2)(A)(iii)(I), is section 107(c)(3) of Puspan. L. 87–781 which is set out in an Effective Date of 1962 Amendment note under section 321 of Title 21, Food and Drugs.

Section 506 of the Federal Food, Drug, and Cosmetic Act, referred to in subsec. (k)(2)(C), was repealed and a new section 506 enacted by Puspan. L. 105–115, title I, §§ 112(a), 125(a)(1), Nov. 21, 1997, 111 Stat. 2309, 2325, which no longer relates to insulin.

Codification

Subsec. (i) of this section, which required the Secretary to transmit to the Committee on Finance of the Senate, the Committee on Energy and Commerce of the House of Representatives, and the Committees on Aging of the Senate and the House of Representatives an annual report on the operation of this section in the preceding fiscal year, terminated, effective May 15, 2000, pursuant to section 3003 of Puspan. L. 104–66, set out as a note under section 1113 of Title 31, Money and Finance. See, also, item 9 on page 93 of House Document No. 103–7.

Prior Provisions

A prior section 1927 of act Aug. 14, 1935, was renumbered section 1939 and is classified to section 1396v of this title.

Amendments

2022—Subsec. (a)(3). Puspan. L. 117–169, § 11001(span)(1)(G)(ii), inserted at end “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.”

Subsec. (span)(3)(D)(i). Puspan. L. 117–169, § 11102(span)(3), substituted “, section 1320f–1(f) of this title, including rebates under paragraph (4) of such section, or section 1395w–114span of this title” for “or section 1320f–1(f) of this title, including rebates under paragraph (4) of such section”.

Puspan. L. 117–169, § 11101(c)(3), inserted “and the rebate” after “the payment amount”.

Puspan. L. 117–169, § 11002(span), substituted “or to carry out section 1395w–3span of this title or section 1320f–1(f) of this title, including rebates under paragraph (4) of such section” for “or to carry out section 1395w–3span of this title”.

Subsec. (c)(1)(C)(i)(VI). Puspan. L. 117–169, § 11201(e)(8)(A), inserted before period at end “or under the manufacturer discount program under section 1395w–114c of this title”.

Puspan. L. 117–169, § 11001(span)(2)(A), substituted “subject to clause (ii)(V), any prices charged” for “any prices charged”.

Subsec. (c)(1)(C)(ii)(I). Puspan. L. 117–169, § 11102(span)(2), substituted “, section 1395w–3a(i) of this title, or section 1395w–114span of this title” for “or section 1395w–3a(i) of this title

Puspan. L. 117–169, § 11101(c)(2), inserted “or section 1395w–3a(i) of this title” after “this section”.

Subsec. (c)(1)(C)(ii)(V). Puspan. L. 117–169, § 11001(span)(2)(B), added subcl. (V).

Subsec. (k)(1)(B)(i)(V). Puspan. L. 117–169, § 11201(e)(8)(B), inserted before period at end “or under section 1395w–114c of this title”.

Subsec. (k)(1)(B)(i)(VI). Puspan. L. 117–169, § 11001(span)(3), added subcl. (VI).

Subsec. (k)(1)(B)(i)(VII). Puspan. L. 117–169, § 11101(c)(4), added subcl. (VII).

Subsec. (k)(1)(B)(i)(VIII). Puspan. L. 117–169, § 11102(span)(4), added subcl. (VIII). Conforming amendments striking “and” at the end of subcl. (VI) and substituting semicolon for period at the end of subcl. (VII) could not be executed as directed after the amendment by Puspan. L. 117–169, § 11101(c)(4)(B), (C).

2021—Subsec. (c)(2)(D). Puspan. L. 117–2, § 9816, inserted “and before January 1, 2024,” after “December 31, 2009,”.

Subsec. (d)(7)(E). Puspan. L. 117–2, § 9811(a)(4)(B), added subpar. (E).

2020—Subsec. (span)(3)(A). Puspan. L. 116–260, § 401(c)(1), inserted at end of concluding provisions “For purposes of applying clause (iii), for calendar quarters beginning on or after January 1, 2022, a drug or biological described in the flush matter following such clause includes items, services, supplies, and products that are payable under part B of subchapter XVIII as a drug or biological.”

Subsec. (span)(3)(A)(iii). Puspan. L. 116–260, § 401(c)(2), substituted “section 1395rr(span)(14)(B) of this title” for “section 1395rr(span)(13)(A)(ii) of this title” in concluding provisions.

Subsec. (span)(3)(D). Puspan. L. 116–260, § 112(span)(5), (6), in concluding provisions, substituted “1395w–104(c)(2)(G) of this title” for “1395w–104(c)(2)(E) of this title” and inserted at end “Any information disclosed to the Executive Director of the Medicare Payment Advisory Commission or the Executive Director of the Medicaid and CHIP Payment and Access Commission pursuant to this subparagraph shall not be disclosed by either such Executive Director in a form which discloses the identity of a specific manufacturer or wholesaler or prices charged for drugs by such manufacturer or wholesaler. Such information also shall not be disclosed by either such Executive Director to individual Commissioners of the Medicare Payment Advisory Commission or of the Medicaid and CHIP Payment and Access Commission in a form which discloses the identity of a specific manufacturer or wholesaler or prices charged for drugs by such manufacturer or wholesaler.”

Puspan. L. 116–260, § 112(span)(1), substituted “subsection (a)(6)(A)” for “subsection (a)(6)(A)(ii)” in introductory provisions.

Subsec. (span)(3)(D)(vii). Puspan. L. 116–260, § 112(span)(2)–(4), added cl. (vii).

Subsec. (d)(7)(D). Puspan. L. 116–159 added subpar. (D).

2019—Subsec. (span)(1)(B). Puspan. L. 116–16, § 6(span)(2), inserted “, including amounts received by a State under subsection (c)(4),” after “in any quarter”.

Subsec. (span)(3). Puspan. L. 116–16, § 6(a)(1)(A), inserted “and drug product” after “price” in span.

Subsec. (span)(3)(A)(ii), (iii). Puspan. L. 116–16, § 6(a)(1)(B)(i), (ii), struck out “and” at end of cl. (ii) and substituted semicolon for period at end of cl. (iii).

Subsec. (span)(3)(A)(v). Puspan. L. 116–16, § 6(a)(1)(B)(iii), (iv), added cl. (v).

Subsec. (span)(3)(C)(ii). Puspan. L. 116–16, § 6(a)(1)(C)(i), (2)(B), inserted “, including information related to drug pricing, drug product information, and data related to drug pricing or drug product information,” after “provides false information” and substituted “subsections (a), (span), (f)(3), and (f)(4)” for “subsections (a) and (span)”.

Subsec. (span)(3)(C)(iii), (iv). Puspan. L. 116–16, § 6(a)(1)(C)(ii), added cls. (iii) and (iv).

Subsec. (span)(3)(D)(vi). Puspan. L. 116–16, § 6(a)(1)(C)(iii), added cl. (vi).

Subsec. (c)(4). Puspan. L. 116–16, § 6(span)(1), added par. (4).

Subsec. (k)(1)(C). Puspan. L. 116–59, § 1603(a), substituted “Exclusion” for “Inclusion” in span and “the manufacturer’s new drug application” for “a new drug application” and “exclusive” for “inclusive” in text.

Subsec. (k)(2)(A). Puspan. L. 116–16, § 6(c)(1), substituted “paragraph (4)” for “paragraph (5)” in introductory provisions.

Subsec. (k)(7)(A)(i). Puspan. L. 116–16, § 6(c)(2)(B), substituted “, including a drug product approved for marketing as a non-prescription drug that is regarded as a covered outpatient drug under paragraph (4),” for “(not including any drug described in paragraph (5))”.

Subsec. (k)(7)(A)(ii). Puspan. L. 116–16, § 6(c)(2)(A), (C), substituted “is marketed” for “was originally marketed” and “a new drug application” for “an original new drug application” and inserted “, unless the Secretary determines that a narrow exception applies (as described in section 447.502 of title 42, Code of Federal Regulations (or any successor regulation))” before period at end.

Subsec. (k)(7)(A)(iv). Puspan. L. 116–16, § 6(c)(2)(A), (D), substituted “a new drug application” for “an original new drug application” and inserted “, including a drug product approved for marketing as a non-prescription drug that is regarded as a covered outpatient drug under paragraph (4),” after “covered outpatient drug”, “unless the Secretary determines that a narrow exception applies (as described in section 447.502 of title 42, Code of Federal Regulations (or any successor regulation))” after “under the new drug application”, and “Such term also includes a covered outpatient drug that is a biological product licensed, produced, or distributed under a biologics license application approved by the Food and Drug Administration.” at end.

Subsec. (k)(11). Puspan. L. 116–59, § 1603(span), struck out “manufacturers,” before “repackers,” and “manufacturer’s and” before “distributor’s warehouses,”.

2018—Subsec. (c)(2)(C). Puspan. L. 115–123 added cls. (i) to (iii) and struck out introductory provisions and former cls. (i) to (iii) which read as follows: “In the case of a drug that is a line extension of a single source drug or an innovator multiple source drug that is an oral solid dosage form, the rebate obligation with respect to such drug under this section shall be the amount computed under this section for such new drug or, if greater, the product of—

“(i) the average manufacturer price of the line extension of a single source drug or an innovator multiple source drug that is an oral solid dosage form;

“(ii) the highest additional rebate (calculated as a percentage of average manufacturer price) under this section for any strength of the original single source drug or innovator multiple source drug; and

“(iii) the total number of units of each dosage form and strength of the line extension product paid for under the State plan in the rebate period (as reported by the State).”

Subsec. (g)(1)(A). Puspan. L. 115–271, § 1004(span)(1)(A), substituted “of section 1396a(a)(54)” for “of section 1396span(i)(10)(B)”, struck out “, by not later than January 1, 1993,” after “shall provide”, and substituted “gross overuse, excessive utilization, inappropriate or medically unnecessary care, or prescribing or billing practices that indicate abuse or excessive utilization” for “gross overuse, or inappropriate or medically unnecessary care”.

Subsec. (g)(2)(B). Puspan. L. 115–271, § 1004(span)(1)(B), substituted “gross overuse, excessive utilization, inappropriate or medically unnecessary care, or prescribing or billing practices that indicate abuse or excessive utilization” for “gross overuse, or inappropriate or medically unnecessary care”.

2016—Subsec. (c)(2)(C). Puspan. L. 114–198 inserted before period at end of concluding provisions “, 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”.

2015—Subsec. (c)(3)(A). Puspan. L. 114–74, § 602(a)(1), substituted “Except as provided in subparagraph (C), the amount” for “The amount”.

Subsec. (c)(3)(C). Puspan. L. 114–74, § 602(a)(2), added subpar. (C).

2010—Subsec. (a)(5)(B). Puspan. L. 111–309 substituted a period for “and a children’s hospital described in section 1395ww(d)(1)(B)(iii) of this title which meets the requirements of clauses (i) and (iii) of section 256span(span)(4)(L) of this title and which would meet the requirements of clause (ii) of such section if that clause were applied by taking into account the percentage of care provided by the hospital to patients eligible for medical assistance under a State plan under this subchapter.”

Subsec. (span)(1)(A). Puspan. L. 111–148, § 2501(c)(2)(A)(i), inserted “, including such drugs dispensed to individuals enrolled with a medicaid managed care organization if the organization is responsible for coverage of such drugs” after “for such period”.

Subsec. (span)(1)(C). Puspan. L. 111–148, § 2501(a)(2), added subpar. (C).

Subsec. (span)(2)(A). Puspan. L. 111–148, § 2501(c)(2)(A)(ii), inserted “including such information reported by each medicaid managed care organization,” after “for which payment was made under the plan during the period,”.

Subsec. (span)(3)(A). Puspan. L. 111–148, § 2503(span)(1)(B), which directed insertion, in the second sentence, of “(relating to the weighted average of the most recently reported monthly average manufacturer prices)” after “(D)(v)” was executed by making the insertion in concluding provisions to reflect the probable intent of Congress.

Subsec. (span)(3)(A)(iv). Puspan. L. 111–148, § 2503(span)(1)(A), which directed, in the first sentence, addition of cl. (iv) after cl. (iii), was executed by adding cl. (iv) after cl. (iii) to reflect the probable intent of Congress.

Subsec. (span)(3)(D)(v). Puspan. L. 111–148, § 2503(span)(2), substituted “the weighted average of the most recently reported monthly average manufacturer prices and the average retail survey price determined for each multiple source drug in accordance with subsection (f)” for “average manufacturer prices”.

Subsec. (c)(1)(B)(i)(IV) to (VI). Puspan. L. 111–148, § 2501(a)(1)(A), struck out “and” at end of subcl. (IV), inserted “and before January 1, 2010” after “December 31, 1995,” and substituted “; and” for period at end in subcl. (V), and added subcl. (VI).

Subsec. (c)(1)(B)(iii). Puspan. L. 111–148, § 2501(a)(1)(B), added cl. (iii).

Subsec. (c)(1)(C)(i)(VI). Puspan. L. 111–148, § 3301(d)(2), inserted “, or any discounts provided by manufacturers under the Medicare coverage gap discount program under section 1395w–114a of this title” before period at end.

Subsec. (c)(2)(C). Puspan. L. 111–152, § 1206(a), amended subpar. (C) generally. Prior to amendment, text read as follows:

“(i) In general.—Except as provided in clause (ii), in the case of a drug that is a new formulation, such as an extended-release formulation, of a single source drug or an innovator multiple source drug, the rebate obligation with respect to the drug under this section shall be the amount computed under this section for the new formulation of the drug or, if greater, the product of—

“(I) the average manufacturer price for each dosage form and strength of the new formulation of the single source drug or innovator multiple source drug;

“(II) the highest additional rebate (calculated as a percentage of average manufacturer price) under this section for any strength of the original single source drug or innovator multiple source drug; and

“(III) the total number of units of each dosage form and strength of the new formulation paid for under the State plan in the rebate period (as reported by the State).

“(ii) No application to new formulations of orphan drugs.—Clause (i) shall not apply to a new formulation of a covered outpatient drug that is or has been designated under section 526 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bspan) for a rare disease or condition, without regard to whether the period of market exclusivity for the drug under section 527 of such Act has expired or the specific indication for use of the drug.”

Puspan. L. 111–148, § 2501(d)(1), added subpar. (C).

Subsec. (c)(2)(D). Puspan. L. 111–148, § 2501(e), added subpar. (D).

Subsec. (c)(3)(B). Puspan. L. 111–148, § 2501(span), struck out “and” at end of cl. (i), inserted “and before January 1, 2010,” after “December 31, 1993,” and substituted “; and” for period at end in cl. (ii), and added cl. (iii).

Subsec. (d)(2)(E). Puspan. L. 111–148, § 2502(a)(1), redesignated subpar. (F) as (E) and struck out former subpar. (E) which read as follows: “Agents when used to promote smoking cessation.”

Subsec. (d)(2)(F). Puspan. L. 111–148, § 4107(span), inserted “, except, in the case of pregnant women when recommended in accordance with the Guideline referred to in section 1396d(bspan)(2)(A) of this title, agents approved by the Food and Drug Administration under the over-the-counter monograph process for purposes of promoting, and when used to promote, tobacco cessation” before period at end.

Puspan. L. 111–148, § 2502(a)(1)(B), redesignated subpar. (G) as (F). Former subpar. (F) redesignated (E).

Subsec. (d)(2)(G) to (K). Puspan. L. 111–148, § 2502(a)(1), redesignated subpars. (H) and (K) as (G) and (H), respectively, and struck out subpars. (I) and (J) which read as follows:

“(I) Barbiturates.

“(J) Benzodiazepines.”

Subsec. (d)(7). Puspan. L. 111–148, § 2502(a)(2), added par. (7).

Subsec. (e)(4). Puspan. L. 111–148, § 2503(a)(1)(A), struck out “(or, effective January 1, 2007, two or more)” after “three or more”.

Subsec. (e)(5). Puspan. L. 111–148, § 2503(a)(1)(B), added par. (5) and struck out former par. (5). Prior to amendment, text read as follows: “Effective January 1, 2007, in applying the Federal upper reimbursement limit under paragraph (4) and section 447.332(span) of title 42 of the Code of Federal Regulations, the Secretary shall substitute 250 percent of the average manufacturer price (as computed without regard to customary prompt pay discounts extended to wholesalers) for 150 percent of the published price.”

Subsec. (f)(1)(A)(i). Puspan. L. 111–148, § 2503(c)(1), inserted “with respect to a retail community pharmacy,” before “the determination”.

Subsec. (f)(1)(C)(ii). Puspan. L. 111–148, § 2503(c)(2), substituted “retail community pharmacies” for “retail pharmacies”.

Subsec. (j)(1). Puspan. L. 111–148, § 2501(c)(2)(B), added par. (1) and struck out former par. (1) which read as follows: “Covered outpatient drugs dispensed by health maintenance organizations, including medicaid managed care organizations that contract under section 1396span(m) of this title, are not subject to the requirements of this section.”

Subsec. (k)(1)(A). Puspan. L. 111–148, § 2503(a)(2)(A), substituted “by—” for “by wholesalers for drugs distributed to the retail pharmacy class of trade.” and added cls. (i) and (ii).

Subsec. (k)(1)(B). Puspan. L. 111–148, § 2503(a)(2)(B), added subpar. (B) and struck out former subpar. (B). Prior to amendment, text read as follows: “The average manufacturer price for a covered outpatient drug shall be determined without regard to customary prompt pay discounts extended to wholesalers.”

Subsec. (k)(1)(B)(i)(IV). Puspan. L. 111–226 inserted at end “, unless the drug is an inhalation, infusion, instilled, implanted, or injectable drug that is not generally dispensed through a retail community pharmacy; and”.

Subsec. (k)(1)(B)(i)(V). Puspan. L. 111–152, § 1101(c), added subcl. (V).

Subsec. (k)(1)(C). Puspan. L. 111–148, § 2503(a)(2)(C), substituted “retail community pharmacies” for “the retail pharmacy class of trade”.

Subsec. (k)(7)(A)(i)(III). Puspan. L. 111–148, § 2503(a)(3)(A), substituted “the United States” for “the State”.

Subsec. (k)(7)(C). Puspan. L. 111–148, § 2503(a)(3)(B), inserted “and” after semicolon at end of cl. (i), substituted period for “; and” at end of cl. (ii), and struck out cl. (iii) which read as follows: “a drug product is considered to be sold or marketed in a State if it appears in a published national listing of average wholesale prices selected by the Secretary, provided that the listed product is generally available to the public through retail pharmacies in that State.”

Subsec. (k)(10), (11). Puspan. L. 111–148, § 2503(a)(4), added pars. (10) and (11).

2009—Subsec. (c)(1)(D)(i)(IV) to (VI). Puspan. L. 111–8, § 221(a)(1), added subcls. (IV) and (V) and redesignated former subcl. (IV) as (VI).

Subsec. (c)(1)(D)(iv). Puspan. L. 111–8, § 221(a)(2), added cl. (iv).

2006—Subsec. (a)(5)(B). Puspan. L. 109–171, § 6004(a), inserted before period at end “and a children’s hospital described in section 1395ww(d)(1)(B)(iii) of this title which meets the requirements of clauses (i) and (iii) of section 256span(span)(4)(L) of this title and which would meet the requirements of clause (ii) of such section if that clause were applied by taking into account the percentage of care provided by the hospital to patients eligible for medical assistance under a State plan under this subchapter”.

Subsec. (a)(7). Puspan. L. 109–171, § 6002(a), added par. (7).

Subsec. (span)(3)(A). Puspan. L. 109–171, § 6001(span)(1)(B), inserted “Beginning July 1, 2006, the Secretary shall provide on a monthly basis to States under subparagraph (D)(iv) the most recently reported average manufacturer prices for single source drugs and for multiple source drugs and shall, on at least a quarterly basis, update the information posted on the website under subparagraph (D)(v).” at end of concluding provisions.

Subsec. (span)(3)(A)(i). Puspan. L. 109–171, § 6003(a)(1), added cl. (i) and struck out former cl. (i) which read as follows: “not later than 30 days after the last day of each month of a rebate period under the agreement (beginning on or after January 1, 1991), on the average manufacturer price (as defined in subsection (k)(1) of this section), customary prompt pay discounts extended to wholesalers, and, (for single source drugs and innovator multiple source drugs), the manufacturer’s best price (as defined in subsection (c)(2)(B) of this section) for covered outpatient drugs for the rebate period under the agreement,;”.

Puspan. L. 109–171, § 6001(span)(1)(A), (c)(2), inserted “month of a” after “last day of each” and “, customary prompt pay discounts extended to wholesalers,” after “(k)(1) of this section)”.

Subsec. (span)(3)(A)(ii). Puspan. L. 109–171, § 6003(a)(2), inserted “(including for such drugs that are sold under a new drug application approved under section 505(c) of the Federal Food, Drug, and Cosmetic Act)” after “drugs”.

Subsec. (span)(3)(A)(iii). Puspan. L. 109–171, § 6001(d)(1), inserted “, and, for calendar quarters beginning on or after January 1, 2007 and only with respect to the information described in subclause (III), for covered outpatient drugs” before period at end.

Subsec. (span)(3)(D)(iv), (v). Puspan. L. 109–171, § 6001(span)(2), added cls. (iv) and (v).

Subsec. (c)(1)(C)(i). Puspan. L. 109–171, § 6003(span)(1)(A), inserted “(including the lowest price available to any entity for any such drug of a manufacturer that is sold under a new drug application approved under section 505(c) of the Federal Food, Drug, and Cosmetic Act)” after “or innovator multiple source drug of a manufacturer” in introductory provisions.

Subsec. (c)(1)(C)(ii)(IV). Puspan. L. 109–171, § 6003(span)(1)(B), added subcl. (IV).

Subsec. (c)(1)(D). Puspan. L. 109–171, § 6001(d)(2), added subpar. (D).

Subsec. (e)(4). Puspan. L. 109–171, § 6001(a)(1), which directed substitution of “Subject to paragraph (5), the Secretary” for “The Secretary” and insertion of “(or, effective January 1, 2007, two or more)” after “three or more” in subsec. (e)(4), was executed to the last par. of subsec. (e) to reflect the probable intent of Congress. See 1993 Amendment note below.

Subsec. (e)(5). Puspan. L. 109–171, § 6001(a)(2), added par. (5).

Subsec. (f). Puspan. L. 109–171, § 6001(e), added subsec. (f).

Subsec. (g)(1)(B)(i)(II). Puspan. L. 109–171, § 6001(f)(1), which directed insertion of “(or its successor publications)” after “United States Pharmacopoeia-Drug Information”, was executed by making insertion after “United States Pharmacopeia-Drug Information” to reflect the probable intent of Congress.

Subsec. (g)(2)(A)(ii). Puspan. L. 109–171, § 6001(f)(2), inserted “, or to require verification of the offer to provide consultation or a refusal of such offer” before period at end of concluding provisions.

Subsec. (k)(1). Puspan. L. 109–171, § 6001(c)(1), designated existing provisions as subpar. (A), inserted span, substituted “Subject to subparagraph (B), the term” for “The term”, struck out “, after deducting customary prompt pay discounts” before period at end, and added subpar. (B).

Subsec. (k)(1)(C). Puspan. L. 109–171, § 6003(span)(2), as amended by Puspan. L. 109–432, added subpar. (C).

Subsec. (k)(7)(A)(i). Puspan. L. 109–171, § 6001(a)(4), substituted “is” for “are” in subcls. (I), (II), and (III).

Puspan. L. 109–171, § 6001(a)(3), substituted “at least 1 other drug product” for “are 2 or more drug products” in introductory provisions.

2005—Subsec. (d)(2)(K). Puspan. L. 109–91 added subpar. (K).

2003—Subsec. (a)(1). Puspan. L. 108–173, § 303(i)(4)(A), inserted “or under part B of subchapter XVIII” after “section 1396span(a) of this title”.

Subsec. (span)(3)(A). Puspan. L. 108–173, § 303(i)(4)(B), added cl. (iii) and concluding provisions.

Subsec. (span)(3)(B). Puspan. L. 108–173, § 303(i)(4)(C), inserted “and manufacturer’s average sales price” after “average manufacturer price” in span and “and manufacturer’s average sales prices (including wholesale acquisition cost) if required to make payment” after “manufacturer prices” in text.

Subsec. (span)(3)(D). Puspan. L. 108–173, § 303(i)(4)(D)(i), inserted “(other than the wholesale acquisition cost for purposes of carrying out section 1395w–3a of this title)” after “subsection (a)(6)(A)(ii)” in introductory provisions.

Puspan. L. 108–173, § 105(span), which directed insertion of “and drug pricing data reported under the first sentence of section 1395w–141(i)(1) of this title” after “section 1395w–104(c)(2)(E) of this title” in last sentence, was executed by making the insertion after “or 1395w–104(c)(2)(E) of this title” in concluding provisions to reflect the probable intent of Congress.

Puspan. L. 108–173, § 101(e)(4), inserted concluding provisions.

Subsec. (span)(3)(D)(i). Puspan. L. 108–173, § 303(i)(4)(D)(ii), inserted “, to carry out section 1395w–3a of this title (including the determination and implementation of the payment amount), or to carry out section 1395w–3span of this title” after “this section”.

Subsec. (c)(1)(C)(i)(I). Puspan. L. 108–173, § 1002(a), inserted “(including inpatient prices charged to hospitals described in section 256span(a)(4)(L) of this title)” before semicolon at end.

Subsec. (c)(1)(C)(i)(V), (VI). Puspan. L. 108–173, § 103(e)(1), added subcls. (V) and (VI).

Subsec. (c)(1)(C)(iii). Puspan. L. 108–173, § 1002(span), added cl. (iii).

Subsec. (e)[(4)]. Puspan. L. 108–173, § 900(e)(1)(K), (L), which directed substitution of “The Secretary” for “HCFA” in subsecs. (e)(4) and (f)(2), was executed to the last par. of subsec. (e) to reflect the probable intent of Congress. See 1993 Amendment note below.

Subsec. (g)(1)(B)(i)(II). Puspan. L. 108–173, § 101(e)(9)(A), inserted “and” at end.

Subsec. (g)(1)(B)(i)(IV). Puspan. L. 108–173, § 101(e)(9)(B), struck out subcl. (IV) which read as follows: “American Medical Association Drug Evaluations; and”.

1999—Subsec. (a)(1). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 606(a)], substituted “shall become effective as of the date on which the agreement is entered into or, at State option, on any date thereafter on or before” for “shall not be effective until”.

Subsec. (g)(2)(A)(ii)(II)(cc). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(u)(1)], substituted “individual’s” for “individuals”.

Subsec. (i)(1). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(u)(2)], substituted “the operation of this section” for “the the operation of this section”.

Subsec. (k)(7)(A)(iv). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(u)(3)(A)], substituted “distributors” for “distributers”.

Subsec. (k)(7)(C)(i). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(u)(3)(B)], substituted “pharmaceutically” for “pharmaceuutically”.

1997—Subsec. (g)(1)(B)(i)(III), (IV). Puspan. L. 105–33, § 4756, added subcl. (III) and redesignated former subcl. (III) as (IV).

Subsec. (j)(1). Puspan. L. 105–33, § 4701(span)(2)(A)(x), substituted “health maintenance organizations, including medicaid managed care organizations” for “* * * Health Maintenance Organizations, including those organizations”.

1993—Subsec. (span)(1)(A). Puspan. L. 103–66, § 13602(a)(2)(A)(i)(II), which directed amendment of subpar. (A) by substituting “dispensed after December 31, 1990, for which payment was made under the State plan for such period” for “dispensed under the plan during the quarter (or other period as the Secretary may specify)”, was executed by making the substitution for “dispensed under the plan during the quarter (or such other period as the Secretary may specify)” to reflect the probable intent of Congress.

Puspan. L. 103–66, § 13602(a)(2)(A)(i)(I), substituted “for a rebate period” for “each calendar quarter (or periodically in accordance with a schedule specified by the Secretary)”.

Subsec. (span)(2)(A). Puspan. L. 103–66, § 13602(a)(2)(A)(ii), substituted “each rebate period” for “each calendar quarter” and “units of each dosage form and strength and package size” for “dosage units”, inserted “after December 31, 1990, for which payment was made” after “dispensed”, and substituted “during the period” for “during the quarter”.

Subsec. (span)(3)(A)(i). Puspan. L. 103–66, § 13602(a)(2)(A)(iii), substituted “rebate period under the agreement” for “quarter” in two places.

Subsec. (c). Puspan. L. 103–66, § 13602(a)(1), added subsec. (c) and struck out former subsec. (c) which related to determination of amount of rebate for certain drugs.

Puspan. L. 103–18 substituted “such drug, except that for the calendar quarter beginning after September 30, 1992, and before January 1, 1993, the amount of the rebate may not exceed 50 percent of such average manufacturer price;” for “such drug;” in par. (1)(B)(ii)(II).

Subsecs. (d) to (f). Puspan. L. 103–66, § 13602(a)(1), added subsecs. (d) and (e), struck out former subsecs. (d) consisting of pars. (1) to (8) relating to limitations on coverage of drugs, (e) relating to denial of Federal financial participation in certain cases, and (f)(1) relating to reductions in pharmacy reimbursement limits, and struck out par. designation for former par. (2) of subsec. (f) without supplying a new designation. The text of former subsec. (f)(2) is now the last par. of subsec. (e).

Subsec. (k)(1). Puspan. L. 103–66, § 13602(a)(2)(B)(i), substituted “rebate period” for “calendar quarter” and inserted before period at end “, after deducting customary prompt pay discounts”.

Subsec. (k)(3). Puspan. L. 103–66, § 13602(a)(2)(B)(ii)(III), in concluding provisions, substituted “for which a National Drug Code number is not required by the Food and Drug Administration or a drug or biological used” for “which is used” and inserted at end “Any drug, biological product, or insulin excluded from the definition of such term as a result of this paragraph shall be treated as a covered outpatient drug for purposes of determining the best price (as defined in subsection (c)(1)(C)) for such drug, biological product, or insulin.”

Subsec. (k)(3)(E). Puspan. L. 103–66, § 13602(a)(2)(B)(ii)(I), struck out “* * * *emergency room visits” after “services”.

Subsec. (k)(3)(F). Puspan. L. 103–66, § 13602(a)(2)(B)(ii)(II), which directed amendment of subpar. (F) by substituting “services and services provided by an intermediate care facility for the mentally retarded” for “services”, was executed by making the substitution for “sevices” to reflect the probable intent of Congress because the word “services” did not appear.

Subsec. (k)(6). Puspan. L. 103–66, § 13602(a)(2)(B)(iii), substituted “or the use of which is supported by one or more citations included or approved for inclusion in any of the compendia described in subsection (g)(1)(B)(i).” for “, which appears in peer-reviewed medical literature or which is accepted by one or more of the following compendia: the American Hospital Formulary Service-Drug Information, the American Medical Association Drug Evaluations, and the United States Pharmacopeia-Drug Information.”

Subsec. (k)(7)(A)(i). Puspan. L. 103–66, § 13602(a)(2)(B)(iv), substituted “rebate period” for “calendar quarter” in introductory provisions.

Subsec. (k)(8), (9). Puspan. L. 103–66, § 13602(a)(2)(B)(v), added par. (8) and redesignated former par. (8) as (9).

1992—Subsec. (a)(1). Puspan. L. 102–585, § 601(span)(1), substituted “manufacturer), and must meet the requirements of paragraph (5) (with respect to drugs purchased by a covered entity on or after the first day of the first month that begins after November 4, 1992) and paragraph (6)” for “manufacturer)”.

Subsec. (a)(5), (6). Puspan. L. 102–585, § 601(span)(2), added pars. (5) and (6).

Subsec. (span)(3)(D). Puspan. L. 102–585, § 601(span)(3), substituted “this paragraph or under an agreement with the Secretary of Veterans Affairs described in subsection (a)(6)(A)(ii)” for “this paragraph”, “Secretary or the Secretary of Veterans Affairs” for “Secretary”, and “except—” and cls. (i) to (iii) for “except as the Secretary determines to be necessary to carry out this section and to permit the Comptroller General to review the information provided.”

Subsec. (span)(4)(B)(ii). Puspan. L. 102–585, § 601(span)(4)(i), (ii), substituted “the calendar quarter beginning at least 60 days” for “such period” and “the manufacturer provides notice to the Secretary.” for “of the notice as the Secretary may provide (but not beyond the term of the agreement).”

Subsec. (span)(4)(B)(iv), (v). Puspan. L. 102–585, § 601(span)(4)(iii), added cls. (iv) and (v).

Subsec. (c)(1)(B)(i). Puspan. L. 102–585, § 601(c)(1), which directed the substitution of “October 1, 1992,” for “January 1, 1993,”, was executed by making the substitution in introductory provisions and in subcl. (II), to reflect the probable intent of Congress.

Subsec. (c)(1)(B)(ii) to (v). Puspan. L. 102–585, § 601(c)(2), (3), added cls. (ii) to (v) and struck out former cl. (ii) which read as follows: “for quarters (or other periods) beginning after December 31, 1992, the greater of—

“(I) the difference between the average manufacturer price for a drug and 85 percent of such price, or

“(II) the difference between the average manufacturer price for a drug and the best price (as defined in paragraph (2)(B)) for such quarter (or period) for such drug.”

Subsec. (c)(1)(C). Puspan. L. 102–585, § 601(a), substituted “(excluding any prices charged on or after October 1, 1992, to the Indian Health Service, the Department of Veterans Affairs, a State home receiving funds under section 1741 of title 38, the Department of Defense, the Public Health Service, or a covered entity described in subsection (a)(5)(B) of this section, any prices charged under the Federal Supply Schedule of the General Services Administration, or any prices used under a State pharmaceutical assistance program, and excluding” for “(excluding”.

Statutory Notes and Related Subsidiaries
Effective Date of 2020 Amendment

Amendment made by Puspan. L. 116–159 effective as if included in the enactment of section 1006(span) of the SUPPORT for Patients and Communities Act (Public Law 115–271; 132 Stat. 3914), see section 2601(c) of Puspan. L. 116–159, set out as a note under section 1396d of this title.

Effective Date of 2019 Amendment

Puspan. L. 116–59, div. B, title VI, § 1603(c), Sept. 27, 2019, 133 Stat. 1108, provided that: “The amendments made by this section [amending this section] shall take effect on the first day of the first fiscal quarter that begins after the date of enactment of this Act [Sept. 27, 2019].”

Amendment by Puspan. L. 116–16 effective on Apr. 18, 2019, and applicable to covered outpatient drugs supplied by manufacturers under agreements under this section on or after that date, see section 6(e) of Puspan. L. 116–16, set out as a note under section 1320a–7 of this title.

Effective Date of 2018 Amendment

Puspan. L. 115–271, title I, § 1004(span)(2), Oct. 24, 2018, 132 Stat. 3912, provided that: “The amendments made by paragraph (1) [amending this section] shall take effect with respect to retrospective drug use reviews conducted on or after October 1, 2020.”

Puspan. L. 115–123, div. E, title XII, § 53104(span), Fespan. 9, 2018, 132 Stat. 302, provided that: “The amendments made [by] subsection (a) [amending this section] shall apply with respect to rebate periods beginning on or after October 1, 2018.”

Effective Date of 2016 Amendment

Puspan. L. 114–198, title VII, § 705(span), July 22, 2016, 130 Stat. 753, provided that: “The amendment made by subsection (a) [amending this section] shall apply to drugs that are paid for by a State in calendar quarters beginning on or after the date of the enactment of this Act [July 22, 2016].”

Effective Date of 2015 Amendment

Puspan. L. 114–74, title VI, § 602(span), Nov. 2, 2015, 129 Stat. 597, provided that: “The amendments made by subsection (a) [amending this section] shall apply to rebate periods beginning after the date that is one year after the date of the enactment of this Act [Nov. 2, 2015].”

Effective Date of 2010 Amendment

Puspan. L. 111–226, title II, § 202, Aug. 10, 2010, 124 Stat. 2394, provided that the amendment made by Puspan. L. 111–226 is effective as if included in the enactment of Puspan. L. 111–148.

Puspan. L. 111–152, title I, § 1206(span), Mar. 30, 2010, 124 Stat. 1057, provided that: “The amendment made by subsection (a) [amending this section] shall take effect as if included in the enactment of the Patient Protection and Affordable Care Act [Puspan. L. 111–148].”

Puspan. L. 111–148, title II, § 2501(d)(2), Mar. 23, 2010, 124 Stat. 309, provided that: “The amendment made by paragraph (1) [amending this section] shall apply to drugs that are paid for by a State after December 31, 2009.”

Puspan. L. 111–148, title II, § 2502(span), Mar. 23, 2010, 124 Stat. 310, provided that: “The amendments made by this section [amending this section] shall apply to services furnished on or after January 1, 2014.”

Puspan. L. 111–148, title II, § 2503(d), Mar. 23, 2010, 124 Stat. 312, provided that: “The amendments made by this section [amending this section] shall take effect on the first day of the first calendar year quarter that begins at least 180 days after the date of enactment of this Act [Mar. 23, 2010], without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.”

Amendment by section 3301(d)(2) of Puspan. L. 111–148 applicable to drugs dispensed on or after July 1, 2010, see section 3301(d)(3) of Puspan. L. 111–148, set out as a note under section 1320a–7span of this title.

Amendment by section 4107(span) of Puspan. L. 111–148 effective Oct. 1, 2010, see section 4107(d) of Puspan. L. 111–148, set out as a note under section 1396d of this title.

Effective Date of 2009 Amendment

Puspan. L. 111–8, div. F, title II, § 221(span), Mar. 11, 2009, 123 Stat. 783, provided that: “The amendments made by this subsection [probably means this section, amending this section] shall take effect as if included in the amendment made by section 6001(d)(2) of the Deficit Reduction Act of 2005 [Puspan. L. 109–171].”

Effective Date of 2006 Amendment

Puspan. L. 109–432, div. B, title IV, § 405(c)(2)(A), Dec. 20, 2006, 120 Stat. 2999, provided that the amendment made by section 405(c)(2)(A) is effective as if included in the enactment of the Deficit Reduction Act of 2005 (Public Law 109–171).

Puspan. L. 109–171, title VI, § 6001(f)(3), Fespan. 8, 2006, 120 Stat. 58, provided that: “The amendments made by this subsection [amending this section and section 1395x of this title] shall take effect on the date of the enactment of this Act [Fespan. 8, 2006].”

Puspan. L. 109–171, title VI, § 6001(g), Fespan. 8, 2006, 120 Stat. 58, provided that: “Except as otherwise provided, the amendments made by this section [amending this section and section 1395x of this title] shall take effect on January 1, 2007, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.”

Puspan. L. 109–171, title VI, § 6003(c), Fespan. 8, 2006, 120 Stat. 61, provided that: “The amendments made by this section [amending this section] take effect on January 1, 2007.”

Puspan. L. 109–171, title VI, § 6004(span), Fespan. 8, 2006, 120 Stat. 61, provided that: “The amendment made by subsection (a) [amending this section] shall apply to drugs purchased on or after the date of the enactment of this Act [Fespan. 8, 2006].”

Effective Date of 2005 Amendment

Amendment by Puspan. L. 109–91 applicable to drugs dispensed on or after Jan. 1, 2006, see section 104(d) of Puspan. L. 109–91, set out as a note under section 1396span of this title.

Effective Date of 2003 Amendment

Puspan. L. 108–173, title I, § 103(e)(2), Dec. 8, 2003, 117 Stat. 2160, provided that: “Section 1927(c)(1)(C)(i)(VI) of the Social Security Act [42 U.S.C. 1396r–8(c)(1)(C)(i)(VI)], as added by paragraph (1), shall apply to prices charged for drugs dispensed on or after January 1, 2006.”

Effective Date of 1999 Amendment

Puspan. L. 106–113, div. B, § 1000(a)(6) [title VI, § 606(span)], Nov. 29, 1999, 113 Stat. 1536, 1501A–396, provided that: “The amendment made by subsection (a) [amending this section] applies to agreements entered into on or after the date of enactment of this Act [Nov. 29, 1999].”

Amendment by section 1000(a)(6) [title VI, § 608(u)] of Puspan. L. 106–113 effective Nov. 29, 1999, see section 1000(a)(6) [title VI, § 608(bspan)] of Puspan. L. 106–113, set out as a note under section 1396a of this title.

Effective Date of 1997 Amendment

Amendment by Puspan. L. 105–33 effective Aug. 5, 1997, and applicable to contracts entered into or renewed on or after Oct. 1, 1997, see section 4710 of Puspan. L. 105–33, set out as a note under section 1396span of this title.

Effective Date of 1993 Amendment

Puspan. L. 103–66, title XIII, § 13602(d), Aug. 10, 1993, 107 Stat. 619, provided that:

“(1) Except as provided in paragraph (2), the amendments made by this section [amending this section and sections 1396a and 1396span of this title] shall take effect as if included in the enactment of OBRA–1990 [Puspan. L. 101–508].
“(2) The amendment made by subsection (a)(1) [amending this section] (insofar as such subsection amends section 1927(d) of the Social Security Act [42 U.S.C. 1396r–8(d)]) and the amendment made by subsection (c) [amending section 1396a of this title] shall apply to calendar quarters beginning on or after October 1, 1993, without regard to whether or not regulations to carry out such amendments have been promulgated by such date.”

Puspan. L. 103–18, § 2(span), Apr. 12, 1993, 107 Stat. 54, provided that: “The amendment made by subsection (a) [amending this section] shall take effect as if included in the enactment of section 601(c) of the Veterans Health Care Act of 1992 [Puspan. L. 102–585].”

Effective Date of 1992 Amendment

Puspan. L. 102–585, title VI, § 601(e), Nov. 4, 1992, 106 Stat. 4966, provided that: “The amendments made by this section [amending this section] shall apply with respect to payments to State plans under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] for calendar quarters (or periods) beginning on or after January 1, 1993 (without regard to whether or not regulations to carry out such amendments have been promulgated by such date).”

Regulations

Puspan. L. 109–171, title VI, § 6001(c)(3), Fespan. 8, 2006, 120 Stat. 55, provided that:

“(A)Inspector general recommendations.—Not later than June 1, 2006, the Inspector General of the Department of Health and Human Services shall—
“(i) review the requirements for, and manner in which, average manufacturer prices are determined under section 1927 of the Social Security Act [42 U.S.C. 1396r–8], as amended by this section; and
“(ii) shall submit to the Secretary of Health and Human Services and Congress such recommendations for changes in such requirements or manner as the Inspector General determines to be appropriate.
“(B)Deadline for promulgation.—Not later than July 1, 2007, the Secretary of Health and Human Services shall promulgate a regulation that clarifies the requirements for, and manner in which, average manufacturer prices are determined under section 1927 of the Social Security Act, taking into consideration the recommendations submitted to the Secretary in accordance with subparagraph (A)(ii).”

Inclusion in the Medicaid Drug Rebate Program of Covered Outpatient Drugs Used for COVID–19 Treatment

Puspan. L. 117–2, title IX, § 9811(a)(4)(A), Mar. 11, 2021, 135 Stat. 210, provided that:

“(A)In general.—The requirements of section 1927 of the Social Security Act (42 U.S.C. 1396r–8) shall apply to any drug or biological product to which subparagraph (F) of section 1905(a)(4) of such Act [42 U.S.C. 1396d(a)(4)], as added by paragraph (1), applies or to which the subclause (XVIII) in the matter following subparagraph (G) of section 1902(a)(10) of such Act [42 U.S.C. 1396a(a)(10)], as added by paragraph (2), applies that is—
“(i) furnished as medical assistance in accordance with section 1902(a)(10)(A) of such Act and such subparagraph (F) [probably means 42 U.S.C. 1396d(a)(4)(F)] or subclause (XVIII) [probably means subcl. (XVIII) in 42 U.S.C. 1396a(a)(10) concluding provisions] and section 1902(a)(10)(A) of such Act, as applicable, for the treatment, or prevention, of COVID–19, as described in such subparagraph or subclause, respectively; and
“(ii) a covered outpatient drug (as defined in section 1927(k) of such Act, except that, in applying paragraph (2)(A) of such section [probably means 42 U.S.C. 1396r–8(k)(2)(A)] to a drug to which such subparagraph (F) [probably means 42 U.S.C. 1396d(a)(4)(F)] or such subclause (XVIII) [probably means subcl. (XVIII) in 42 U.S.C. 1396a(a)(10) concluding provisions] applies, such drug shall be deemed a prescribed drug for purposes of section 1905(a)(12) of such Act).”

Pharmacy Reimbursement Under Medicaid

Puspan. L. 110–275, title II, § 203, July 15, 2008, 122 Stat. 2592, provided that:

“(a)Delay in Application of New Payment Limit for Multiple Source Drugs Under Medicaid.—Notwithstanding paragraphs (4) and (5) of subsection (e) of section 1927 of the Social Security Act (42 U.S.C. 1396r–8) or part 447 of title 42, Code of Federal Regulations, as published on July 17, 2007 (72 Federal Register 39142)—
“(1) the specific upper limit under section 447.332 of title 42, Code of Federal Regulations (as in effect on December 31, 2006) applicable to payments made by a State for multiple source drugs under a State Medicaid plan shall continue to apply through September 30, 2009, for purposes of the availability of Federal financial participation for such payments; and
“(2) the Secretary of Health and Human Services shall not, prior to October 1, 2009, finalize, implement, enforce, or otherwise take any action (through promulgation of regulation, issuance of regulatory guidance, use of Federal payment audit procedures, or other administrative action, policy, or practice, including a Medical Assistance Manual transmittal or letter to State Medicaid directors) to impose the specific upper limit established under section 447.514(span) of title 42, Code of Federal Regulations as published on July 17, 2007 (72 Federal Register 39142).
“(span)Temporary Suspension of Updated Publicly Available AMP Data.—Notwithstanding clause (v) of section 1927(span)(3)(D) of the Social Security Act (42 U.S.C. 1396r–8(span)(3)(D)), the Secretary of Health and Human Services shall not, prior to October 1, 2009, make publicly available any AMP disclosed to the Secretary.
“(c)Definitions.—In this subsection:
“(1) The term ‘multiple source drug’ has the meaning given that term in section 1927(k)(7)(A)(i) of the Social Security Act (42 U.S.C. 1396r–8(k)(7)(A)(i)).
“(2) The term ‘AMP’ has the meaning given ‘average manufacturer price’ in section 1927(k)(1) of the Social Security Act (42 U.S.C. 1396r–8(k)(1)) and ‘AMP’ in section 447.504(a) of title 42, Code of Federal Regulations as published on July 17, 2007 (72 Federal Register 39142).”

Application of 2003 Amendment to Physician Specialties

Amendment by section 303 of Puspan. L. 108–173, insofar as applicable to payments for drugs or biologicals and drug administration services furnished by physicians, is applicable only to physicians in the specialties of hematology, hematology/oncology, and medical oncology under subchapter XVIII of this chapter, see section 303(j) of Puspan. L. 108–173, set out as a note under section 1395u of this title.

Notwithstanding section 303(j) of Puspan. L. 108–173 (see note above), amendment by section 303 of Puspan. L. 108–173 also applicable to payments for drugs or biologicals and drug administration services furnished by physicians in specialties other than the specialties of hematology, hematology/oncology, and medical oncology, see section 304 of Puspan. L. 108–173, set out as a note under section 1395u of this title.

Reports on Best Price Changes and Payment of Rebates

Puspan. L. 102–585, title VI, § 601(d), Nov. 4, 1992, 106 Stat. 4965, provided that not later than 90 days after the expiration of each calendar quarter beginning on or after Oct. 1, 1992, and ending on or before Dec. 31, 1995, Secretary of Health and Human Services was to submit to Congress a report containing information as to percentage of single source drugs whose best price either increased, decreased, or stayed the same in comparison to best price during previous calendar quarter, median and mean percentage increase or decrease of such price, and, with respect to drugs for which manufacturers were required to pay rebates under subsec. (c) of this section, Secretary’s best estimate, on State-by-State and national aggregate basis, of total amount of rebates paid under subsec. (c) of this section and percentages of such total amounts attributable to rebates paid under pars. (1) to (3) of subsec. (c) of this section, limited consideration to drugs which are considered significant expenditures under medicaid program, and contained requirements for initial report.

Demonstration Projects To Evaluate Efficiency and Cost-Effectiveness of Prospective Drug Utilization Review

Puspan. L. 101–508, title IV, § 4401(c), Nov. 5, 1990, 104 Stat. 1388–159, directed Secretary of Health and Human Services to establish statewide demonstration projects to evaluate efficiency and cost-effectiveness of prospective drug utilization review and to evaluate impact on quality of care and cost-effectiveness of paying pharmacists under this subchapter whether or not drugs were dispensed for drug use review services, with two reports to be submitted to Congress, the first not later than Jan. 1, 1994, and the second not later than Jan. 1, 1995.

Study of Drug Purchasing and Billing Practices in Health Care Industry; Report

Puspan. L. 101–508, title IV, § 4401(d), Nov. 5, 1990, 104 Stat. 1388–160, as amended by Puspan. L. 104–316, title I, § 122(i), Oct. 19, 1996, 110 Stat. 3837, provided for various studies and reports as follows: (1) directed Comptroller General to conduct study of drug purchasing and billing activities of various health care systems, and to submit report to Secretary of Health and Human Services and to Congress by not later than May 1, 1991; (2) directed Comptroller General to submit to Secretary and Congress report on changes in prices charged by manufacturers for prescription drugs to Department of Veterans Affairs, other Federal programs, hospital pharmacies, and other purchasing groups and managed care plans; (3) directed Secretary, acting in consultation with Comptroller General, to study prior approval procedures utilized by State medical assistance programs conducted under this subchapter, and to submit report to Congress by not later than Dec. 31, 1991; (4) directed Secretary to conduct study on adequacy of current reimbursement rates to pharmacists under each State medical assistance program conducted under this subchapter, and to submit report to Congress by not later than Dec. 31, 1991; and (5) directed Secretary to undertake study of relationship between State medical assistance plans and Federal and State acquisition and reimbursement policies for vaccines and accessibility of vaccinations and immunization to children, and to report to Congress not later than one year after Nov. 5, 1990.