Improving Transparency and Accuracy in Medicare Part D Spending Act

31 U.S.C. 5336 - Filed in the 116th Congress as H.R.2513/S.1978 Corporate Transparency Act of 2019. To ensure that persons who form corporations or limited liability companies in the United States disclose the beneficial owners of those corporations or limited liability companies, in order to prevent wrongdoers from exploiting United States corporations and limited liability companies for criminal gain, to assist law enforcement in detecting, preventing, and punishing terrorism, money laundering, and other misconduct involving United States corporations and limited liability companies, and for other purposes. Oppose. H.R.703/S.213 - Main Street Tax Certainty Act. To amend the Internal Revenue Code of 1986 to make permanent the deduction for qualified business income. Support. H.Con.Res.14 - House Budget Resolution. Establishing the congressional budget for the United States Government for fiscal year 2025 and setting forth the appropriate budgetary levels for fiscal years 2026 through 2034. Support. S.Con.Res.7 - Senate Budget Resolution. An original concurrent resolution setting forth the congressional budget for the United States Government for fiscal year 2025 and setting forth the appropriate budgetary levels for fiscal years 2026 through 2034. Support. H.R.736/S.505 - Protect Small Businesses from Excessive Paperwork Act. To amend title 31, United States Code, to modify the deadline for filing beneficial ownership information reports for reporting companies formed or registered before January 1, 2024. Support. H.R.425/S.100 - Repealing Big Brother Overreach Act. To repeal the Corporate Transparency Act. Support. S.305 - Small Business Technological Act of 2025. To authorize small business loans to finance access to modern business software, and for other purposes. Support. H.R.1968 - Full-Year Continuing Appropriations and Extensions Act, 2025. Making further continuing appropriations and other extensions for the fiscal year ending September 30, 2025, and for other purposes. Support. H.R.919 - Chronic Disease Flexible Coverage Act. To codify Internal Revenue Service guidance relating to treatment of certain services and items for chronic conditions as meeting the preventive care deductible safe harbor for purposes of high deductible health plans in connection with health savings accounts. Support. S.1211 - Assisting in Developing (AID) Youth Employment Act. To amend the Workforce Innovation and Opportunity Act to provide funding, on a competitive basis, for summer and year-round employment opportunities for youth ages 14 through 24. Support. S.1210 - Helping to Encourage Real Opportunity (HERO) for Youth Act. To amend the Internal Revenue Code of 1986 to modify the work opportunity credit for certain youth employees. Support. H.R.832 - Small Business Advocacy Improvements Act of 2025. To clarify the primary functions and duties of the Office of Advocacy of the Small Business Administration, and for other purposes. Support. H.R.818 - Small Business Procurement and Utilization Reform Act of 2025. To amend the Small Business Act to include requirements relating to new small business entrants in the scorecard program, and for other purposes. Support. H.R.788 - DOE and SBA Research Act. To provide for Department of Energy and Small Business Administration joint research and development activities, and for other purposes. Support. H.R.825 - Assisting Small Businesses Not Fraudsters Act. To prohibit individuals convicted of defrauding the Government from receiving any assistance from the Small Business Administration, and for other purposes. Support. H.R.754 - Investing in Main Street Act. To amend the Small Business Investment Act of 1958 to increase the amount that may be invested in small business investment companies. Support. H.R.804 - Rural Small Business Resilience Act. To require the Administrator of the Small Business Administration to improve access to disaster assistance for individuals located in rural areas, and for other purposes. Support. H.R.828 - Successful Entrepreneurship for Reservists and Veterans (SERV) Act. To require the Administrator of the Small Business Administration to report on the veterans interagency task force, to require the Comptroller General of the United States to report on access to credit for small business concerns owned and controlled by covered individuals, and for other purposes. Support. H.R.872 - Federal Contractor Cybersecurity Vulnerability Reduction Act of 2025. To require covered contractors implement a vulnerability disclosure policy consistent with NIST guidelines, and for other purposes. Support. H.R.789 - Transparency and Predictability in Small Business Opportunities Act. To require the Administrator of the Small Business Administration to issue rules for cancelled covered solicitations, to amend the Small Business Act to provide assistance to small business concerns relating to certain cancelled solicitations, and for other purposes. Support. H.R.1804 - 7(a) Loan Agent Oversight Act. To amend the Small Business Act to require a report on 7(a) agents, and for other purposes. Support. H.R.1816 - WOSB Accountability Act. To establish requirements relating to certification of small business concerns owned and controlled by women for certain purposes, and for other purposes. Support. S.202 - Helping Small Businesses To Hedge Risk and Insure against Volatile Expenses (THRIVE) Act. To require the Administrator of the Small Business Administration to establish a program to allow small business concerns to purchase certain commodities futures, and for other purposes. Support. H.R.1 - One Big Beautiful Bill Act. To reduce taxes, reduce or increase spending for various federal programs, increase the statutory debt limit, and otherwise address agencies and programs throughout the federal government. Support. H.R.3169 - SBIR/STTR Reauthorization Act of 2025. To reauthorize and modify the Small Business Innovation Research and Small Business Technology Transfer Research programs. Support. H.R.2966 - American Entrepreneurs First Act of 2025. To prohibit Small Business Administration (SBA) funds from being distributed to individuals or businesses with foreign or undocumented ownership. Support. H.R.1163/S.495 - Prove It Act of 2025. To amend title 5, United States Code, to require greater transparency for Federal regulatory decisions that impact small businesses. Support. H.R.2804 - Protecting Small Business Competitions Act of 2025. To amend the Small Business Act to codify the Rule of Two. Support. H.R.5100 - To extend the SBIR and STTR programs, and for other purposes. This bill reauthorizes through FY2026 the Small Business Innovation Research (SBIR) program, the Small Business Technology Transfer (STTR) program, and related pilot programs. Support. S.2777 - Small Business RELIEF Act. To exempt small business concerns from duties imposed pursuant to the national emergency declared on April 2, 2025, by the President and to refund small business concerns the amount of any such duties paid. Support H.R. 5371 - Continuing Appropriations and Extensions Act, 2026. To provide continuing FY2026 appropriations for federal agencies, additional funding for security for federal officials, and extensions of various expiring programs and authorities. Support. PN11-4 - Nomination of Lori Chavez-DeRemer, of Oregon, to be Secretary of Labor. Support. PN11-18 - Nomination of Kelly Loeffler, of Georgia, to be Administrator of the Small Business Administration. Support. PN13-3 - Nomination of Williams Briggs, of Texas, to be Deputy Administrator of the Small Business Administration. Support. PN13-11 - Nomination of Casey Mulligan, of Illinois, to be Chief Counsel for Advocacy, Small Business Administration. Support. In addition to contacts associated with the legislation described above: Implementation of the Corporate Transparency Act Small business tax relief Small Business Administration staffing Small Business Administration lending requirements and rules Federal regulatory reform Federal privacy issues State privacy issues Independent contractor rules Joint employer rules Overtime/White-Collar Exemption rules Noncompete provisions Government funding and shutdown concerns Healthcare and paid leave issues White House Conference on Small Business Yellow Pages Test and government competition with the private sector Commodities markets and small business commodity risks Adherence to and improvement of the Regulatory Flexibility Act (RFA) Adherence to and improvement of the Small Business Regulatory Enforcement Fairness Act (SBREFA) Reauthorization of the Workforce Innovation and Opportunity Act (WIOA) Artificial Intelligence Implementation & Impacts Reducing Monopolistic Business Practices Preparation for the National Defense Authorization Act (NDAA) for Fiscal Year 2025 Preparation for Tax Cuts and Jobs Act provision expirations in 2025 Export and import concerns for small companies Streamlining federal resources and support for access to international markets Accessibility of Federal Awards for small businesses Supply chain stability Improving cyber resilience for small businesses Revolutionary Far Overhaul (RFO) impact on small businesses DOL-OSHA Proposed Rule on Heat Injury and Illness Prevention in Outdoor and Indoor Work Settings SBA Proposed Rule on Increasing Small Business Participation on Multiple Award Contracts DoD-Defense Acquisition Regulations System Proposed Rule on Assessing Contractor Implementation of Cybersecurity Requirements SBA Government Contracting: Subcontracting Program Federal Acquisition Regulation: Inflation Adjustment of Acquisition-Related Thresholds ("MPT & SAT Proposed Rule") Treasury Trade and National Security Actions and Low-Value Shipments ("Modifications to De Minimis") NSF Request for Information: Development of an Artificial Intelligence Action Plan FAR Controlled Unclassified Information (CUI) Rule USTR Request for Comments: To Assist in Reviewing and Identifying Unfair Trade Practices and Initiating All Necessary Actions to Investigate Harm From Non-Reciprocal Trade Arrangements Federal Acquisition Regulation: Small Business Participation on Certain Multiple-Award Contracts Congressional Request for Information to Explore Data Privacy and Security Framework SBA Office of Advocacy Comments re: FTC RFI on Anti-Competitive Regulations FTC RFI on Anticompetitive Regulations NSF RFI on AI R&D Plan HHS RFI on Outdated and Unnecessary Regulations DoD Request for Comment on Modernizing Defense Acquisitions ED Proposed Priority and Definitions - Advancing AI in Education

Client expense: $50,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), SENATE, Small Business Administration (SBA)

31 U.S.C. 5336 - Filed in the 116th Congress as H.R.2513/S.1978 Corporate Transparency Act of 2019. To ensure that persons who form corporations or limited liability companies in the United States disclose the beneficial owners of those corporations or limited liability companies, in order to prevent wrongdoers from exploiting United States corporations and limited liability companies for criminal gain, to assist law enforcement in detecting, preventing, and punishing terrorism, money laundering, and other misconduct involving United States corporations and limited liability companies, and for other purposes. Oppose. H.R.703/S.213 - Main Street Tax Certainty Act. To amend the Internal Revenue Code of 1986 to make permanent the deduction for qualified business income. Support. H.Con.Res.14 - House Budget Resolution. Establishing the congressional budget for the United States Government for fiscal year 2025 and setting forth the appropriate budgetary levels for fiscal years 2026 through 2034. Support. S.Con.Res.7 - Senate Budget Resolution. An original concurrent resolution setting forth the congressional budget for the United States Government for fiscal year 2025 and setting forth the appropriate budgetary levels for fiscal years 2026 through 2034. Support. H.R.736/S.505 - Protect Small Businesses from Excessive Paperwork Act. To amend title 31, United States Code, to modify the deadline for filing beneficial ownership information reports for reporting companies formed or registered before January 1, 2024. Support. H.R.425/S.100 - Repealing Big Brother Overreach Act. To repeal the Corporate Transparency Act. Support. S.305 - Small Business Technological Act of 2025. To authorize small business loans to finance access to modern business software, and for other purposes. Support. H.R.1968 - Full-Year Continuing Appropriations and Extensions Act, 2025. Making further continuing appropriations and other extensions for the fiscal year ending September 30, 2025, and for other purposes. Support. H.R.919 - Chronic Disease Flexible Coverage Act. To codify Internal Revenue Service guidance relating to treatment of certain services and items for chronic conditions as meeting the preventive care deductible safe harbor for purposes of high deductible health plans in connection with health savings accounts. Support. S.1211 - Assisting in Developing (AID) Youth Employment Act. To amend the Workforce Innovation and Opportunity Act to provide funding, on a competitive basis, for summer and year-round employment opportunities for youth ages 14 through 24. Support. S.1210 - Helping to Encourage Real Opportunity (HERO) for Youth Act. To amend the Internal Revenue Code of 1986 to modify the work opportunity credit for certain youth employees. Support. H.R.832 - Small Business Advocacy Improvements Act of 2025. To clarify the primary functions and duties of the Office of Advocacy of the Small Business Administration, and for other purposes. Support. H.R.818 - Small Business Procurement and Utilization Reform Act of 2025. To amend the Small Business Act to include requirements relating to new small business entrants in the scorecard program, and for other purposes. Support. H.R.788 - DOE and SBA Research Act. To provide for Department of Energy and Small Business Administration joint research and development activities, and for other purposes. Support. H.R.825 - Assisting Small Businesses Not Fraudsters Act. To prohibit individuals convicted of defrauding the Government from receiving any assistance from the Small Business Administration, and for other purposes. Support. H.R.754 - Investing in Main Street Act. To amend the Small Business Investment Act of 1958 to increase the amount that may be invested in small business investment companies. Support. H.R.804 - Rural Small Business Resilience Act. To require the Administrator of the Small Business Administration to improve access to disaster assistance for individuals located in rural areas, and for other purposes. Support. H.R.828 - Successful Entrepreneurship for Reservists and Veterans (SERV) Act. To require the Administrator of the Small Business Administration to report on the veterans interagency task force, to require the Comptroller General of the United States to report on access to credit for small business concerns owned and controlled by covered individuals, and for other purposes. Support. H.R.872 - Federal Contractor Cybersecurity Vulnerability Reduction Act of 2025. To require covered contractors implement a vulnerability disclosure policy consistent with NIST guidelines, and for other purposes. Support. H.R.789 - Transparency and Predictability in Small Business Opportunities Act. To require the Administrator of the Small Business Administration to issue rules for cancelled covered solicitations, to amend the Small Business Act to provide assistance to small business concerns relating to certain cancelled solicitations, and for other purposes. Support. H.R.1804 - 7(a) Loan Agent Oversight Act. To amend the Small Business Act to require a report on 7(a) agents, and for other purposes. Support. H.R.1816 - WOSB Accountability Act. To establish requirements relating to certification of small business concerns owned and controlled by women for certain purposes, and for other purposes. Support. S.202 - Helping Small Businesses To Hedge Risk and Insure against Volatile Expenses (THRIVE) Act. To require the Administrator of the Small Business Administration to establish a program to allow small business concerns to purchase certain commodities futures, and for other purposes. Support. H.R.1 - One Big Beautiful Bill Act. To reduce taxes, reduce or increase spending for various federal programs, increase the statutory debt limit, and otherwise address agencies and programs throughout the federal government. Support. H.R.3169 - SBIR/STTR Reauthorization Act of 2025. To reauthorize and modify the Small Business Innovation Research and Small Business Technology Transfer Research programs. Support. H.R. 2966 - American Entrepreneurs First Act of 2025. To prohibit Small Business Administration (SBA) funds from being distributed to individuals or businesses with foreign or undocumented ownership. Support. H.R. 1163/S.495 - Prove It Act of 2025. To amend title 5, United States Code, to require greater transparency for Federal regulatory decisions that impact small businesses. Support. H.R.2804 - Protecting Small Business Competitions Act of 2025. To amend the Small Business Act to codify the Rule of Two. Support. PN11-4 - Nomination of Lori Chavez-DeRemer, of Oregon, to be Secretary of Labor. Support. PN11-18 - Nomination of Kelly Loeffler, of Georgia, to be Administrator of the Small Business Administration. Support. PN13-3 - Nomination of Williams Briggs, of Texas, to be Deputy Administrator of the Small Business Administration. Support. PN13-11 - Nomination of Casey Mulligan, of Illinois, to be Chief Counsel for Advocacy, Small Business Administration. Support. In addition to contacts associated with the legislation described above: Implementation of the Corporate Transparency Act Small business tax relief Small Business Administration staffing Small Business Administration lending requirements and rules Federal regulatory reform Federal privacy issues State privacy issues Independent contractor rules Joint employer rules Overtime/White-Collar Exemption rules Noncompete provisions Government funding and shutdown concerns Healthcare and paid leave issues White House Conference on Small Business Yellow Pages Test and government competition with the private sector Commodities markets and small business commodity risks Adherence to and improvement of the Regulatory Flexibility Act (RFA) Adherence to and improvement of the Small Business Regulatory Enforcement Fairness Act (SBREFA) Reauthorization of the Workforce Innovation and Opportunity Act (WIOA) Artificial Intelligence Implementation & Impacts Reducing Monopolistic Business Practices Preparation for the National Defense Authorization Act (NDAA) for Fiscal Year 2025 Preparation for Tax Cuts and Jobs Act provision expirations in 2025 Export and import concerns for small companies Streamlining federal resources and support for access to international markets Accessibility of Federal Awards for small businesses Supply chain stability DOL-OSHA Proposed Rule on Heat Injury and Illness Prevention in Outdoor and Indoor Work Settings SBA Proposed Rule on Increasing Small Business Participation on Multiple Award Contracts DoD-Defense Acquisition Regulations System Proposed Rule on Assessing Contractor Implementation of Cybersecurity Requirements SBA Government Contracting: Subcontracting Program Federal Acquisition Regulation: Inflation Adjustment of Acquisition-Related Thresholds ("MPT & SAT Proposed Rule") Treasury Trade and National Security Actions and Low-Value Shipments ("Modifications to De Minimis") NSF Request for Information: Development of an Artificial Intelligence Action Plan FAR Controlled Unclassified Information (CUI) Rule USTR Request for Comments: To Assist in Reviewing and Identifying Unfair Trade Practices and Initiating All Necessary Actions to Investigate Harm From Non-Reciprocal Trade Arrangements Federal Acquisition Regulation: Small Business Participation on Certain Multiple-Award Contracts Congressional Request for Information to Explore Data Privacy and Security Framework SBA Office of Advocacy response to FTC Request for Information (RFI) on Anti-Competitive Regulations FTC RFI on Anti-Competitive Regulations NSF RFI on AI R&D Plan Senate RFI on American Science Acceleration Project (ASAP)

31 U.S.C. 5336 - Filed in the 116th Congress as H.R.2513/S.1978 Corporate Transparency Act of 2019. To ensure that persons who form corporations or limited liability companies in the United States disclose the beneficial owners of those corporations or limited liability companies, in order to prevent wrongdoers from exploiting United States corporations and limited liability companies for criminal gain, to assist law enforcement in detecting, preventing, and punishing terrorism, money laundering, and other misconduct involving United States corporations and limited liability companies, and for other purposes. Oppose. H.R.703/S.213 - Main Street Tax Certainty Act. To amend the Internal Revenue Code of 1986 to make permanent the deduction for qualified business income. Support. H.Con.Res.14 - House Budget Resolution. Establishing the congressional budget for the United States Government for fiscal year 2025 and setting forth the appropriate budgetary levels for fiscal years 2026 through 2034. Support. S.Con.Res.7 - Senate Budget Resolution. An original concurrent resolution setting forth the congressional budget for the United States Government for fiscal year 2025 and setting forth the appropriate budgetary levels for fiscal years 2026 through 2034. Support. H.R.736/S.505 - Protect Small Businesses from Excessive Paperwork Act. To amend title 31, United States Code, to modify the deadline for filing beneficial ownership information reports for reporting companies formed or registered before January 1, 2024. Support. H.R.425/S.100 - Repealing Big Brother Overreach Act. To repeal the Corporate Transparency Act. Support. S.305 - Small Business Technological Act of 2025. To authorize small business loans to finance access to modern business software, and for other purposes. Support. H.R.1968 - Full-Year Continuing Appropriations and Extensions Act, 2025. Making further continuing appropriations and other extensions for the fiscal year ending September 30, 2025, and for other purposes. Support. H.R.919 - Chronic Disease Flexible Coverage Act. To codify Internal Revenue Service guidance relating to treatment of certain services and items for chronic conditions as meeting the preventive care deductible safe harbor for purposes of high deductible health plans in connection with health savings accounts. Support. S.1211 - Assisting in Developing (AID) Youth Employment Act. To amend the Workforce Innovation and Opportunity Act to provide funding, on a competitive basis, for summer and year-round employment opportunities for youth ages 14 through 24. Support. S.1210 - Helping to Encourage Real Opportunity (HERO) for Youth Act. To amend the Internal Revenue Code of 1986 to modify the work opportunity credit for certain youth employees. Support. H.R.832 - Small Business Advocacy Improvements Act of 2025. To clarify the primary functions and duties of the Office of Advocacy of the Small Business Administration, and for other purposes. Support. H.R.818 - Small Business Procurement and Utilization Reform Act of 2025. To amend the Small Business Act to include requirements relating to new small business entrants in the scorecard program, and for other purposes. Support. H.R.788 - DOE and SBA Research Act. To provide for Department of Energy and Small Business Administration joint research and development activities, and for other purposes. Support. H.R.825 - Assisting Small Businesses Not Fraudsters Act. To prohibit individuals convicted of defrauding the Government from receiving any assistance from the Small Business Administration, and for other purposes. Support. H.R.754 - Investing in Main Street Act. To amend the Small Business Investment Act of 1958 to increase the amount that may be invested in small business investment companies. Support. H.R.804 - Rural Small Business Resilience Act. To require the Administrator of the Small Business Administration to improve access to disaster assistance for individuals located in rural areas, and for other purposes. Support. H.R.828 - Successful Entrepreneurship for Reservists and Veterans (SERV) Act. To require the Administrator of the Small Business Administration to report on the veterans interagency task force, to require the Comptroller General of the United States to report on access to credit for small business concerns owned and controlled by covered individuals, and for other purposes. Support. H.R.872 - Federal Contractor Cybersecurity Vulnerability Reduction Act of 2025. To require covered contractors implement a vulnerability disclosure policy consistent with NIST guidelines, and for other purposes. Support. H.R.789 - Transparency and Predictability in Small Business Opportunities Act. To require the Administrator of the Small Business Administration to issue rules for cancelled covered solicitations, to amend the Small Business Act to provide assistance to small business concerns relating to certain cancelled solicitations, and for other purposes. Support. H.R.1804 - 7(a) Loan Agent Oversight Act. To amend the Small Business Act to require a report on 7(a) agents, and for other purposes. Support. H.R.1816 - WOSB Accountability Act. To establish requirements relating to certification of small business concerns owned and controlled by women for certain purposes, and for other purposes. Support. S.202 - Helping Small Businesses To Hedge Risk and Insure against Volatile Expenses (THRIVE) Act. To require the Administrator of the Small Business Administration to establish a program to allow small business concerns to purchase certain commodities futures, and for other purposes. Support. PN11-4 - Nomination of Lori Chavez-DeRemer, of Oregon, to be Secretary of Labor. Support. PN11-18 - Nomination of Kelly Loeffler, of Georgia, to be Administrator of the Small Business Administration. Support. PN13-3 - Nomination of Williams Briggs, of Texas, to be Deputy Administrator of the Small Business Administration. Support. PN13-11 - Nomination of Casey Mulligan, of Illinois, to be Chief Counsel for Advocacy, Small Business Administration. Support. In addition to contacts associated with the legislation described above: Implementation of the Corporate Transparency Act Small business tax relief Small Business Administration staffing Small Business Administration lending requirements and rules Federal regulatory reform Federal privacy issues State privacy issues Independent contractor rules Joint employer rules Overtime/White-Collar Exemption rules Noncompete provisions Government funding and shutdown concerns Healthcare and paid leave issues White House Conference on Small Business Yellow Pages Test and government competition with the private sector Commodities markets and small business commodity risks Adherence to and improvement of the Regulatory Flexibility Act (RFA) Adherence to and improvement of the Small Business Regulatory Enforcement Fairness Act (SBREFA) Reauthorization of the Workforce Innovation and Opportunity Act (WIOA) Artificial Intelligence Implementation & Impacts Reducing Monopolistic Business Practices Preparation for the National Defense Authorization Act (NDAA) for Fiscal Year 2025 Preparation for Tax Cuts and Jobs Act provision expirations in 2025 Export and import concerns for small companies Streamlining federal resources and support for access to international markets Accessibility of Federal Awards for small businesses Supply chain stability DOL-OSHA Proposed Rule on Heat Injury and Illness Prevention in Outdoor and Indoor Work Settings SBA Proposed Rule on Increasing Small Business Participation on Multiple Award Contracts DoD-Defense Acquisition Regulations System Proposed Rule on Assessing Contractor Implementation of Cybersecurity Requirements SBA Government Contracting: Subcontracting Program Federal Acquisition Regulation: Inflation Adjustment of Acquisition-Related Thresholds ("MPT & SAT Proposed Rule") Treasury Trade and National Security Actions and Low-Value Shipments ("Modifications to De Minimis") NSF Request for Information: Development of an Artificial Intelligence Action Plan FAR Controlled Unclassified Information (CUI) Rule USTR Request for Comments: To Assist in Reviewing and Identifying Unfair Trade Practices and Initiating All Necessary Actions to Investigate Harm From Non-Reciprocal Trade Arrangements Federal Acquisition Regulation: Small Business Participation on Certain Multiple-Award Contracts Congressional Request for Information to Explore Data Privacy and Security Framework

H.R. 789 - To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. H.R. 803 - This bill prohibits Medicare prescription drug plan sponsors from retroactively reducing payment on clean claims submitted by pharmacies. (A "clean claim" is a Medicare claim that is free of defects such as incomplete documentation.) H.R. 1034 - Phair Pricing Act of 2019; To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program S. 640 - To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program, and for other purposes. S. 476 - Creating Transparency to Have Drug Rebates Unlocked (C-Thru) Act of 2019 - To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. S.2543 Prescription Drug Pricing Reduction Act of 2019 -To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes. HR 5304 PBM Transparency in Prescription Drug Cost Act - To amend title XXVII of the Public Health Service Act to require health plan oversight of pharmacy benefit manager service HR 5442 - Lowest Price for Patients Act - To amend title XXVII of the Public Health Service Act and title XVIII of the Social Security Act to require pharmacies to disclose any differential between the cost of a prescription drug based on whether certain individuals use prescription drug coverage to acquire such drug, and for other purposes. S. 3129 - To provide for certain reforms with respect to the Medicare program under title XVIII of the Social Security Act, and for other purposes. HR 19 - To provide for certain reforms with respect to the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, the Food and Drug Administration, and for other purposes. Lower Costs, More Cures Act of 2019.

H.R. 789 - To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. H.R. 803 - This bill prohibits Medicare prescription drug plan sponsors from retroactively reducing payment on clean claims submitted by pharmacies. (A "clean claim" is a Medicare claim that is free of defects such as incomplete documentation.) H.R. 1034 - Phair Pricing Act of 2019; To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program S. 640 - To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program, and for other purposes. S. 476 - Creating Transparency to Have Drug Rebates Unlocked (C-Thru) Act of 2019 - To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. S.2543 Prescription Drug Pricing Reduction Act of 2019 -To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes. HR 5304 PBM Transparency in Prescription Drug Cost Act - To amend title XXVII of the Public Health Service Act to require health plan oversight of pharmacy benefit manager service HR 5442 - Lowest Price for Patients Act - To amend title XXVII of the Public Health Service Act and title XVIII of the Social Security Act to require pharmacies to disclose any differential between the cost of a prescription drug based on whether certain individuals use prescription drug coverage to acquire such drug, and for other purposes. S. 3129 - To provide for certain reforms with respect to the Medicare program under title XVIII of the Social Security Act, and for other purposes. HR 19 - To provide for certain reforms with respect to the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, the Food and Drug Administration, and for other purposes. Lower Costs, More Cures Act of 2019. HR 3 -To establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes.

H.R. 789 - To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. H.R. 803 - This bill prohibits Medicare prescription drug plan sponsors from retroactively reducing payment on clean claims submitted by pharmacies. (A "clean claim" is a Medicare claim that is free of defects such as incomplete documentation.) H.R. 1034 - Phair Pricing Act of 2019; To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program S. 640 - To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program, and for other purposes. S. 476 - Creating Transparency to Have Drug Rebates Unlocked (C-Thru) Act of 2019 - To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. S. 476 - Creating Transparency to Have Drug Rebates Unlocked (C-Thru) Act of 2019 - To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. H.R. 3 Lower Drug Costs Now Act of 2019-To establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes. S.2543 Prescription Drug Pricing Reduction Act of 2019 -To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes. HR 5304 PBM Transparency in Prescription Drug Cost Act - To amend title XXVII of the Public Health Service Act to require health plan oversight of pharmacy benefit manager service HR 5442 - Lowest Price for Patients Act - To amend title XXVII of the Public Health Service Act and title XVIII of the Social Security Act to require pharmacies to disclose any differential between the cost of a prescription drug based on whether certain individuals use prescription drug coverage to acquire such drug, and for other purposes. S. 3129 - To provide for certain reforms with respect to the Medicare program under title XVIII of the Social Security Act, and for other purposes. HR 19 - To provide for certain reforms with respect to the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, the Food and Drug Administration, and for other purposes. Lower Costs, More Cures Act of 2019. HR 3 -To establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes.

H.R. 789 - To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. H.R. 803 - This bill prohibits Medicare prescription drug plan sponsors from retroactively reducing payment on clean claims submitted by pharmacies. (A "clean claim" is a Medicare claim that is free of defects such as incomplete documentation.) H.R. 1034 - Phair Pricing Act of 2019; To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program S. 640 - To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program, and for other purposes. S. 476 - Creating Transparency to Have Drug Rebates Unlocked (C-Thru) Act of 2019 - To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. S. 476 - Creating Transparency to Have Drug Rebates Unlocked (C-Thru) Act of 2019 - To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. H.R. 3 Lower Drug Costs Now Act of 2019-To establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes. S.2543 Prescription Drug Pricing Reduction Act of 2019 -To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes. HR 5304 PBM Transparency in Prescription Drug Cost Act - To amend title XXVII of the Public Health Service Act to require health plan oversight of pharmacy benefit manager service HR 5442 - Lowest Price for Patients Act - To amend title XXVII of the Public Health Service Act and title XVIII of the Social Security Act to require pharmacies to disclose any differential between the cost of a prescription drug based on whether certain individuals use prescription drug coverage to acquire such drug, and for other purposes. S. 3129 - To provide for certain reforms with respect to the Medicare program under title XVIII of the Social Security Act, and for other purposes. HR 19 - To provide for certain reforms with respect to the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, the Food and Drug Administration, and for other purposes. Lower Costs, More Cures Act of 2019. HR 3 -To establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes. HR 6021 - pharmacy and pharmacist provisions in emergency supplemental appropriations for the fiscal year ending September 30, 2020, and for other purposes due coronoavirus pandemic. hr 6074 - pharmacist and pharmacy provisions in bill to provide FY2020 supplemental appropriations for the Department of Health and Human Services (HHS), the State Department, and the Small Business Administration to respond to the coronavirus outbreak. HR 748 - This bill responds to the COVID-19 (i.e., coronavirus disease 2019) outbreak and its impact on the economy, public health, state and local governments, individuals, and businesses.

H.R. 789 - To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. H.R. 803 - This bill prohibits Medicare prescription drug plan sponsors from retroactively reducing payment on clean claims submitted by pharmacies. (A "clean claim" is a Medicare claim that is free of defects such as incomplete documentation.) H.R. 1034 - Phair Pricing Act of 2019; To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program S. 640 - To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program, and for other purposes. S. 476 - Creating Transparency to Have Drug Rebates Unlocked (C-Thru) Act of 2019 - To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. S. 476 - Creating Transparency to Have Drug Rebates Unlocked (C-Thru) Act of 2019 - To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. H.R. 3 Lower Drug Costs Now Act of 2019-To establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes. S.2543 Prescription Drug Pricing Reduction Act of 2019 -To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes. HR 5304 PBM Transparency in Prescription Drug Cost Act - To amend title XXVII of the Public Health Service Act to require health plan oversight of pharmacy benefit manager service HR 5442 - Lowest Price for Patients Act - To amend title XXVII of the Public Health Service Act and title XVIII of the Social Security Act to require pharmacies to disclose any differential between the cost of a prescription drug based on whether certain individuals use prescription drug coverage to acquire such drug, and for other purposes.

S. 62, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 99, Medicare Drug Price Negotiation Act (Sanders) - Part D price negotiations, formulary changes S. 205, Right Rebate Act (Wyden) - Medicaid drug rebate program S. 317, ACE Kids Act (Grassley) - health homes for children with medically complex conditions S. 377, Medicare Negotiation and Competitive Licensing Act (Brown) - Part D price negotiation S. 470, Medicare at 50 Act (Stabenow) - Medicare buy-in option S. 475, RxCAP Act (Wyden) - Part D cost-sharing S. 489, State Public Option Act (Schatz) - Medicaid buy-in option S. 516, Prescription Drug Monitoring Act (Klobuchar) - required use of PDMPs S. 548, EMPOWER Care Act (Portman) - MFP demonstration S. 640, Phair Pricing Act (Kennedy) -- Part D rebates at the point of sale S. 691, Medicare Extra Rx HELP Act (Casey) - Part D assistance for low-income seniors S. 709, Prescription Drug Pricing Dashboard Act (Casey) - interactive dashboard with drug price and utilization data for federal programs S. 773, Telehealth Innovation and Improvement Act (Gardner) - testing expanded coverage of telehealth services in Medicare S. 988, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - payments on clean claims S. 1114, Medicare Advantage Quality Payment Relief Act (Daines-King) - MA benchmark cap S. 2081, Stop Drug Companies from Overcharging Seniors in Medicare Part B Act of 2019 (Peters)- drugs in Part B S. 2252, Empowering States to Address Drug Costs Act (Van Hollen)- drug pricing S. 2446, Medicare Audiologist Access and Services Act of 2019 (Warren)-Medicare coverage of audiologist services S. 2650 - Medicare Prescription Drug Savings and Choice Act of 2019 (Durbin) - lowering prescription drug costs S. 2807, Hospice Care Improvement Act of 2019 (Portman) - Medicare hospice programs S. 2846, Protecting Patients Transportation to Care Act (Isakson) - Medicaid coverage of transportation S. 2911, Seniors Prescription Drug Relief Act of 2019 (Cassidy) - Part D smoothing S. 3000, Patient Shared Savings Act (Cassidy) - prescription drug plans S. 3001, Permanent Relief for Seniors and Medicare, Medicaid, Human Services Extension Act of 2019 (Toomey) - extensions S. 3029, Territories Medicare Prescription Drug Assistance Equity Act of 2019 (Menendez) - Territories, low-income Medicare part D beneficiaries S. 3078, Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2019 (Grassley) - Medicare appeals process S. 3129, Lower Costs, More Cures Act of 2019 (Crapo) - drug pricing H.R. 19, Lower Costs, More Cures Act of 2019 (Walden) - drug pricing H.R. 259, Medicaid Extenders Act (Pallone) - MFP demonstration, spousal impoverishment protections H.R. 448, Medicare Drug Price Negotiation Act (Cummings) - Part D price negotiations, formulary changes H.R. 789, Improving Transparency and Accuracy in Medicare Part D Spending Act (Welch) - payments on clean claims H.R. 937, Right Rebate Act (Schrader) - Medicaid drug rebate program H.R. 1034, Phair Pricing Act (Collins) - Part D rebates at the point of sale H.R. 1035, Prescription Drug Price Transparency Act (Collins) - Medicare PBM standards H.R. 1046, Medicare Negotiation and Competitive Licensing Act (Doggett) - Part D price negotiation H.R. 1226, ACE Kids Act (Castor) - health homes for children with medically complex conditions H.R. 1277, State Public Option Act (Lujan) - Medicaid buy-in option H.R. 1301, Mental Health Telemedicine Expansion Act (DelBene) - Medicare coverage of mental health telehealth services H.R. 1342, EMPOWER Care Act (Dingell) - MFP demonstration H.R. 1343, Protecting Married Seniors from Impoverishment Act (Dingell) - spousal impoverishment protections H.R. 1346, Medicare Buy-In and Health Care Stabilization Act (Higgins) - Medicare buy-in option H.R. 1375, PAID Act (Kind) - transparency of Medicare secondary payer information H.R. 1394, Medigap Consumer Protection Act (Doggett) - Medicare supplemental consumer protections H.R. 1551, Quality Care for Moms and Babies Act (Engel) - quality measures in Medicaid and CHIP H.R. 1781, Payment Commission Data Act (Carter) - MedPAC and MACPAC access to drug pricing and rebate data in Medicare and Medicaid H.R. 1839, Medicaid Services Investment and Accountability Act (Ruiz) - MFP demonstration, spousal impoverishment protections, ACE Kids Act, Medicaid drug rebate program, health homes for children with medically complex conditions H.R. 2131, Medicare Advantage Quality Payment Relief Act (Kind-Kelly) - MA benchmark cap H.R. 2757, Creating Lower Cost Alternatives for Your Prescription Drugs Act (Cunningham) - eliminate copay for generic drugs in Medicare Part D H.R. 3107, Improving Seniors' Timely Access to Care Act (DelBene) - Medicare Advantage prior authorization H.R. 3253, Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act (Dingell) - MFP demonstration, spousal impoverishment protections, Medicaid drug rebate program H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act (Neal) - funding for quality measurement initiatives, Medicare coverage of mental health telehealth services, real-time benefit tools in Medicare Part D, Medicare eligibility and enrollment notices H.R. 3461, Community-Based Independence for Seniors Act (Sanchez-Kelly) - Community-Based Institutional Special Needs Plan H.R. 3613, State Accountability, Flexibility, and Equity for Hospitals Act of 2019 (Bilirakis) -Medicaid DSH payments H.R. 3631, Territories Health Care Improvement Act (Soto) -Medicaid funding H.R. 3644, Independence at Home Demonstration Act of 2019 (Burgess)-Medicare demonstration program H.R. 3925, Reducing Barriers to Substance Use Treatment Act (Tonko)- Opioids H.R. 3935, Protecting Patients Transportation to Care Act (Carter)-Medicaid coverage for transportation H.R. 4378, Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 (Lowey)-Health extenders H.R. 4453, Protecting Seniors from Health Care Fraud Act of 2019 (Ruiz)-Distributing information to Medicare beneficiaries to prevent fraud H.R. 4527, Expanding Health Care Options for Early Retirees Act (Malinowski)-Option for first responders to buy-in to Medicare H.R. 4529, Promoting Access to Broadband Act of 2019 (Maloney)-Medicaid H.R. 4583, Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 (Schneider) - prescription drug affordability H.R. 4597, Acting to Cancel Copays and Ensure Substantial Savings for Biosimilars Act of 2019 (Peters) - biosimilars, Part B H.R. 4618, Medicare Hearing Act of 2019 (McBath) - coverage for certain hearing items and services under part B H.R. 4619, Pharmaceutical Rebates for Excessive Pricing Above Inflation Act (Schakowsky) - drug rebates, Part D H.R. 4620, More Help for Seniors Act of 2019 (Rose) - expand eligibility for low-income subsidies under Part D of the Medicare program H.R. 4621, Collecting and Analyzing Resources Integral and Necessary for Guidance for Social Determinants Act of 2019 (Blunt Rochester) - best practices re social determinants of health H.R. 4628, Better Tools to Lower Costs Act of 2019 (Scanlon) - resource requirements H.R. 4629, Star Rating for Biosimilars Act (Tonko) - biosimilars H.R. 4632, Better Transparency in Information for Medicare Beneficiaries Act of 2019 (Kind) - provides consumers information regarding premiums under LIS benchmark plans H.R. 4649, Capping Drug Costs for Seniors Act of 2019 (Horsford) - cap on beneficiary liability under part D of the Medicare program H.R. 4650, Medicare Dental Act of 2019 (Kelly) - Medicare dental coverage H.R. 4655, Enhancing Retirement Security for Medicare Beneficiaries Act of 2019 (Lee) - eligibility of individuals for premium and cost-sharing subsidies under part D H.R. 4661, Advancing Enrollment and Reducing Drug Costs Act of 2019 (Pappas) - Medicaid in territories H.R. 4663, Freedom from Price Gouging Act (Porter) - drug rebates, Part B H.R. 4665, Medicare Vision Act of 2019 (Schrier) - vision items and services under part B H.R. 4666, To amend title XVIII of the Social Security Act to provide certain low-income territorial residents with automatic eligibility for premium and cost-sharing subsidies under the Medicare program, and for other purposes (Shalala) - Medicare in territories H.R. 4669, Maximizing Drug Coverage for Low-Income Seniors Act of 2019 (Stevens) - auto enrollment and intelligent assignment H.R. 4671, Helping Seniors Afford Health Care Act (Kim) - Medicare affordability and low income beneficiaries H.R. 4676, Protecting Medicare Beneficiaries with Pre-Existing Conditions Act (Schneider) - Medigap H.R. 4699, To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals (Gonzales-Colon) - Part D, territories H.R. 4769, Medicare Prescription Drug Savings and Choice Act of 2019 (Schakowsky) - lowering prescription drug costs H.R. 4946, Ensuring Seniors Access to Local Pharmacies Act of 2019 (Welch) - equal access of Medicare beneficiaries to community pharmacies in underserved areas H.R. 4996, Helping Medicaid Offer Maternity Services Act of 2019 (Kelly) - State extension of Medicaid H.R. 5006, Expanding Access to Inpatient Mental Health Act (Emmer) - Medicaid coverage for SUD/mental health for institutionalized H.R. 5039, Life Sustaining Prescription Drug Price Relief Act of 2019 (Lipinski) - part D H.R. 5057, Pass- Through Technical Corrections Act (Tonko) - drug pass-through status under Medicare outpatient payment H.R. 5201, Telemental Health Expansion Act of 2019 (Matsui) - Medicare coverage of mental telehealth H.R. 5232, Road to Recovery Act (Fitzpatrick) - Medicaid and CHIP SUD treatment H.R. 5281, Drug Price Transparency in Medicaid Act of 2019 (Carter) - transparency and spread pricing affordability Discussion Draft, Medicare Part D Reform (Neal-Pallone-Brady-Walden) - maximum out-of-pocket limit, federal reinsurance payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2021 Rate Notice and Call Letter; issues related to MLTSS; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

HR 803: Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, pharmacy payments & adjustments in Part D/ DIR. HR 789: To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. HR 1035: The Prescription Drug Price Transparency Act, requires greater transparency and accountability from PBMs. HR 1034/S 640: The Phair Pricing Act, lowers the cost of prescription medication for patients in the Medicare Part D program. HR 965/S 340: "The Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act." S 64: "Preserve Access to Affordable Generics and Biosimilars Act," bars pay-for-delay for generics and biosimilars. Proposals to address pay-for-delay, orphan drug abuse and patent evergreening. Implementation of the e-prescribing provisions of controlled substances provisions of the SUPPORT Act, (P.L. 115-271). The Payment Commission Data Act, H.R. 1264, H.R. 1781 and S. 801: provisions allowing MACPAC and MedPAC access to certain drug price concession and rebate information. S. 1895: The Lower Health Care Costs Act, Sec. 306 Health Plan Oversight of PBMs. Issues related to implementation of a real-time benefit tool. S. 1416: The Affordable Prescriptions for Patients Act of 2019, address product hopping and patent thickets by giving the FTC greater powers to investigate and bring legal actions. S. 1384: The Prescription Drug Rebate Reform Act, would require all patients coinsurance obligations be set as a percentage of net price, rather than list price, before or after a deductible is met. S. 1532: The Pharmacy Benefit Manager Accountability Study Act of 2019, (provisions requiring GAO to submit a report on PBMs). H.R. 2115: the "Public Disclosure of Drug Discounts Act, requires PBMs to disclose the aggregate amount of rebates, discounts, and price concessions that PBMs negotiate with drug manufacturers, and make this information publicly available to allow the public to compare the aggregate rebates, discounts, and price concessions that PBMs receive. H.R. 2113: "The Prescription Drug STAR (Sunshine, Transparency, Accountability and Reporting) Act," provisions related to disclosure of PBM-pharmaceutical company negotiated rebates. H.R. 2376/S. 1227: Prescription Pricing for the People Act of 2019," FTC study of PBMs. S.2199: The Insulin Price Reduction Act, require private health insurance plans and Medicare Part D plans to eliminate rebates for insulin and limit out of pocket costs ($250 for individuals, and $500 for families) if manufacturers reduce insulin list prices to prices during plan year 2006 and do not raise insulin prices above inflation. H.R. 3: Lower Drug Costs Now Act of 2019, Provisions to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollment.

S.771/H.R.1776: Improving Access to Affordable Prescription Drugs Act, issues related to ensuring a competitive marketplace for prescription drugs. H.R.1316: The Prescription Drug Price Transparency Act, issues related to ensuring the continuity of MAC pricing. Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program Proposed Rule & Request for Information--Provisions on Part D. CMS Proposed and Final Policy Changes and Updates for Medicare Advantage and the Prescription Drug Benefit Program for Contract Year 2019 (CMS-4182-P as in proposed and final version CMS-4182-F, particularly issues related to pharmacy DIR and implementation of a real-time-benefit tool); provisions in a Request for Information related to rebates at the point-of-sale and pharmacist direct and indirect renumeration. Outreach and education on pharmacy Direction and Indirection Remuneration in Medicare. Provisions related to opening the Medicare doughnut hole in P.L. 115-123. HR 803: Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, pharmacy payments & adjustments in Part D/ DIR. HR 789: To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies." HR 1035: The Prescription Drug Price Transparency Act, requires greater transparency and accountability from PBMs. HR 1034/S 640: The Phair Pricing Act, lowers the cost of prescription medication for patients in the Medicare Part D program. HR 965/S 340: "The Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act." Proposals to address pay-for-delay, orphan drug abuse and patent evergreening. Implementation of the e-prescribing provisions of controlled substances provisions of the SUPPORT Act, (P.L. 115-271). The Payment Commission Data Act, H.R. 1264, H.R. 1781 and S. 801: provisions allowing MACPAC and MedPAC access to certain drug price concession and rebate information. S. 64: Preserve Access to Affordable Generics and Biosimilars Act, bars pay-for-delay for generics and biosimilars. S. 1416: The Affordable Prescriptions for Patients Act of 2019, address product hopping and patent thickets by giving the FTC greater powers to investigate and bring legal actions. S. 1384: The Prescription Drug Rebate Reform Act, would require all patients coinsurance obligations be set as a percentage of net price, rather than list price, before or after a deductible is met. S. 1505: a bill to require prescription drug plans and MA-PD plans to report potential fraud, waste, and abuse to the Secretary of Health and Human Services under Medicare part D, and for other purposes. S. 1532: The Pharmacy Benefit Manager Accountability Study Act of 2019, (Provisions requiring GAO to submit a report on PBMs). Modernization and cost-sharing of the Part D drug benefit. H.R. 2115: the "Public Disclosure of Drug Discounts Act, requires PBMs to disclose the aggregate amount of rebates, discounts, and price concessions that PBMs negotiate with drug manufacturers, and make this information publicly available to allow the public to compare the aggregate rebates, discounts, and price concessions that PBMs receive. H.R. 2113: "The Prescription Drug STAR (Sunshine, Transparency, Accountability and Reporting) Act," provisions related to disclosure of PBM-pharmaceutical company negotiated rebates. H.R. 2376/S. 1227: Prescription Pricing for the People Act of 2019, FTC study of PBMs. S.2199: The Insulin Price Reduction Act, require private health insurance plans and Medicare Part D plans to eliminate rebates for insulin and limit out of pocket costs ($250 for individuals, and $500 for families) if manufacturers reduce insulin list prices to prices during plan year 2006 and do not raise insulin prices above inflation. S.2543: The Prescription Drug Pricing Reduction Act (PDPRA) of 2019, -Legislation to amend Medicare and Medicaid to lower prescription drug prices and strengthen safeguards related to prescription drugs. Provisions related to inflation protection provisions and PBM transparency. S.2247: Phair Relief Act, Provisions related to pharmacy DIR. H.R. 3: Lower Drug Costs Now Act of 2019, Provisions to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollment. CMS Proposed rule: "Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses," (CMS-4180-P)-provisions related to pharmacy Direct and Indirect Negotiation.

S. 62, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 99, Medicare Drug Price Negotiation Act (Sanders) - Part D price negotiations, formulary changes S. 205, Right Rebate Act (Wyden) - Medicaid drug rebate program S. 317, ACE Kids Act (Grassley) - health homes for children with medically complex conditions S. 377, Medicare Negotiation and Competitive Licensing Act (Brown) - Part D price negotiation S. 470, Medicare at 50 Act (Stabenow) - Medicare buy-in option S. 475, RxCAP Act (Wyden) - Part D cost-sharing S. 489, State Public Option Act (Schatz) - Medicaid buy-in option S. 516, Prescription Drug Monitoring Act (Klobuchar) - required use of PDMPs S. 548, EMPOWER Care Act (Portman) - MFP demonstration S. 640, Phair Pricing Act (Kennedy) -- Part D rebates at the point of sale S. 691, Medicare Extra Rx HELP Act (Casey) - Part D assistance for low-income seniors S. 709, Prescription Drug Pricing Dashboard Act (Casey) - interactive dashboard with drug price and utilization data for federal programs S. 773, Telehealth Innovation and Improvement Act (Gardner) - testing expanded coverage of telehealth services in Medicare S. 988, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - payments on clean claims S. 1114, Medicare Advantage Quality Payment Relief Act (Daines-King) - MA benchmark cap S. 2081, Stop Drug Companies from Overcharging Seniors in Medicare Part B Act of 2019 (Peters)- drugs in Part B S. 2252, Empowering States to Address Drug Costs Act (Van Hollen)- drug pricing S. 2446, Medicare Audiologist Access and Services Act of 2019 (Warren)-Medicare coverage of audiologist services H.R. 259, Medicaid Extenders Act (Pallone) - MFP demonstration, spousal impoverishment protections H.R. 448, Medicare Drug Price Negotiation Act (Cummings) - Part D price negotiations, formulary changes H.R. 789, Improving Transparency and Accuracy in Medicare Part D Spending Act (Welch) - payments on clean claims H.R. 937, Right Rebate Act (Schrader) - Medicaid drug rebate program H.R. 1034, Phair Pricing Act (Collins) - Part D rebates at the point of sale H.R. 1035, Prescription Drug Price Transparency Act (Collins) - Medicare PBM standards H.R. 1046, Medicare Negotiation and Competitive Licensing Act (Doggett) - Part D price negotiation H.R. 1226, ACE Kids Act (Castor) - health homes for children with medically complex conditions H.R. 1277, State Public Option Act (Lujan) - Medicaid buy-in option H.R. 1301, Mental Health Telemedicine Expansion Act (DelBene) - Medicare coverage of mental health telehealth services H.R. 1342, EMPOWER Care Act (Dingell) - MFP demonstration H.R. 1343, Protecting Married Seniors from Impoverishment Act (Dingell) - spousal impoverishment protections H.R. 1346, Medicare Buy-In and Health Care Stabilization Act (Higgins) - Medicare buy-in option H.R. 1375, PAID Act (Kind) - transparency of Medicare secondary payer information H.R. 1394, Medigap Consumer Protection Act (Doggett) - Medicare supplemental consumer protections H.R. 1551, Quality Care for Moms and Babies Act (Engel) - quality measures in Medicaid and CHIP H.R. 1781, Payment Commission Data Act (Carter) - MedPAC and MACPAC access to drug pricing and rebate data in Medicare and Medicaid H.R. 1839, Medicaid Services Investment and Accountability Act (Ruiz) - MFP demonstration, spousal impoverishment protections, ACE Kids Act, Medicaid drug rebate program, health homes for children with medically complex conditions H.R. 2131, Medicare Advantage Quality Payment Relief Act (Kind-Kelly) - MA benchmark cap H.R. 2757, Creating Lower Cost Alternatives for Your Prescription Drugs Act (Cunningham) - eliminate copay for generic drugs in Medicare Part D H.R. 3107, Improving Seniors' Timely Access to Care Act (DelBene) - Medicare Advantage prior authorization H.R. 3253, Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act (Dingell) - MFP demonstration, spousal impoverishment protections, Medicaid drug rebate program H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act (Neal) - funding for quality measurement initiatives, Medicare coverage of mental health telehealth services, real-time benefit tools in Medicare Part D, Medicare eligibility and enrollment notices H.R. 3461, Community-Based Independence for Seniors Act (Sanchez-Kelly) - Community-Based Institutional Special Needs Plan Discussion Draft, Medicare Part D Reform (Neal-Pallone-Brady-Walden) - maximum out-of-pocket limit, federal reinsurance payments H.R. 3613, State Accountability, Flexibility, and Equity for Hospitals Act of 2019 (Bilirakis) -Medicaid DSH payments H.R. 3631, Territories Health Care Improvement Act (Soto) -Medicaid funding H.R. 3644, Independence at Home Demonstration Act of 2019 (Burgess)-Medicare demonstration program H.R. 3925, Reducing Barriers to Substance Use Treatment Act (Tonko)- Opioids H.R. 3935, Protecting Patients Transportation to Care Act (Carter)-Medicaid coverage for transportation H.R. 4378, Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 (Lowey)-Health extenders H.R. 4453, Protecting Seniors from Health Care Fraud Act of 2019 (Ruiz)-Distributing information to Medicare beneficiaries to prevent fraud H.R. 4527, Expanding Health Care Options for Early Retirees Act (Malinowski)-Option for first responders to buy-in to Medicare H.R. 4529, Promoting Access to Broadband Act of 2019 (Maloney)-Medicaid Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2020 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2020 Rate Notice and Call Letter; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

H.R. 789 - To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. H.R. 803 - This bill prohibits Medicare prescription drug plan sponsors from retroactively reducing payment on clean claims submitted by pharmacies. (A "clean claim" is a Medicare claim that is free of defects such as incomplete documentation.) H.R. 1034 - Phair Pricing Act of 2019; To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program S. 640 - To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program, and for other purposes. H.R. 3 Lower Drug Costs Now Act of 2019-To establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes. S.2543 Prescription Drug Pricing Reduction Act of 2019 -To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes.

Client expense: $34,000 · Firm income: Not reported

S.771/H.R.1776: Improving Access to Affordable Prescription Drugs Act, issues related to ensuring a competitive marketplace for prescription drugs. H.R.1316: The Prescription Drug Price Transparency Act, issues related to ensuring the continuity of MAC pricing. Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program Proposed Rule & Request for Information--Provisions on Part D. CMS Proposed and Final Policy Changes and Updates for Medicare Advantage and the Prescription Drug Benefit Program for Contract Year 2019 (CMS-4182-P as in proposed and final version CMS-4182-F, particularly issues related to pharmacy DIR and implementation of a real-time-benefit tool); provisions in a Request for Information related to rebates at the point-of-sale and pharmacist direct and indirect renumeration. Outreach and education on pharmacy Direction and Indirection Remuneration in Medicare. Provisions related to opening the Medicare doughnut hole in P.L. 115-123. HR 803: Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, pharmacy payments & adjustments in Part D/ DIR. HR 789: To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies." HR 1035: The Prescription Drug Price Transparency Act, requires greater transparency and accountability from PBMs. HR 1034/S 640: The Phair Pricing Act, lowers the cost of prescription medication for patients in the Medicare Part D program. HR 965/S 340: "The Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act." Proposals to address pay-for-delay, orphan drug abuse and patent evergreening. Implementation of the e-prescribing provisions of controlled substances provisions of the SUPPORT Act, (P.L. 115-271). The Payment Commission Data Act, H.R. 1264, H.R. 1781 and S. 801: provisions allowing MACPAC and MedPAC access to certain drug price concession and rebate information. S. 64: Preserve Access to Affordable Generics and Biosimilars Act, bars pay-for-delay for generics and biosimilars. S. 1416: The Affordable Prescriptions for Patients Act of 2019, address product hopping and patent thickets by giving the FTC greater powers to investigate and bring legal actions. S. 1384: The Prescription Drug Rebate Reform Act, would require all patients coinsurance obligations be set as a percentage of net price, rather than list price, before or after a deductible is met. S. 1505: a bill to require prescription drug plans and MA-PD plans to report potential fraud, waste, and abuse to the Secretary of Health and Human Services under Medicare part D, and for other purposes. S. 1532: The Pharmacy Benefit Manager Accountability Study Act of 2019, (Provisions requiring GAO to submit a report on PBMs). Modernization and cost-sharing of the Part D drug benefit. H.R. 2115: the "Public Disclosure of Drug Discounts Act, requires PBMs to disclose the aggregate amount of rebates, discounts, and price concessions that PBMs negotiate with drug manufacturers, and make this information publicly available to allow the public to compare the aggregate rebates, discounts, and price concessions that PBMs receive. H.R. 2087: "The STAR (Sunshine, Transparency, Accountability and Reporting) Act," provisions related to disclosure of PBM-pharmaceutical company negotiated rebates. H.R. 2376/S. 1227: Prescription Pricing for the People Act of 2019, FTC study of PBMs. S.2199: The Insulin Price Reduction Act, require private health insurance plans and Medicare Part D plans to eliminate rebates for insulin and limit out of pocket costs ($250 for individuals, and $500 for families) if manufacturers reduce insulin list prices to prices during plan year 2006 and do not raise insulin prices above inflation. S.2543: The Prescription Drug Pricing Reduction Act (PDPRA) of 2019, -Legislation to amend Medicare and Medicaid to lower prescription drug prices and strengthen safeguards related to prescription drugs. Provisions related to inflation protection provisions and PBM transparency. S.2247: Phair Relief Act, Provisions related to pharmacy DIR. H.R. 3: Lower Drug Costs Now Act of 2019, Provisions to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollment. CMS Proposed rule: "Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses," (CMS-4180-P)-provisions related to pharmacy Direct and Indirect Negotiation.

HR 803: Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, pharmacy payments & adjustments in Part D/ DIR. HR 789: To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. HR 1035: The Prescription Drug Price Transparency Act, requires greater transparency and accountability from PBMs. HR 1034/S 640: The Phair Pricing Act, lowers the cost of prescription medication for patients in the Medicare Part D program. HR 965/S 340: "The Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act." S 64: "Preserve Access to Affordable Generics and Biosimilars Act," bars pay-for-delay for generics and biosimilars. Proposals to address pay-for-delay, orphan drug abuse and patent evergreening. Implementation of the e-prescribing provisions of controlled substances provisions of the SUPPORT Act, (P.L. 115-271). The Payment Commission Data Act, H.R. 1264, H.R. 1781 and S. 801: provisions allowing MACPAC and MedPAC access to certain drug price concession and rebate information. S. 1895: The Lower Health Care Costs Act, Sec. 306 Health Plan Oversight of PBMs. Issues related to implementation of a real-time benefit tool. S. 1416: The Affordable Prescriptions for Patients Act of 2019, address product hopping and patent thickets by giving the FTC greater powers to investigate and bring legal actions. S. 1384: The Prescription Drug Rebate Reform Act, would require all patients coinsurance obligations be set as a percentage of net price, rather than list price, before or after a deductible is met. S. 1532: The Pharmacy Benefit Manager Accountability Study Act of 2019, (provisions requiring GAO to submit a report on PBMs). H.R. 2115: the "Public Disclosure of Drug Discounts Act, requires PBMs to disclose the aggregate amount of rebates, discounts, and price concessions that PBMs negotiate with drug manufacturers, and make this information publicly available to allow the public to compare the aggregate rebates, discounts, and price concessions that PBMs receive. H.R. 2087: "The STAR (Sunshine, Transparency, Accountability and Reporting) Act," provisions related to disclosure of PBM-pharmaceutical company negotiated rebates. H.R. 2376/S. 1227: Prescription Pricing for the People Act of 2019," FTC study of PBMs. S.2199: The Insulin Price Reduction Act, require private health insurance plans and Medicare Part D plans to eliminate rebates for insulin and limit out of pocket costs ($250 for individuals, and $500 for families) if manufacturers reduce insulin list prices to prices during plan year 2006 and do not raise insulin prices above inflation. H.R. 3: Lower Drug Costs Now Act of 2019, Provisions to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollment.

S. 62, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 99, Medicare Drug Price Negotiation Act (Sanders) - Part D price negotiations, formulary changes S. 205, Right Rebate Act (Wyden) - Medicaid drug rebate program S. 317, ACE Kids Act (Grassley) - health homes for children with medically complex conditions S. 377, Medicare Negotiation and Competitive Licensing Act (Brown) - Part D price negotiation S. 470, Medicare at 50 Act (Stabenow) - Medicare buy-in option S. 475, RxCAP Act (Wyden) - Part D cost-sharing S. 489, State Public Option Act (Schatz) - Medicaid buy-in option S. 516, Prescription Drug Monitoring Act (Klobuchar) - required use of PDMPs S. 548, EMPOWER Care Act (Portman) - MFP demonstration S. 640, Phair Pricing Act (Kennedy) -- Part D rebates at the point of sale S. 691, Medicare Extra Rx HELP Act (Casey) - Part D assistance for low-income seniors S. 709, Prescription Drug Pricing Dashboard Act (Casey) - interactive dashboard with drug price and utilization data for federal programs S. 773, Telehealth Innovation and Improvement Act (Gardner) - testing expanded coverage of telehealth services in Medicare S. 988, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - payments on clean claims S. 1114, Medicare Advantage Quality Payment Relief Act (Daines-King) - MA benchmark cap H.R. 259, Medicaid Extenders Act (Pallone) - MFP demonstration, spousal impoverishment protections H.R. 448, Medicare Drug Price Negotiation Act (Cummings) - Part D price negotiations, formulary changes H.R. 789, Improving Transparency and Accuracy in Medicare Part D Spending Act (Welch) - payments on clean claims H.R. 937, Right Rebate Act (Schrader) - Medicaid drug rebate program H.R. 1034, Phair Pricing Act (Collins) - Part D rebates at the point of sale H.R. 1035, Prescription Drug Price Transparency Act (Collins) - Medicare PBM standards H.R. 1046, Medicare Negotiation and Competitive Licensing Act (Doggett) - Part D price negotiation H.R. 1226, ACE Kids Act (Castor) - health homes for children with medically complex conditions H.R. 1277, State Public Option Act (Lujan) - Medicaid buy-in option H.R. 1301, Mental Health Telemedicine Expansion Act (DelBene) - Medicare coverage of mental health telehealth services H.R. 1342, EMPOWER Care Act (Dingell) - MFP demonstration H.R. 1343, Protecting Married Seniors from Impoverishment Act (Dingell) - spousal impoverishment protections H.R. 1346, Medicare Buy-In and Health Care Stabilization Act (Higgins) - Medicare buy-in option H.R. 1375, PAID Act (Kind) - transparency of Medicare secondary payer information H.R. 1394, Medigap Consumer Protection Act (Doggett) - Medicare supplemental consumer protections H.R. 1551, Quality Care for Moms and Babies Act (Engel) - quality measures in Medicaid and CHIP H.R. 1781, Payment Commission Data Act (Carter) - MedPAC and MACPAC access to drug pricing and rebate data in Medicare and Medicaid H.R. 1839, Medicaid Services Investment and Accountability Act (Ruiz) - MFP demonstration, spousal impoverishment protections, ACE Kids Act, Medicaid drug rebate program, health homes for children with medically complex conditions H.R. 2131, Medicare Advantage Quality Payment Relief Act (Kind-Kelly) - MA benchmark cap H.R. 2757, Creating Lower Cost Alternatives for Your Prescription Drugs Act (Cunningham) - eliminate copay for generic drugs in Medicare Part D H.R. 3107, Improving Seniors' Timely Access to Care Act (DelBene) - Medicare Advantage prior authorization H.R. 3253, Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act (Dingell) - MFP demonstration, spousal impoverishment protections, Medicaid drug rebate program H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act (Neal) - funding for quality measurement initiatives, Medicare coverage of mental health telehealth services, real-time benefit tools in Medicare Part D, Medicare eligibility and enrollment notices H.R. 3461, Community-Based Independence for Seniors Act (Sanchez-Kelly) - Community-Based Institutional Special Needs Plan Discussion Draft, Medicare Part D Reform (Neal-Pallone-Brady-Walden) - maximum out-of-pocket limit, federal reinsurance payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2020 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2020 Rate Notice and Call Letter; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

S. 988 - Improving Transparency and Accuracy in Medicare Part D Drug Spending Act H.R. 789 - To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. H.R. 803 - This bill prohibits Medicare prescription drug plan sponsors from retroactively reducing payment on clean claims submitted by pharmacies. (A "clean claim" is a Medicare claim that is free of defects such as incomplete documentation.) H.R. 1034 - Phair Pricing Act of 2019; To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program H.R. 1035 - Prescription Drug Price Transparency Act H.R. 1959 - Preserving Patient Access to Compounded Medications Act of 2019 S. 988 - To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. H.R. 1034/S. 640 - To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program, and for other purposes.

Client expense: $34,000 · Firm income: Not reported

Legislation to address abuses of the REMS program to allow generic drugs to come to market faster. Request for information: "HHS Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs," provisions affecting market competition for prescription drugs and the drug supply chain. HR 803: Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, pharmacy payments & adjustments in Part D/ DIR. HR 789: To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. HR 1035: The Prescription Drug Price Transparency Act, requires greater transparency and accountability from PBMs. HR 1034/S 640: The Phair Pricing Act, lowers the cost of prescription medication for patients in the Medicare Part D program. HR 965/S 340: "The Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act." S 64: "Preserve Access to Affordable Generics and Biosimilars Act," bars pay-for-delay for generics and biosimilars. S 476: The Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act. S 657: Drug Price Transparency Act, eliminates rebates in ERISA plans. Proposed Rule: 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, HHSIG-2019-0001-0001. Proposals to address pay-for-delay, orphan drug abuse and patent evergreening. Implementation of the e-prescribing provisions of controlled substances provisions of the SUPPORT Act, (P.L. 115-271). The Payment Commission Data Act, H.R. 1264, H.R. 1781 and S. 801: provisions allowing MACPAC and MedPAC access to certain drug price concession and rebate information. S. 1497: Health Care Price Check Act of 2019, requires Medicare and insurance companies to make available an online tool and a toll-free # for beneficiaries to inquire about the cost, for that specific consumer, of any services, procedure or product including prescription drugs. S. 1895: The Lower Health Care Costs Act, Sec. 306 Health Plan Oversight of PBMs. Issues related to implementation of a real-time benefit tool. S. 1416: The Affordable Prescriptions for Patients Act of 2019, address product hopping and patent thickets by giving the FTC greater powers to investigate and bring legal actions. S. 1384: The Prescription Drug Rebate Reform Act, would require all patients coinsurance obligations be set as a percentage of net price, rather than list price, before or after a deductible is met. S. 1532: The Pharmacy Benefit Manager Accountability Study Act of 2019, (provisions requiring GAO to submit a report on PBMs). H.R. 2115: the "Public Disclosure of Drug Discounts Act, requires PBMs to disclose the aggregate amount of rebates, discounts, and price concessions that PBMs negotiate with drug manufacturers, and make this information publicly available to allow the public to compare the aggregate rebates, discounts, and price concessions that PBMs receive. H.R. 2087: "The STAR (Sunshine, Transparency, Accountability and Reporting) Act," provisions related to disclosure of PBM-pharmaceutical company negotiated rebates. H.R. 2376/S. 1227: Prescription Pricing for the People Act of 2019," FTC study of PBMs.

S.771/H.R.1776: Improving Access to Affordable Prescription Drugs Act, issues related to ensuring a competitive marketplace for prescription drugs. H.R.1316: The Prescription Drug Price Transparency Act, issues related to ensuring the continuity of MAC pricing. Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program Proposed Rule & Request for Information--Provisions on Part D. Request for Information: HHS Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs, provisions affecting market competition for prescription drugs and the drug supply chain. CMS Proposed and Final Policy Changes and Updates for Medicare Advantage and the Prescription Drug Benefit Program for Contract Year 2019 (CMS-4182-P as in proposed and final version CMS-4182-F, particularly issues related to pharmacy DIR and implementation of a real-time-benefit tool); provisions in a Request for Information related to rebates at the point-of-sale and pharmacist direct and indirect renumeration. Proposed HHS-OIG rule currently under OMB review entitled, Removal of Safe Harbor Protections for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection, RIN-936-AAO8. (See https://www.reginfo.gov/public/do/eoReviewSearch for questions). Outreach and education on pharmacy Direction and Indirection Remuneration in Medicare. Provisions related to opening the Medicare doughnut hole in P.L. 115-123. HR 803: Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, pharmacy payments & adjustments in Part D/ DIR. HR 789: To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies." HR 1035: The Prescription Drug Price Transparency Act, requires greater transparency and accountability from PBMs. HR 1034/S 640: The Phair Pricing Act, lowers the cost of prescription medication for patients in the Medicare Part D program. HR 965/S 340: "The Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act." S 476: The Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act. S 657: Drug Price Transparency Act, eliminates rebates in ERISA plans. Proposed Rule: 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, HHSIG-2019-0001-0001. Proposals to address pay-for-delay, orphan drug abuse and patent evergreening. Implementation of the e-prescribing provisions of controlled substances provisions of the SUPPORT Act, (P.L. 115-271). The Payment Commission Data Act, H.R. 1264, H.R. 1781 and S. 801: provisions allowing MACPAC and MedPAC access to certain drug price concession and rebate information. S. 1497: Health Care Price Check Act of 2019, requires Medicare and insurance companies to make available an online tool and a toll-free # for beneficiaries to inquire about the cost, for that specific consumer, of any services, procedure or product including prescription drugs. S. 64: Preserve Access to Affordable Generics and Biosimilars Act, bars pay-for-delay for generics and biosimilars. S. 1416: The Affordable Prescriptions for Patients Act of 2019, address product hopping and patent thickets by giving the FTC greater powers to investigate and bring legal actions. S. 1384: The Prescription Drug Rebate Reform Act, would require all patients coinsurance obligations be set as a percentage of net price, rather than list price, before or after a deductible is met. S. 1505: a bill to require prescription drug plans and MA-PD plans to report potential fraud, waste, and abuse to the Secretary of Health and Human Services under Medicare part D, and for other purposes. S. 1532: The Pharmacy Benefit Manager Accountability Study Act of 2019, (Provisions requiring GAO to submit a report on PBMs). Modernization and cost-sharing of the Part D drug benefit. H.R. 2115: the "Public Disclosure of Drug Discounts Act, requires PBMs to disclose the aggregate amount of rebates, discounts, and price concessions that PBMs negotiate with drug manufacturers, and make this information publicly available to allow the public to compare the aggregate rebates, discounts, and price concessions that PBMs receive. H.R. 2087: "The STAR (Sunshine, Transparency, Accountability and Reporting) Act," provisions related to disclosure of PBM-pharmaceutical company negotiated rebates. H.R. 2376/S. 1227: Prescription Pricing for the People Act of 2019, FTC study of PBMs.

S. 62, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 99, Medicare Drug Price Negotiation Act (Sanders) - Part D price negotiations, formulary changes S. 205, Right Rebate Act (Wyden) - Medicaid drug rebate program S. 317, ACE Kids Act (Grassley) - health homes for children with medically complex conditions S. 377, Medicare Negotiation and Competitive Licensing Act (Brown) - Part D price negotiation S. 470, Medicare at 50 Act (Stabenow) - Medicare buy-in option S. 475, RxCAP Act (Wyden) - Part D cost-sharing S. 489, State Public Option Act (Schatz) - Medicaid buy-in option S. 516, Prescription Drug Monitoring Act (Klobuchar) - required use of PDMPs S. 548, EMPOWER Care Act (Portman) - MFP demonstration S. 640, Phair Pricing Act (Kennedy) -- Part D rebates at the point of sale S. 691, Medicare Extra Rx HELP Act (Casey) - Part D assistance for low-income seniors S. 709, Prescription Drug Pricing Dashboard Act (Casey) - interactive dashboard with drug price and utilization data for federal programs S. 773, Telehealth Innovation and Improvement Act (Gardner) - testing expanded coverage of telehealth services in Medicare S. 988, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - payments on clean claims H.R. 259, Medicaid Extenders Act (Pallone) - MFP demonstration, spousal impoverishment protections H.R. 448, Medicare Drug Price Negotiation Act (Cummings) - Part D price negotiations, formulary changes H.R. 789, Improving Transparency and Accuracy in Medicare Part D Spending Act (Welch) - payments on clean claims H.R. 937, Right Rebate Act (Schrader) - Medicaid drug rebate program H.R. 1034, Phair Pricing Act (Collins) - Part D rebates at the point of sale H.R. 1035, Prescription Drug Price Transparency Act (Collins) - Medicare PBM standards H.R. 1046, Medicare Negotiation and Competitive Licensing Act (Doggett) - Part D price negotiation H.R. 1226, ACE Kids Act (Castor) - health homes for children with medically complex conditions H.R. 1277, State Public Option Act (Lujan) - Medicaid buy-in option H.R. 1301, Mental Health Telemedicine Expansion Act (DelBene) - Medicare coverage of mental health telehealth services H.R. 1342, EMPOWER Care Act (Dingell) - MFP demonstration H.R. 1343, Protecting Married Seniors from Impoverishment Act (Dingell) - spousal impoverishment protections H.R. 1346, Medicare Buy-In and Health Care Stabilization Act (Higgins) - Medicare buy-in option H.R. 1375, PAID Act (Kind) - transparency of Medicare secondary payer information H.R. 1384, Medicare for All Act (Jayapal) - Medicare for All health care system H.R. 1394, Medigap Consumer Protection Act (Doggett) - Medicare supplemental consumer protections H.R. 1551, Quality Care for Moms and Babies Act (Engel) - quality measures in Medicaid and CHIP H.R. 1781, Payment Commission Data Act (Carter) - MedPAC and MACPAC access to drug pricing and rebate data in Medicare and Medicaid H.R. 1839, Medicaid Services Investment and Accountability Act (Ruiz) - MFP demonstration, spousal impoverishment protections, ACE Kids Act, Medicaid drug rebate program Draft Medicare Advantage Quality Payment Relief Act (Kelly-Kind) - MA benchmark cap Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2020 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2019 Rate Notice and Call Letter; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Bipartisan Budget Act of 2018 changes to SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

S.771/H.R.1776: Improving Access to Affordable Prescription Drugs Act--issues related to ensuring a competitive marketplace for prescription drugs. H.R.1316: The Prescription Drug Price Transparency Act--issues related to ensuring the continuity of MAC pricing. Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program Proposed Rule & Request for Information --Provisions on Part D. Request for Information: HHS Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs, provisions affecting market competition for prescription drugs and the drug supply chain. CMS Proposed and Final Policy Changes and Updates for Medicare Advantage and the Prescription Drug Benefit Program for Contract Year 2019 (CMS-4182-P), provisions in a Request for Information related to rebates at the point-of-sale and pharmacist direct and indirect renumeration. Proposed HHS-OIG rule currently under OMB review entitled, Removal of Safe Harbor Protections for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection, RIN-936-AAO8. (See https://www.reginfo.gov/public/do/eoReviewSearch for questions). Outreach and education on pharmacy Direction and Indirection Remuneration in Medicare. Provisions related to opening the Medicare doughnut hole in P.L. 115-123. HR 803: Improving Transparency and Accuracy in Medicare Part D Drug Spending Act Pharmacy payments & adjustments in Part D/ DIR. HR 789: To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. HR 1035: The Prescription Drug Price Transparency Act, requires greater transparency and accountability from PBMs. HR 1034/S 640: The Phair Pricing Act, lowers the cost of prescription medication for patients in the Medicare Part D program. HR 965/S 340: The Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act. S 64: Preserve Access to Affordable Generics and Biosimilars Act - Prohibits brand name drug companies from compensating generic drug companies to delay the entry of a generic drug into the market, and to prohibit biological product manufacturers from compensating biosimilar and interchangeable companies to delay the entry of biosimilar biological products and interchangeable biological products. S 476: The Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act. S 657: Drug Price Transparency Act - eliminates rebates in ERISA plans. Proposed Rule: 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, HHSIG-2019-0001-0001. Proposals to address pay-for-delay, orphan drug abuse and patent evergreening. Implementation of the e-prescribing provisions of controlled substances provisions of the SUPPORT Act, (P.L. 115-271). The Payment Commission Data Act H.R. 1264 and H.R. 1781 and S. 801 - Provisions allowing MACPAC and MedPAC access to certain drug price concession and rebate information.

Legislation to address abuses of the REMS program to allow generic drugs to come to market faster. Request for information: "HHS Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs," provisions affecting market competition for prescription drugs and the drug supply chain. HR 803: Improving Transparency and Accuracy in Medicare Part D Drug Spending Act Pharmacy payments & adjustments in Part D/ DIR. HR 789: To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. HR 1035: The Prescription Drug Price Transparency Act, requires greater transparency and accountability from PBMs. HR 1034/S 640: The Phair Pricing Act, lowers the cost of prescription medication for patients in the Medicare Part D program. HR 965/S 340: The Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act. S 64: Preserve Access to Affordable Generics and Biosimilars Act - Prohibits brand name drug companies from compensating generic drug companies to delay the entry of a generic drug into the market, and to prohibit biological product manufacturers from compensating biosimilar and interchangeable companies to delay the entry of biosimilar biological products and interchangeable biological products. S 476: The Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act. S 657: Drug Price Transparency Act - eliminates rebates in ERISA plans. Proposed Rule: 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, HHSIG-2019-0001-0001. Proposals to address pay-for-delay, orphan drug abuse and patent evergreening. Implementation of the e-prescribing provisions of controlled substances provisions of the SUPPORT Act, (P.L. 115-271). The Payment Commission Data Act H.R. 1264 and H.R. 1781 and S. 801 - Provisions allowing MACPAC and MedPAC access to certain drug price concession and rebate information.

S. 988 - Improving Transparency and Accuracy in Medicare Part D Drug Spending Act H.R. 789 - To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. H.R. 803 - This bill prohibits Medicare prescription drug plan sponsors from retroactively reducing payment on clean claims submitted by pharmacies. (A "clean claim" is a Medicare claim that is free of defects such as incomplete documentation.) H.R. 1034 - Phair Pricing Act of 2019; To amend title XVIII of the Social Security Act to require pharmacy-negotiated price concessions to be included in negotiated prices at the point-of-sale under part D of the Medicare program H.R. 1035 - Prescription Drug Price Transparency Act H.R. 1959 - Preserving Patient Access to Compounded Medications Act of 2019

Client expense: $34,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE