The Secretary shall establish a Drug Price Negotiation Program (in this part referred to as the "program"). Under the program, with respect to each price applicability period, the Secretary shall-
For purposes of this part:
The term "initial price applicability year" means a year (beginning with 2026).
The term "price applicability period" means, with respect to a qualifying single source drug, the period beginning with the first initial price applicability year with respect to which such drug is a selected drug and ending with the last year during which the drug is a selected drug.
The term "selected drug publication date" means, with respect to each initial price applicability year, February 1 of the year that begins 2 years prior to such year.
The term "negotiation period" means, with respect to an initial price applicability year with respect to a selected drug, the period-
For purposes of this part:
The term "manufacturer" has the meaning given that term in section 1395w-3a(c)(6)(A) of this title.
The term "maximum fair price eligible individual" means, with respect to a selected drug-
The term "maximum fair price" means, with respect to a year during a price applicability period and with respect to a selected drug (as defined in section 1320f-1(c) of this title) with respect to such period, the price negotiated pursuant to section 1320f-3 of this title, and updated pursuant to section 1320f-4(b) of this title, as applicable, for such drug and year.
The term "reference product" has the meaning given such term in section 262(i) of this title.
The term "total expenditures" includes, in the case of expenditures with respect to part D of subchapter XVIII, the total gross covered prescription drug costs (as defined in section 1395w-115(b)(3) of this title). The term "total expenditures" excludes, in the case of expenditures with respect to part B of such subchapter, expenditures for a drug or biological product that are bundled or packaged into the payment for another service.
The term "unit" means, with respect to a drug or biological product, the lowest identifiable amount (such as a capsule or tablet, milligram of molecules, or grams) of the drug or biological product that is dispensed or furnished.
Notwithstanding the provisions of this part, in the case of initial price applicability year 2026, the following rules shall apply for purposes of implementing the program:
1So in original. Probably should be followed by "and".
2So in original. Probably should read as follows: "during the most recent 12-month period for which data are available prior to such selected drug publication date (but ending no later than October 31 of the year prior to the year of such drug publication date)".
42 U.S.C. § 1320f
STATUTORY NOTES AND RELATED SUBSIDIARIES
IMPLEMENTATION FOR 2026 THROUGH 2028 Pub. L. 117-169, title I, §11001(c), Aug. 16, 2022, 136 Stat. 1854, provided that: "The Secretary of Health and Human Services shall implement this section [enacting this part and amending sections 1395w-3a, 1395w-22, 1395w-27, 1395w-102, 1395w-104, 1395w-111, 1395w-112, 1395w-115, 1395w-153, and 1396r-8 of this title], including the amendments made by this section, for 2026, 2027, and 2028 by program instruction or other forms of program guidance."
- Secretary
- The term "Secretary" means the Secretary of Housing and Urban Development.1See References in Text note below.