§ 1395w–152.
(e)
Essential retail pharmacies
(1)
In general
With respect to plan years beginning on or after January 1, 2028, the Secretary shall publish reports, at least once every 2 years until 2034, and periodically thereafter, that provide information, to the extent feasible, on—
(A)
trends in ingredient cost reimbursement, dispensing fees, incentive payments and other fees paid by PDP sponsors offering prescription drug plans and MA organizations offering MA–PD plans under this part to essential retail pharmacies (as defined in paragraph (2)) with respect to the dispensing of covered part D drugs, including a comparison of such trends between essential retail pharmacies and pharmacies that are not essential retail pharmacies;
(B)
trends in amounts paid to PDP sponsors offering prescription drug plans and MA organizations offering MA–PD plans under this part by essential retail pharmacies with respect to the dispensing of covered part D drugs, including a comparison of such trends between essential retail pharmacies and pharmacies that are not essential retail pharmacies;
(C)
trends in essential retail pharmacy participation in pharmacy networks and preferred pharmacy networks for prescription drug plans offered by PDP sponsors and MA–PD plans offered by MA organizations under this part, including a comparison of such trends between essential retail pharmacies and pharmacies that are not essential retail pharmacies;
(D)
trends in the number of essential retail pharmacies, including variation in such trends by geographic region or other factors;
(E)
a comparison of cost-sharing for covered part D drugs dispensed by essential retail pharmacies that are network pharmacies for prescription drug plans offered by PDP sponsors and MA–PD plans offered by MA organizations under this part and cost-sharing for covered part D drugs dispensed by other network pharmacies for such plans located in similar geographic areas that are not essential retail pharmacies;
(F)
a comparison of the volume of covered part D drugs dispensed by essential retail pharmacies that are network pharmacies for prescription drug plans offered by PDP sponsors and MA–PD plans offered by MA organizations under this part and such volume of dispensing by network pharmacies for such plans located in similar geographic areas that are not essential retail pharmacies, including information on any patterns or trends in such comparison specific to certain types of covered part D drugs, such as generic drugs or drugs specified as specialty drugs by a PDP sponsor under a prescription drug plan or an MA organization under an MA–PD plan; and
(G)
a comparison of the information described in subparagraphs (A) through (F) between essential retail pharmacies that are network pharmacies for prescription drug plans offered by PDP sponsors under this part and essential retail pharmacies that are network pharmacies for MA–PD plans offered by MA organizations under this part.
(2)
Definition of essential retail pharmacy
In this subsection, the term “essential retail pharmacy” means, with respect to a plan year, a retail pharmacy that—
(A)
is not a pharmacy that is an affiliate as defined in paragraph (4); and
(B)
is located in—
(i)
a rural area in which there is no other retail pharmacy within 10 miles, as determined by the Secretary;
(ii)
a suburban area in which there is no other retail pharmacy within 2 miles, as determined by the Secretary; or
(iii)
an urban area in which there is no other retail pharmacy within 1 mile, as determined by the Secretary.
(3)
List of essential retail pharmacies
(A)
Publication of list of essential retail pharmacies
(B)
Required submissions from PDP sponsors
(C)
Reporting by PDP sponsors and MA organizations
(E)
Nonapplication of Paperwork Reduction Act
(4)
Definition of affiliate; pharmacy benefit manager
([Aug. 14, 1935, ch. 531], title XVIII, § 1860D–42, as added [Pub. L. 108–173, title I, § 101(a)(2)], Dec. 8, 2003, [117 Stat. 2149]; amended [Pub. L. 111–152, title I, § 1101(a)(1)], Mar. 30, 2010, [124 Stat. 1036]; [Pub. L. 114–198, title VII, § 704(d)], July 22, 2016, [130 Stat. 750]; [Pub. L. 119–75, div. J, title II, § 6223(b)], (e), Feb. 3, 2026, [140 Stat. 665], 669.)