81_FR_53537 81 FR 53381 - 340B Drug Pricing Program; Administrative Dispute Resolution

81 FR 53381 - 340B Drug Pricing Program; Administrative Dispute Resolution

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Federal Register Volume 81, Issue 156 (August 12, 2016)

Page Range53381-53388
FR Document2016-18969

The Health Resources and Services Administration (HRSA) implements section 340B of the Public Health Service Act (PHSA), which is referred to as the ``340B Drug Pricing Program'' or the ``340B Program.'' This proposed rule will apply to all drug manufacturers and covered entities that participate in the 340B Program. The proposed rule sets forth the requirements and procedures for the 340B Program's administrative dispute resolution process.

Federal Register, Volume 81 Issue 156 (Friday, August 12, 2016)
[Federal Register Volume 81, Number 156 (Friday, August 12, 2016)]
[Proposed Rules]
[Pages 53381-53388]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-18969]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

42 CFR Part 10

RIN 0906-AA90


340B Drug Pricing Program; Administrative Dispute Resolution

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Notice of proposed rulemaking.

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SUMMARY: The Health Resources and Services Administration (HRSA) 
implements section 340B of the Public Health Service Act (PHSA), which 
is referred to as the ``340B Drug Pricing Program'' or the ``340B 
Program.'' This proposed rule will apply to all drug manufacturers and 
covered entities that participate in the 340B Program. The proposed 
rule sets forth the requirements and procedures for the 340B Program's 
administrative dispute resolution process.

DATES: Submit written comments on or before October 11, 2016.

ADDRESSES: You may submit comments, identified by the Regulatory 
Information Number (RIN) 0906-AA90, by any of the following methods. 
Please submit your comments in only one of these ways to minimize the 
receipt of duplicate submissions.
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow instructions for submitting comments. This is the preferred 
method for the submission of comments.
     Email: 340BNPRMADR@hrsa.gov. Include 0906-AA90 in the 
subject line of the message.
     Regular, express, or overnight mail: CAPT Krista Pedley, 
Director, Office of Pharmacy Affairs (OPA), Healthcare Systems Bureau 
(HSB), HRSA, 5600 Fishers Lane, Mail Stop 08W05A, Rockville, MD 20857. 
Please allow sufficient time for mailed comments to be received before 
the close of the comment period.
    All submitted comments will be available to the public in their 
entirety. All comments received may be posted without change to http://www.regulations.gov, including any personally identifiable or 
confidential business information that is included in a comment.

FOR FURTHER INFORMATION CONTACT: CAPT Krista Pedley, Director, OPA, HSB 
HRSA, 5600 Fishers Lane, Mail Stop 08W05A, Rockville, MD 20857, or by 
telephone at 301-594-4353.

SUPPLEMENTARY INFORMATION: The President encourages Federal agencies 
through Executive Order 13563 to develop balanced regulations by 
encouraging broad public participation in the regulatory process and an 
open exchange of ideas. Accordingly, the Department of Health and Human 
Services (HHS or the Department) urges all interested parties to 
examine this regulatory proposal carefully and to share your views with 
us, including any data to support your positions. If you have questions 
before submitting comments, please see the FOR FURTHER INFORMATION 
CONTACT field above for the name and contact information of the 
subject-matter expert involved in the development of this proposal. We 
will consider all written comments received during the comment period 
before issuing a final rule.
    If you are a person with a disability and/or a user of assistive 
technology who has difficulty accessing this document, please contact 
HRSA's Regulations Officer at: Room 13N82, 5600 Fishers Lane, 
Rockville, MD 20857; or by telephone at 301-443-1785, to obtain this 
information in an accessible format. This is not a toll free telephone 
number.
    Please visit http://www.HHS.gov/regulations for more information on 
HHS rulemaking and opportunities to comment on proposed and existing 
rules.

I. Background

    Section 602 of Public Law 102-585, the ``Veterans Health Care Act 
of 1992,'' enacted section 340B of the PHSA entitled ``Limitation on 
Prices of Drugs Purchased by Covered Entities,'' which was codified at 
42 U.S.C. 256b. The 340B Program permits covered entities ``to stretch 
scarce Federal resources as far as possible, reaching more eligible 
patients and providing more comprehensive services.'' H.R. REP. No. 
102-384(II), at 12 (1992). The Secretary of the HHS delegated the 
authority to operate section 340B of the PHSA to the Administrator of 
HRSA. Pursuant to this delegation of authority, HRSA established and 
administers the 340B Program. Operationally, the 340B Program is housed 
within HRSA's Healthcare Systems Bureau (HSB), Office of Pharmacy 
Affairs (OPA). Eligible covered entity types are defined in section 
340B(a)(4) of the PHSA, as amended. Section 340B of the PHSA instructs 
HHS to enter into pharmaceutical pricing agreements (PPA) with 
manufacturers of covered outpatient drugs. Manufacturers are required 
by section 1927(a)(5)(A) of the Social Security Act to enter into 
agreements with the Secretary of HHS that comply with section 340B of 
the PHSA if they participate in the Medicaid Drug Rebate Program. When 
a drug manufacturer signs a PPA, it agrees that the prices charged for 
covered outpatient drugs to covered entities will not exceed defined 
340B ceiling prices, which are based on quarterly pricing data reported 
by manufacturers to the Centers for Medicare & Medicaid Services (CMS).
    Section 7102 of the Patient Protection and Affordable Care Act 
(Pub. L. 111-148), as amended by section 2302 of the Health Care and 
Education Reconciliation Act (Pub. L. 111-152), hereinafter referred to 
as the ``Affordable Care Act,'' added section 340B(d)(3) of the PHSA, 
which requires the Secretary of HHS (or the Secretary) to promulgate a 
regulation establishing

[[Page 53382]]

and implementing a binding administrative dispute resolution (ADR) 
process for certain disputes arising under the 340B Program. The 
purpose of the ADR process is to resolve (1) claims by covered entities 
that they have been overcharged for covered outpatient drugs by 
manufacturers; and (2) claims by manufacturers, after a manufacturer 
has conducted an audit as authorized by section 340B(a)(5)(C) of the 
PHSA, that a covered entity has violated the prohibition on diversion 
to ineligible patients or duplicate discounts. The 340B ADR process is 
not intended to be a trial-like proceeding governed by formal review of 
evidence and procedure. Rather, it is an administrative process that is 
designed to assist covered entities and manufacturers in resolving 
disputes regarding overcharging, duplicate discounts, or diversion. 
Historically, HHS has encouraged manufacturers and covered entities to 
work with each other to attempt to resolve disputes in good faith. The 
ADR process as proposed in this rule is not intended to replace these 
good faith efforts, but should be considered as a last resort in the 
event good faith efforts to resolve disputes have not been successful. 
In addition, covered entities and manufacturers should carefully 
evaluate whether the ADR process is appropriate for de minimis claims 
given the investment of the time and resources required of the parties 
involved.
    In 2010, HHS issued an advanced notice of proposed rulemaking 
(ANPRM) that requested comments on the development of an ADR process 
(75 FR 57233, September 20, 2010). The ANPRM specifically requested 
comments on: (1) Administrative procedures, (2) existing models, (3) 
threshold requirements, (4) hearings, (5) decision-making officials or 
bodies, (6) appropriate appeals procedures, (7) deadlines, (8) 
discovery procedures, (9) manufacturer audits, (10) consolidation of 
manufacturer claims, (11) covered entity consolidation of claims; (12) 
claims by organizations representing covered entities, and (13) 
integration of dispute resolution with other 340B requirements added by 
the Affordable Care Act. HHS received 14 comments on the ANPRM. The 
comments received were considered in the development of this proposed 
rule.
    HHS encourages all stakeholders to provide written comments on this 
NPRM. This proposed regulation, when finalized, will replace the 340B 
Program's guidelines on the informal dispute resolution process 
developed to resolve disputes between covered entities and 
manufacturers, which was published on December 12, 1996 (61 FR 65406).

II. Summary of the Proposed Regulations

    The proposed revisions to 42 CFR part 10 are described according to 
the applicable section of the regulations. The United States District 
Court for the District of Columbia vacated the 340B Program Regulations 
at 42 CFR part 10 relating to Orphan Drugs (subpart C). (PhRMA v. HHS, 
No. 13-01501 (D.D.C. May 23, 2014). This NPRM proposes to add new 
definitions to Sec.  10.3 and retitle and replace the language in 
subpart C as set forth below.


Sec.  10.3  Definitions.

    HHS is proposing to add the following definitions: ``Administrative 
Dispute Resolution Process,'' ``Administrative Dispute Resolution Panel 
(340B ADR Panel),'' ``claim,'' and ``consolidated claim.''

Subpart C--Administrative Dispute Resolution

Sec.  10.20 340B Administrative Dispute Resolution Panel
    (a) Members of the 340B ADR Panel.
    As required by section 340B(d)(3)(B)(i), regulations promulgated by 
the Secretary shall designate or establish a decision-making official 
or body within HHS to review and make a binding decision for claims 
filed by covered entities and manufacturers. HHS proposes to establish 
a decision-making body (referred to as the ``340B ADR Panel'' or 
``Panel'') to review and resolve such claims.
    The proposed 340B ADR Panel will ensure an unbiased and fair review 
of the claims, and reduce the individual burden associated with having 
a single decision-making official who is solely responsible for 
reviewing and resolving claims. The proposed 340B ADR Panel will 
include three members, chosen from a roster of eligible individuals 
alternating from claim to claim, and one ex-officio, non-voting member 
chosen from the staff of OPA to facilitate the review and resolution of 
claims within a reasonable time frame. The proposed roster of eligible 
individuals will be comprised of Federal employees (e.g., employees of 
CMS or the U.S. Department of Veterans Affairs) with demonstrated 
expertise or familiarity with the 340B Program. The ADR panel will not 
be compensated.
    HHS proposes that for each filed claim that is reviewed, HSB will 
review the qualifications of individuals on the 340B ADR Panel roster 
and select those with expertise or familiarity with the appropriate 
aspects of the 340B Program. HHS also proposes that individuals serving 
on a 340B ADR Panel may be removed for cause. For example, if it is 
determined prior to or during the course of a Panel member's review of 
a claim that there is a conflict of interest, as described in 
subsection (b), with respect to that claim, the Panel member will be 
removed from the Panel and replaced by another individual from the 340B 
ADR Panel roster.
    HHS is soliciting specific comments on the proposed size and 
composition of the 340B ADR Panel, in particular whether the 340B ADR 
Panel should be comprised of a set number of voting members to maintain 
consistency and transparency across each claim that is reviewed, 
whether HHS should retain the flexibility to appoint a requisite number 
of voting members based on the complexity of the claim and other 
factors, and whether the 340B ADR Panel should include at least one OPA 
staff member as a voting member or whether the inclusion of an OPA 
staff member as an ex-officio, non-voting member is sufficient to 
ensure adherence to 340B policies and procedures.
    (b) Conflicts of interest.
    To ensure fairness and objectiveness, HHS proposes that each 340B 
ADR Panel member be screened prior to reviewing a claim and not allowed 
to conduct a review if any conflicts of interest exist. For example, 
the individual would not review a claim if he or she has a conflict of 
interest with respect to the parties involved in the claim or the 
subject matter of the claim. HHS proposes that individuals be screened 
for conflicts of interest in accordance with U.S. Office of Government 
Ethics policies and procedures applicable to Federal employees. 
Conflicts of interest may include the following: (1) Financial 
interest; (2) family or close relation to a party involved; and (3) 
current or former business or employment relation to a party. The 
specific procedures for screening members of the panel prior to their 
service on the 340B ADR Panel will be detailed in future guidance.
    (c) Duties of the 340B ADR Panel.
    In subsection (c), HHS proposes that once the 340B ADR Panel 
receives the claim, the 340B ADR Panel will consider all documentation 
provided by the parties and may request additional information or 
clarification from any party involved with the claim. HHS also proposes 
that the 340B ADR Panel review claims in a session closed to the 
parties involved, including any associations or organizations, or legal 
counsel representing the parties.

[[Page 53383]]

    In this subsection, HHS also proposes that the 340B ADR Panel may 
consult with subject matter experts within OPA regarding 340B program 
requirements while reviewing a claim. The 340B ADR Panel will provide a 
final decision only with respect to the claim. HHS proposes that the 
340B ADR Panel's final decision must represent the decision of a 
majority of the Panel members but need not be unanimous.
Sec.  10.21 Claims
    (a) Claims permitted.
    Section 7102 of the Affordable Care Act added section 340B(d)(3) of 
the PHSA, which instructs the Secretary to establish and implement a 
binding ADR process to resolve certain 340B Program statutory 
violations. Section 340B(d)(3)(A) of the PHSA specifies that the ADR 
process is to be used to resolve: (1) Claims by covered entities that 
they have been overcharged by manufacturers for drugs purchased under 
this section and (2) claims by manufacturers, after a manufacturer has 
conducted an audit of a covered entity, as authorized by section 
340B(a)(5)(C) of the PHSA, that a covered entity has violated the 
prohibitions against duplicate discounts and diversion (sections 
340B(a)(5)(A) and (B) of the PHSA).
    (b) Requirements for filing a claim.
    In subsection (b), HHS proposes that the covered entity and the 
manufacturer meet certain requirements for filing a claim. These 
proposed requirements will ensure that a claim of the type specified in 
section 340B(d)(3)(A) of the PHSA is the subject of the dispute.
    The Department is proposing that covered entities and manufacturers 
file a written claim, based on the facts available, to HSB within 3 
years of the date of the sale (or payment) at issue in the alleged 
violation and that any claim not filed within 3 years shall be time 
barred. The proposed requirement that a claim be filed within 3 years 
is consistent with the record retention expectations for the 340B 
Program and will ensure that covered entities and manufacturers have 
access to relevant records needed to review and respond to claims. This 
proposal ensures documents must be submitted with each claim to verify 
that the alleged violation is not time barred. This proposed 
requirement will prevent a party from asserting a claim that is stale. 
HHS requests public comment concerning the 3 year limitation on claims 
submission.
    HHS is also proposing that once a claim is submitted and the 
opposing party has been notified of the claim, any file, document, or 
record associated with a claim be maintained by the covered entity and/
or manufacturer until the 340B ADR Panel's final agency decision is 
issued.

Covered Entity Claims

    In section 10.21(b)(2), HHS proposes that to be eligible for the 
ADR process, each claim filed by a covered entity must include 
documents sufficient to demonstrate a covered entity's claim that it 
has been overcharged by a manufacturer, along with any such 
documentation as may be requested by HSB to evaluate the veracity of 
the claim. Such documentation may include: (1) A 340B purchasing 
account invoice which shows the purchase price by national drug code 
(NDC), less any taxes and fees; (2) the 340B ceiling price for the drug 
during the quarter(s) corresponding to the time period(s) of the claim; 
and (3) documentation of the attempts made to purchase the drug via a 
340B account at the ceiling price, which resulted in the instance of 
overcharging. HHS believes that these documents are readily available 
to a covered entity through the usual course of business and should not 
be overly burdensome to produce, however HHS requests public comment on 
the feasibility or producing the documentation as proposed. HHS may 
also request that the covered entity provide it with a written summary 
of attempts to work in good faith to resolve the instance of 
overcharging with the manufacturer at issue.
    Pursuant to section 340B(d)(1)(B) of the PHSA, HHS is developing a 
system to verify the ceiling price of a 340B drug and allow covered 
entities to access and verify the ceiling price. Until such system is 
developed, HHS has access to ceiling price data and will ensure that 
the 340B ADR panel will also have access as they evaluate any 
particular claim. Covered entities will be able to access ceiling price 
information through this system, which may lessen the burden in 
submitting the information accompanying a claim.

Manufacturer Claims

    In section 10.21(b)(3), HHS proposes that to be eligible for the 
340B ADR process, each claim filed by a manufacturer must include 
documents sufficient to demonstrate a manufacturer's claim that a 
covered entity has violated the prohibition on diversion and/or 
duplicate discount, along with any such documentation as may be 
requested by HSB to evaluate the veracity of the claim. Such 
documentation may include: (1) A final audit report which indicates 
that the manufacturer audited the covered entity for compliance with 
the prohibition on diversion (section 340B(a)(5)(B) of the PHSA) and/or 
duplicate discounts (section 340B(a)(5)(A) of the PHSA) and (2) the 
covered entity's written response to the manufacturer's audit 
finding(s). HHS may also request that the manufacturer submit a written 
summary of attempts to work in good faith to resolve the claim with the 
covered entity.
    (c) Consolidation of claims.
    In subsection (c), HHS proposes that, if requested, covered 
entities or manufacturers may be permitted to consolidate their 
individual claims. Section 340B(d)(3)(B)(vi) of the PHSA permits 
``multiple covered entities to jointly assert claims of overcharges by 
the same manufacturer for the same drug or drugs in one administrative 
proceeding. . . .'' HHS proposes that for consolidated claims, the 
claim must list each covered entity and include documentation and/or 
information from each covered entity demonstrating that the covered 
entity meets all of the requirements for filing a claim with HHS and 
that a letter requesting consolidation of claims must also accompany 
the claim and must document that each covered entity consents to the 
consolidation of the claim.
    Pursuant to section 340B(d)(3)(B)(vi) of the PHSA, consolidated 
claims are also permitted on behalf of covered entities by associations 
or organizations representing their interests. Therefore, HHS proposes 
that the covered entities must be members of the association or the 
organization representing them and that each covered entity must meet 
the requirements listed in subsection (b) for filing a claim with HSB. 
The proposed consolidated claim must assert overcharging by the same 
manufacturer for the same drug(s), and the organization or association 
will be responsible for filing the claim. HHS also proposes requiring 
that a letter requesting consolidation of claims must accompany the 
claim and must document that each covered entity consents to the 
organization or association asserting a claim on its behalf.
    Similarly, at the request of two or more manufacturers, section 
340B(d)(3)(B)(v) of the PHSA permits the consolidation of claims 
brought by more than one manufacturer against the same covered entity 
if consolidation is consistent with the statutory goals of fairness and 
economy of resources. This NPRM proposes that the claim must list each 
manufacturer and include documentation and/or information from each 
manufacturer demonstrating that the manufacturer meets the

[[Page 53384]]

requirements listed in subsection (b) for filing a claim with HSB. HHS 
also proposes that a letter requesting consolidation of claims must be 
submitted with the claim and must document that each manufacturer 
consents to the consolidation of the claims. The statutory authority 
for implementing the 340B ADR process does not permit consolidated 
claims on behalf of manufacturers by associations or organizations 
representing their interests. Therefore, HHS is not proposing this 
option in this NPRM.
    With regard to the consolidation of claims by manufacturers against 
a covered entity, HHS is seeking specific comment on the grounds under 
which consolidation would be consistent with the statutory goals of 
fairness and economy of resources, as required by section 
340B(d)(3)(B)(v) of the PHSA. In addition, while HHS is proposing, as 
required by the 340B statute, an ADR process that allows manufacturers 
to consolidate claims against a covered entity, we recognize the 
operational challenges presented by the statutory requirement for a 
manufacturer to first audit the covered entity. HHS is, therefore, 
seeking comment on how manufacturers requesting a consolidated claim 
against a covered entity can satisfy the audit requirement.
    (d) Deadlines and procedures for filing a claim.
    In subsection (d), HHS proposes that covered entities and 
manufacturers file a claim with HSB demonstrating that they satisfy the 
requirements described in subsection (b) and that the party filing a 
claim must send written notice to the opposing party regarding the 
claim within 3 business days of submitting the claim and the party must 
submit confirmation of the opposing party's receipt or acknowledgement 
of receipt within 3 business days. HHS also proposes that the written 
notice to the opposing party must include a summary of the documents 
submitted as part of the claim.
    HHS proposes that HSB will review the information submitted as part 
of the claim to verify that the requirements for filing a claim have 
been met. HSB would contact the initiating party once the claim has 
been received and may request additional information before accepting a 
claim for review by the 340B ADR Panel. If additional information is 
requested, the party filing the claim will have 20 business days of 
receipt of the request to respond. Claims will not move forward for 
review by the 340B ADR Panel if the initiating party does not respond 
to the request for additional information or if a party files a claim 
for any purpose other than those specified in the statute (i.e., 
overcharging, duplicate discount, or diversion), or if the alleged 
violation occurred more than 3 years before the date of filing the 
claim.
    HHS proposes that HSB will make a determination as to whether all 
requirements are met and provide written notice to all parties within 
20 business days after receiving the claim and any subsequently 
requested information, which will be transmitted via both hard copy and 
email. If HSB determines the claim includes all necessary documentation 
and meets the requirements for filing a claim, the claim will be 
forwarded to the 340B ADR Panel for review. HSB would provide 
additional information on the 340B ADR process to all parties at that 
time, including contact information for requested follow-up 
communications and an approximate timeframe for the 340B ADR Panel's 
review.
    HHS proposes that if the claim does not move forward for review by 
the ADR Panel, written notice will be sent by HSB to the parties 
involved that includes the basis for the decision and will advise the 
party that they may revise and refile the claim if the party has new 
information to support the alleged statutory violation.
    (e) Responding to a submitted claim.
    In subsection (e), HHS proposes that once the parties have been 
notified by HSB that the claim has met the requirements in subsection 
(b) and will move forward for review by the 340B ADR Panel, the 
opposing party will have 20 business days to submit a written response 
to the allegation to the 340B ADR Panel and the party who filed the 
claim. Subsequent requests for information regarding the claim would be 
made by the 340B ADR Panel as needed, and the 340B ADR Panel will 
consider any additional information that was provided by the parties 
involved. However, if an opposing party does not respond to a request 
for information from HSB or the 340B ADR Panel or otherwise elects not 
to participate in the 340B ADR process, the 340B ADR Panel will make a 
decision on the claim based on the information submitted in the claim.


Sec.  10.22  Covered entity information requests.

    Pursuant to section 340B(d)(3)(B)(iii) of the PHSA, regulations 
promulgated by the Secretary for the 340B ADR process will establish 
procedures by which a covered entity may discover or obtain information 
and documents from manufacturers and third parties relevant to a claim 
that the covered entity has been overcharged by the manufacturer. This 
NPRM proposes that such covered entity information requests be 
facilitated by the 340B ADR Panel. HHS proposes that a covered entity 
must submit a written request for information to the 340B ADR Panel no 
later than 20 business days after the entity was notified by HSB that 
the claim would move forward for the ADR Panel's review. The 340B ADR 
Panel will review the information/document request to ensure that it is 
reasonable and within the scope of the asserted claim. The 340B ADR 
Panel will notify the covered entity in writing if any request is 
deemed reasonable and within the scope of the asserted claim and permit 
the covered entity to submit a revised information/document request, if 
it is not.
    In this section, HHS proposes that the 340B ADR Panel will consider 
relevant factors, such as the scope of the information/document 
request, whether there are consolidated claims, or the involvement of 
one or more third parties in distributing drugs on behalf of the 
manufacturer and that once reviewed, the 340B ADR Panel will submit the 
information/document request to the manufacturer, which must respond 
within 20 business days.
    HHS also proposes that the manufacturer must fully respond in 
writing to the information request and submit its response to the 340B 
ADR Panel by the stated deadline and that the manufacturer is 
responsible for obtaining relevant information/documents from 
wholesalers or other third parties that may facilitate sales or 
distribution of its drugs to covered entities. HHS proposes that if a 
manufacturer anticipates it will not be able to fully respond by the 
deadline, the manufacturer may request one extension in writing within 
15 business days. The extension request that is submitted to the 340B 
ADR Panel must include any available information, the reason why the 
deadline is not feasible, and outline a proposed timeline for fully 
responding to the information request. The 340B ADR Panel will review 
the extension request and notify both the manufacturer and the covered 
entity in writing as to whether the request for an extension is granted 
and the date of the new deadline. If a manufacturer does not respond to 
a request for information from HSB or the 340B ADR Panel, HHS proposes 
that the 340B ADR Panel will make a decision on the claim based on the 
information submitted in the claim package that moved forward for 
review.

[[Page 53385]]

Sec.  10.23 Final agency decision
    In Sec.  10.23, HHS proposes that the 340B ADR Panel review the 
documents submitted by the parties and determine if there is adequate 
support to conclude that a violation as described in subsection (a)(1) 
or (2) of Sec.  10.21 has occurred. The 340B ADR Panel will prepare a 
draft agency decision letter, which includes the 340B ADR Panel's 
findings and conclusions regarding the alleged violation. HHS is 
proposing a process whereby the 340B ADR Panel's draft agency decision 
letter will be sent to all parties, and the parties involved will have 
20 business days to respond to the 340 ADR Panel. HHS is seeking 
specific comments on this process and whether this proposed process 
will facilitate or hinder the fair, efficient, and timely resolution of 
claims.
    HHS also proposes that once the parties have reviewed and submitted 
comments to the draft agency decision letter, the 340B ADR Panel will 
prepare and submit its final agency decision letter to all parties in 
the dispute, which may incorporate rebuttals from the parties that were 
considered by the 340B ADR Panel to help inform the final agency 
decision. The final agency decision made by 340B ADR Panel will 
conclude the administrative resolution process; however, HHS proposes 
that the final agency decision letter also be submitted to HSB to take 
enforcement action or apply sanctions, as appropriate. For example, if 
the 340B ADR Panel makes a decision that a covered entity has violated 
the prohibition against diversion, HSB may require, as a sanction, that 
the covered entity repay the affected manufacturer. If the 340B ADR 
Panel makes a decision that a manufacturer overcharged a covered 
entity, HSB may require, as a sanction, that the manufacturer refund or 
issue a credit to the affected covered entity. In both cases, HSB will 
work with the party in violation on any remedy and corrective action.
    HHS proposes that the 340B ADR Panel's final agency decision letter 
will be binding upon the parties involved, unless invalidated by an 
order of a court of competent jurisdiction in accordance with section 
340B(d)(3)(C) of the PHSA. HHS may, at its sole discretion, publish a 
summary of the claims that have gone through the 340B ADR process on 
the HRSA Web site, including the names of the parties and the nature of 
the 340B ADR Panel's findings (e.g., overcharging, duplicate discount, 
or diversion). HHS will consider issuing future subregulatory guidance 
on this topic as necessary.

III. Regulatory Impact Analysis

    HHS has examined the effects of this proposed rule as required by 
Executive Order 12866 on Regulatory Planning and Review (September 30, 
1993), Executive Order 13563 on Improving Regulation and Regulatory 
Review (January 8, 2011), the Regulatory Flexibility Act (September 19, 
1980, Pub. L. 96-354), the Unfunded Mandates Reform Act of 1995 (Pub. 
L. 104-4), and Executive Order 13132 on Federalism (August 4, 1999).

Executive Orders 12866 and 13563

    Executive Orders 12866 and 13563 direct agencies to assess all 
costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). Executive 
Order 13563 is supplemental to and reaffirms the principles, 
structures, and definitions governing regulatory review as established 
in Executive Order 12866, emphasizing the importance of quantifying 
both costs and benefits, of reducing costs, harmonizing rules, and 
promoting flexibility. Section 3(f) of Executive Order 12866 defines a 
``significant regulatory action'' as an action that is likely to result 
in a rule: (1) Having an annual effect on the economy of $100 million 
or more in any one year, or adversely and materially affecting a sector 
of the economy, productivity, competition, jobs, the environment, 
public health or safety, or State, local, or tribal governments or 
communities (also referred to as ``economically significant''); (2) 
creating a serious inconsistency or otherwise interfering with an 
action taken or planned by another agency; (3) materially altering the 
budgetary impacts of entitlement grants, user fees, or loan programs or 
the rights and obligations of recipients thereof; or (4) raising novel 
legal or policy issues arising out of legal mandates, the President's 
priorities, or the principles set forth in the Executive Order. A 
regulatory impact analysis must be prepared for major rules with 
economically significant effects ($100 million or more in any one 
year), and a ``significant'' regulatory action is subject to review by 
the Office of Management and Budget (OMB).
    This proposed rule is not likely to have economic impacts of $100 
million or more in any one year; therefore, it has not been designated 
an ``economically significant'' rule under section 3(f)(1) of Executive 
Order 12866. This proposed rule creates a framework for the Department 
to resolve certain disputed claims regarding manufacturers overcharging 
covered entities and disputed claims of diversion and duplicate 
discounts by covered entities audited by manufacturers under the 340B 
Program. HHS does not anticipate the introduction of an administrative 
dispute resolution process to result in significant economic impacts.

The Regulatory Flexibility Act

    The Regulatory Flexibility Act (5 U.S.C. 601 et seq.) (RFA) and the 
Small Business Regulatory Enforcement and Fairness Act of 1996, which 
amended the RFA, require HHS to analyze options for regulatory relief 
of small businesses. If a rule has a significant economic effect on a 
substantial number of small entities, HHS must specifically consider 
the economic effect of the rule on small entities and analyze 
regulatory options that could lessen the impact of the rule. HHS will 
use an RFA threshold of at least a 3 percent impact on at least 5 
percent of small entities.
    The proposed rule would affect drug manufacturers (North American 
Industry Classification System code 325412: Pharmaceutical Preparation 
Manufacturing). The small business size standard for drug manufacturers 
is 750 employees. Approximately 600 drug manufacturers participate in 
the 340B Program. While it is possible to estimate the impact of the 
proposed rule on the industry as a whole, the data necessary to project 
changes for specific manufacturers or groups of manufacturers is not 
available, as HRSA does not collect the information necessary to assess 
the size of an individual manufacturer that participates in the 340B 
Program. The proposed rule would also affect health care providers. For 
purposes of the RFA, HHS considers all health care providers to be 
small entities either by virtue of meeting the Small Business 
Administration (SBA) size standard for a small business, or for being a 
nonprofit organization that is not dominant in its market. The current 
SBA size standard for health care providers ranges from annual receipts 
of $7 million to $35.5 million. As of July 1, 2016, over 12,000 covered 
entities participate in the 340B Program, which represent safety-net 
healthcare providers across the country.
    The proposed rule introduces an administrative mechanism to review 
claims by manufacturers that covered entities have violated certain 
statutory obligations and claims by covered entities that have been 
overcharged for

[[Page 53386]]

covered outpatient drugs by manufacturers. The documentation required 
as part of this administrative process are documents that manufacturers 
and covered entities are already required to maintain as part of their 
participation in the 340B Program. HHS expects that this documentation 
would be sufficiently available prior to submitting a claim. Therefore, 
the collection of this information would not result in an economic 
impact or create additional administrative burden on these businesses.
    HHS believes the proposed administrative dispute resolution process 
will provide a cost-efficient option for resolving claims that would 
otherwise remain unresolved or require litigation. The proposed rule 
provides an option to consolidate claims by similar situated entities, 
and covered entities may have claims asserted on their behalf by 
associations or organizations which could reduce costs. HHS has 
determined, and the Secretary certifies that this final rule will not 
have a significant economic impact on a substantial number of small 
health care providers or a significant impact on the operations of a 
substantial number of small manufacturers; therefore we are not 
preparing an analysis of impact for the purposes of the RFA. HHS 
estimates that the economic impact on small entities and small 
manufacturers will be minimal and less than 3 percent. HHS welcomes 
comments concerning the impact of this proposed rule on small 
manufacturers and small health care providers.

Unfunded Mandates Reform Act

    Section 202(a) of the Unfunded Mandates Reform Act of 1995 requires 
that agencies prepare a written statement, which includes an assessment 
of anticipated costs and benefits, before proposing ``any rule that 
includes any Federal mandate that may result in the expenditure by 
State, local, and Tribal governments, in the aggregate, or by the 
private sector, of $100 million or more (adjusted annually for 
inflation) in any one year.'' In 2014, that threshold level was 
approximately $155 million. HHS does not expect this proposed rule to 
exceed the threshold.

Executive Order 13132--Federalism

    HHS has reviewed this proposed rule in accordance with Executive 
Order 13132 regarding federalism, and has determined that it does not 
have ``federalism implications.'' This proposed rule would not ``have 
substantial direct effects on the States, or on the relationship 
between the national government and the States, or on the distribution 
of power and responsibilities among the various levels of government.'' 
The proposals in this notice of proposed rulemaking, if implemented, 
would not adversely affect the following family elements: family 
safety, family stability, marital commitment; parental rights in the 
education, nurture, and supervision of their children; family 
functioning, disposable income, or poverty; or the behavior and 
personal responsibility of youth, as determined under section 654(c) of 
the Treasury and General Government Appropriations Act of 1999. HHS 
invites additional comments on the impact of this proposed rule from 
affected stakeholders.

Paperwork Reduction Act

    The Paperwork Reduction Act of 1995 (44 U.S.C. 3507(d)) requires 
that OMB approve all collections of information by a Federal agency 
from the public before they can be implemented. This proposed rule will 
not have a significant impact on the current reporting and 
recordkeeping burden for manufacturers or covered entities under the 
340B Program. Based on current experience with the informal ADR process 
offered by the 340B Program, there have only been four requests for 
informal dispute resolution since the inception of the Program. Of the 
four dispute resolution requests, two were terminated by HRSA due to 
non-participation by one of the parties, another was dismissed due to 
lack of sufficient evidence, and the last was terminated because the 
parties disputed the existence of any attempt of good faith resolution. 
The relatively small number is attributed to the success of parties' 
attempts to resolve issues in good faith. Due to this very small number 
of informal dispute resolution requests, there has been very limited 
experience to date with dispute resolution record keeping. Changes 
proposed in this rulemaking would not result in significant reporting 
or recordkeeping burden. Comments are welcome on the accuracy of this 
statement.

    Dated: May 24, 2016.
James Macrae,
Acting Administrator, Health Resources and Services Administration.
    Approved: June 7, 2016.
Sylvia M. Burwell,
Secretary. Department of Health and Human Services.

List of Subjects in 42 CFR Part 10

    Biologics, Business and industry, Diseases, Drugs, Health, Health 
care, Health facilities, Hospitals, 340B drug pricing program.

    For the reasons set forth in the preamble, the Department of Health 
and Human Services proposes to amend 42 CFR part 10 as follows:

PART 10--340B DRUG PRICING PROGRAM

0
1. The authority citation for part 10 is revised to read as follows:

    Authority: Sec. 340B of the Public Health Service Act (42 U.S.C. 
256b), as amended.

0
2. Amend Sec.  10.3 by adding definitions for ``Administrative Dispute 
Resolution (ADR) process'','' Administrative Dispute Resolution Panel 
(340B ADR Panel)'', ``Claim'', and ``Consolidated claim'' to read as 
follows:


Sec.  10.3  Definitions.

* * * * *
    Administrative Dispute Resolution (ADR) process means a process 
used to resolve claims by covered entities that may have been 
overcharged for 340B drugs purchased by manufacturers, and claims by 
manufacturers of 340B drugs, after a manufacturer has conducted an 
audit of a covered entity, that a covered entity may have violated the 
prohibitions against duplicate discounts or diversion.
    Administrative Dispute Resolution Panel (340B ADR Panel) means a 
decision-making body within the Department that reviews and makes a 
binding decision for claims brought under the ADR Process.
* * * * *
    Claim means an allegation made by or on behalf of a covered entity 
or by a manufacturer for purposes of the ADR Process.
    Consolidated claim means the submittal of joint claims by covered 
entities (or their membership organization or association) or 
manufacturers to the 340B ADR Panel asserting the same allegation 
against the same party.
* * * * *
0
3. Revise subpart C to read as follows:

Subpart C--Administrative Dispute Resolution

Sec.
10.20 Administrative Dispute Resolution Panel.
10.21 Claims.
10.22 Covered entity information requests.
10.23 Final agency decision.


Sec.  10.20  Administrative Dispute Resolution Panel.

    The Secretary shall establish a decision-making body known as the 
Administrative Dispute Resolution Panel (340B ADR Panel) to review and 
make a binding final agency decision

[[Page 53387]]

regarding claims filed by covered entities and manufacturers.
    (a) Members of the 340B ADR Panel. (1) The Health Resources and 
Services Administration (HRSA) shall:
    (A) Select three voting members of the 340B ADR Panel from a roster 
of eligible individuals and one ex-officio, non-voting member from the 
staff of HRSA's Office of Pharmacy Affairs (OPA);
    (B) Alternate the individuals on the 340B ADR Panel for each claim;
    (C) Remove an individual from the 340B ADR Panel for cause; and
    (D) Appoint replacement members should an individual be unable to 
complete his or her duties.
    (2) No member of the 340B ADR Panel may have a conflict of 
interest, as defined in subsection (b) of this section.
    (b) Conflicts of interest. All members of the 340B ADR Panel will 
be screened for conflicts of interest prior to reviewing a claim. 
Conflicts of interest may include:
    (1) Financial interest in a party involved, a subsidiary of a party 
involved, or in the claim before the 340B ADR Panel;
    (2) Family or close relation to a party involved; and
    (3) Current or former business or employment relation to a party.
    (c) Duties of the 340B ADR Panel. The 340B ADR Panel will:
    (1) Review and evaluate documents or information submitted by 
covered entities and manufacturers;
    (2) Request additional information or clarification of an issue 
from any or all parties to make a final decision;
    (3) Evaluate a claim in a separate session from the parties 
involved;
    (4) Consult with OPA regarding any inquiries or concerns while 
reviewing a claim; and
    (5) Make a final agency decision on each claim that will be 
communicated to HRSA for appropriate enforcement.


Sec.  10.21  Claims.

    (a) Claims permitted. The ADR process is limited to the following:
    (1) Claims by a covered entity that it has been overcharged, as 
defined in Sec.  10.11(b), by a manufacturer for a covered outpatient 
drug; and
    (2) Claims by a manufacturer, after it has conducted an audit of a 
covered entity pursuant to section 340B(a)(5)(C) of the PHSA, that the 
covered entity has violated section 340B(a)(5)(A) of the PHSA, 
regarding the prohibition of duplicate discounts, or section 
340B(a)(5)(B) of the PHSA, regarding the prohibition of the resale or 
transfer of covered outpatient drugs to a person who is not a patient 
of the covered entity.
    (b) Requirements for filing a claim. (1) A covered entity or 
manufacturer must file a claim for administrative dispute resolution in 
writing to HRSA within 3 years of the date of the alleged violation. 
Any file, document, or record associated with the claim that is the 
subject of a dispute must be maintained by the covered entity and 
manufacturer until the final agency decision letter is issued by the 
340B ADR Panel.
    (2) A covered entity filing a claim described in paragraph (a)(1) 
of this section must provide documents sufficient to demonstrate its 
claim that it has been overcharged by a manufacturer, along with any 
such other documentation as may be requested by HRSA.
    (3) A manufacturer filing a claim under paragraph (a)(2) of this 
section must provide documents sufficient to demonstrate its claim that 
a covered entity has violated the prohibition on diversion and/or 
duplicate discount, along with any such documentation as may be 
requested by HRSA.
    (c) Consolidation of claims. (1) Two or more covered entities may 
jointly file claims of overcharges by the same manufacturer for the 
same drug or drugs if each covered entity that could file a claim 
against the manufacturer consents to the jointly filed claim, and meets 
the minimum requirements, including submission of the required 
documentation, described in paragraph (b) of this section.
    (2) An association or organization may file claims of overcharges 
by the same manufacturer for the same drug or drugs on behalf of 
multiple covered entities if each covered entity represented could file 
a claim against the manufacturer, is a member of the association or 
organization, meets the requirements described in paragraph (b) of this 
section, including submission of the required documentation, and each 
covered entity has agreed to representation by the association or 
organization on its behalf.
    (3) A manufacturer or manufacturers may request to consolidate 
claims brought by more than one manufacturer against the same covered 
entity if each manufacturer could individually file a claim against the 
covered entity, consents to the jointly filed claim, meets the 
requirements described in paragraph (b) of this section for that claim, 
and the 340B ADR Panel determines that such consolidation is 
appropriate and consistent with the goals of fairness and economy of 
resources. The 340B ADR Panel will not permit joint claims filed on 
behalf of manufacturers by associations or organizations representing 
their interests.
    (d) Deadlines and procedures for filing a claim. (1) Covered 
entities and manufacturers must file claims in writing to HRSA. A claim 
must include all of the requirements in paragraph (b) of this section. 
Additional information to substantiate a claim may be submitted.
    (2) The party filing the claim must notify the opposing party in 
writing within 3 business days of the date the claim was filed and must 
provide documentation of such notification to HRSA. The written notice 
to the opposing party must include a summary of the documents submitted 
as part of the claim.
    (3) HRSA will review all information submitted by the party filing 
the claim and will make a determination as to whether all requirements 
are met and provide written notice to all parties within 20 business 
days after receiving the claim and any subsequently requested 
information.
    (A) Claims that move forward for review. If HRSA finds that the 
party filing the claim submitted all required documentation and thereby 
meets the requirements described in paragraph (b) of this section, 
written notification will be sent to both the manufacturer and covered 
entity advising that the claim will be forwarded to the 340B ADR Panel 
for review.
    (B) Claims that do not move forward for review. If HRSA finds that 
the claim does not meet the requirements described in paragraph (b) of 
this section, written notification will be sent to both the 
manufacturer and covered entity detailing the reasons that the claim 
did not move forward. A claim will not move forward for review by the 
340B ADR Panel if the claim does not meet the requirements in paragraph 
(b) of this section. That same claim may only be resubmitted if new 
information is presented to support the alleged statutory violation.
    (e) Responding to a submitted claim. Upon receipt of notification 
that a claim will move forward to the 340B ADR Panel for review, the 
party in alleged violation will have 20 business days to submit a 
written response to the 340B ADR Panel. If an opposing party does not 
respond to a request for information from HRSA or the 340B ADR Panel, 
or elects not to participate in the 340B ADR process, the 340B ADR 
Panel will make a decision on the claim based on the information 
submitted in the claim. The 340B ADR Panel will consider any additional 
information that was provided by the parties involved.

[[Page 53388]]

Sec.  10.22  Covered entity information requests.

    (a) A covered entity must submit a written request for additional 
information necessary to support its claim to the 340B ADR Panel within 
20 business days of the claim acceptance date. The 340B ADR Panel will 
review the information request and notify the covered entity if the 
information request is beyond the scope of the claim and will permit 
the covered entity to resubmit a revised information request if 
necessary.
    (b) The 340B ADR Panel will submit the covered entity's information 
request to the manufacturer who must respond to the request within 20 
business days.
    (c) The manufacturer must fully respond, in writing, to an 
information request from the 340B ADR Panel by the response deadline.
    (1) A manufacturer is responsible for obtaining relevant 
information from any wholesaler or other third party that may 
facilitate the sale or distribution of its drugs to covered entities.
    (2) If a manufacturer anticipates that it will not be able to 
respond to the information request by the deadline, it can request one 
extension by notifying the 340B ADR Panel in writing within 15 business 
days of receipt of the request.
    (3) A request to extend the deadline must include the reason why 
the current deadline is not feasible and must outline the proposed 
timeline for fully responding to the information request.
    (4) The 340B ADR Panel may approve or disapprove the request for an 
extension of time and will notify all parties in writing of its 
decision.


Sec.  10.23  Final agency decision.

    (a) The 340B ADR Panel will review documents submitted by the 
parties and determine if there is adequate support to conclude that a 
violation as described in paragraph (a)(1) or (2) of Sec.  10.21 has 
occurred.
    (1) The 340B ADR Panel will prepare a draft agency decision letter 
based on its review and evaluation of all documents submitted by the 
parties, including documents provided as required in paragraph (b) of 
Sec.  10.21, information requests in support of a claim, and responses 
to a claim.
    (2) The draft agency decision letter will be sent to all parties 
and will include the 340B ADR Panel's preliminary findings regarding 
the alleged violation.
    (3) All parties will have 20 business days to respond to the 340B 
ADR Panel's draft agency decision letter.
    (b) The 340B ADR Panel will review the responses of all parties in 
producing the final agency decision letter.
    (1) The final agency decision letter will represent the decision of 
a majority of the 340B ADR Panel's findings regarding the claim and 
discuss the findings supporting the decision.
    (2) The 340B ADR Panel will submit the binding final agency 
decision letter to all parties, and to HRSA, as necessary, for 
appropriate enforcement action.

[FR Doc. 2016-18969 Filed 8-11-16; 8:45 am]
 BILLING CODE 4165-15-P



                                                                        Federal Register / Vol. 81, No. 156 / Friday, August 12, 2016 / Proposed Rules                                          53381

                                               637–4258; or by email at                                manufacturers and covered entities that                  If you are a person with a disability
                                               singerman.joel@epa.gov.                                 participate in the 340B Program. The                  and/or a user of assistive technology
                                               SUPPLEMENTARY INFORMATION:      In the                  proposed rule sets forth the                          who has difficulty accessing this
                                               ‘‘Rules and Regulations’’ Section of                    requirements and procedures for the                   document, please contact HRSA’s
                                               today’s Federal Register, EPA is                        340B Program’s administrative dispute                 Regulations Officer at: Room 13N82,
                                               publishing a direct final Notice of                     resolution process.                                   5600 Fishers Lane, Rockville, MD
                                               Deletion (NOD) of the Site without a                    DATES: Submit written comments on or                  20857; or by telephone at 301–443–
                                               prior NOID because EPA views this as                    before October 11, 2016.                              1785, to obtain this information in an
                                               a noncontroversial revision and                                                                               accessible format. This is not a toll free
                                                                                                       ADDRESSES: You may submit comments,
                                               anticipates no adverse comment. EPA                                                                           telephone number.
                                                                                                       identified by the Regulatory Information                 Please visit http://www.HHS.gov/
                                               has explained its reasons for this                      Number (RIN) 0906–AA90, by any of the
                                               deletion in the preamble to the direct                                                                        regulations for more information on
                                                                                                       following methods. Please submit your                 HHS rulemaking and opportunities to
                                               final NOD. If EPA receives no adverse                   comments in only one of these ways to
                                               comment(s) on this deletion action, EPA                                                                       comment on proposed and existing
                                                                                                       minimize the receipt of duplicate                     rules.
                                               will proceed with the deletion without                  submissions.
                                               further action on this NOID. If EPA                        • Federal eRulemaking Portal: http://              I. Background
                                               receives adverse comment(s), EPA will                   www.regulations.gov. Follow                              Section 602 of Public Law 102–585,
                                               withdraw the direct final NOD, and it                   instructions for submitting comments.                 the ‘‘Veterans Health Care Act of 1992,’’
                                               will not take effect. EPA will, as                      This is the preferred method for the                  enacted section 340B of the PHSA
                                               appropriate, address all public                         submission of comments.                               entitled ‘‘Limitation on Prices of Drugs
                                               comments in a subsequent final NOD
                                                                                                          • Email: 340BNPRMADR@hrsa.gov.                     Purchased by Covered Entities,’’ which
                                               based on this NOID. EPA will not                                                                              was codified at 42 U.S.C. 256b. The
                                                                                                       Include 0906–AA90 in the subject line
                                               institute a second comment period on                                                                          340B Program permits covered entities
                                                                                                       of the message.
                                               this NOID. Any parties interested in
                                                                                                          • Regular, express, or overnight mail:             ‘‘to stretch scarce Federal resources as
                                               commenting must do so at this time.                                                                           far as possible, reaching more eligible
                                                  For additional information, see the                  CAPT Krista Pedley, Director, Office of
                                                                                                       Pharmacy Affairs (OPA), Healthcare                    patients and providing more
                                               direct final NOD, which is located in the                                                                     comprehensive services.’’ H.R. REP. No.
                                               ‘‘Rules’’ section of this Federal Register.             Systems Bureau (HSB), HRSA, 5600
                                                                                                       Fishers Lane, Mail Stop 08W05A,                       102–384(II), at 12 (1992). The Secretary
                                               List of Subjects in 40 CFR Part 300                     Rockville, MD 20857. Please allow                     of the HHS delegated the authority to
                                                                                                       sufficient time for mailed comments to                operate section 340B of the PHSA to the
                                                 Environmental protection, Air
                                                                                                       be received before the close of the                   Administrator of HRSA. Pursuant to this
                                               pollution control, Chemicals, Hazardous
                                                                                                       comment period.                                       delegation of authority, HRSA
                                               waste, Hazardous substances,
                                                                                                          All submitted comments will be                     established and administers the 340B
                                               Intergovernmental relations, Penalties,
                                                                                                       available to the public in their entirety.            Program. Operationally, the 340B
                                               Reporting and recordkeeping
                                                                                                       All comments received may be posted                   Program is housed within HRSA’s
                                               requirements, Superfund, Water                                                                                Healthcare Systems Bureau (HSB),
                                               pollution control, Water supply.                        without change to http://
                                                                                                       www.regulations.gov, including any                    Office of Pharmacy Affairs (OPA).
                                                 Authority: 33 U.S.C. 1321(c)(2); 42 U.S.C.                                                                  Eligible covered entity types are defined
                                                                                                       personally identifiable or confidential
                                               9601–9675; E.O. 12777, 56 FR 54757, 3 CFR,                                                                    in section 340B(a)(4) of the PHSA, as
                                               1991 Comp., p. 351; E.O. 12580, 52 FR 2923,             business information that is included in
                                                                                                       a comment.                                            amended. Section 340B of the PHSA
                                               3 CFR, 1987 Comp., p. 193.                                                                                    instructs HHS to enter into
                                                 Dated: August 2, 2016.                                FOR FURTHER INFORMATION CONTACT:
                                                                                                                                                             pharmaceutical pricing agreements
                                               Judith A. Enck,
                                                                                                       CAPT Krista Pedley, Director, OPA,                    (PPA) with manufacturers of covered
                                                                                                       HSB HRSA, 5600 Fishers Lane, Mail                     outpatient drugs. Manufacturers are
                                               Regional Administrator, EPA Region.
                                                                                                       Stop 08W05A, Rockville, MD 20857, or                  required by section 1927(a)(5)(A) of the
                                               [FR Doc. 2016–19142 Filed 8–11–16; 8:45 am]
                                                                                                       by telephone at 301–594–4353.                         Social Security Act to enter into
                                               BILLING CODE 6560–50–P
                                                                                                       SUPPLEMENTARY INFORMATION: The                        agreements with the Secretary of HHS
                                                                                                       President encourages Federal agencies                 that comply with section 340B of the
                                                                                                       through Executive Order 13563 to                      PHSA if they participate in the
                                               DEPARTMENT OF HEALTH AND                                develop balanced regulations by                       Medicaid Drug Rebate Program. When a
                                               HUMAN SERVICES                                          encouraging broad public participation                drug manufacturer signs a PPA, it agrees
                                               42 CFR Part 10                                          in the regulatory process and an open                 that the prices charged for covered
                                                                                                       exchange of ideas. Accordingly, the                   outpatient drugs to covered entities will
                                               RIN 0906–AA90                                           Department of Health and Human                        not exceed defined 340B ceiling prices,
                                                                                                       Services (HHS or the Department) urges                which are based on quarterly pricing
                                               340B Drug Pricing Program;                              all interested parties to examine this                data reported by manufacturers to the
                                               Administrative Dispute Resolution                       regulatory proposal carefully and to                  Centers for Medicare & Medicaid
                                               AGENCY: Health Resources and Services                   share your views with us, including any               Services (CMS).
                                               Administration, HHS.                                    data to support your positions. If you                   Section 7102 of the Patient Protection
                                               ACTION: Notice of proposed rulemaking.                  have questions before submitting                      and Affordable Care Act (Pub. L. 111–
                                                                                                       comments, please see the FOR FURTHER                  148), as amended by section 2302 of the
ehiers on DSK5VPTVN1PROD with PROPOSALS




                                               SUMMARY:   The Health Resources and                     INFORMATION CONTACT field above for the               Health Care and Education
                                               Services Administration (HRSA)                          name and contact information of the                   Reconciliation Act (Pub. L. 111–152),
                                               implements section 340B of the Public                   subject-matter expert involved in the                 hereinafter referred to as the
                                               Health Service Act (PHSA), which is                     development of this proposal. We will                 ‘‘Affordable Care Act,’’ added section
                                               referred to as the ‘‘340B Drug Pricing                  consider all written comments received                340B(d)(3) of the PHSA, which requires
                                               Program’’ or the ‘‘340B Program.’’ This                 during the comment period before                      the Secretary of HHS (or the Secretary)
                                               proposed rule will apply to all drug                    issuing a final rule.                                 to promulgate a regulation establishing


                                          VerDate Sep<11>2014   14:23 Aug 11, 2016   Jkt 238001   PO 00000   Frm 00048   Fmt 4702   Sfmt 4702   E:\FR\FM\12AUP1.SGM   12AUP1


                                               53382                   Federal Register / Vol. 81, No. 156 / Friday, August 12, 2016 / Proposed Rules

                                               and implementing a binding                              published on December 12, 1996 (61 FR                 appropriate aspects of the 340B
                                               administrative dispute resolution (ADR)                 65406).                                               Program. HHS also proposes that
                                               process for certain disputes arising                                                                          individuals serving on a 340B ADR
                                                                                                       II. Summary of the Proposed
                                               under the 340B Program. The purpose of                                                                        Panel may be removed for cause. For
                                                                                                       Regulations
                                               the ADR process is to resolve (1) claims                                                                      example, if it is determined prior to or
                                               by covered entities that they have been                    The proposed revisions to 42 CFR part              during the course of a Panel member’s
                                               overcharged for covered outpatient                      10 are described according to the                     review of a claim that there is a conflict
                                               drugs by manufacturers; and (2) claims                  applicable section of the regulations.                of interest, as described in subsection
                                               by manufacturers, after a manufacturer                  The United States District Court for the              (b), with respect to that claim, the Panel
                                               has conducted an audit as authorized by                 District of Columbia vacated the 340B                 member will be removed from the Panel
                                               section 340B(a)(5)(C) of the PHSA, that                 Program Regulations at 42 CFR part 10                 and replaced by another individual from
                                               a covered entity has violated the                       relating to Orphan Drugs (subpart C).                 the 340B ADR Panel roster.
                                               prohibition on diversion to ineligible                  (PhRMA v. HHS, No. 13–01501 (D.D.C.                      HHS is soliciting specific comments
                                               patients or duplicate discounts. The                    May 23, 2014). This NPRM proposes to                  on the proposed size and composition of
                                               340B ADR process is not intended to be                  add new definitions to § 10.3 and retitle             the 340B ADR Panel, in particular
                                               a trial-like proceeding governed by                     and replace the language in subpart C as              whether the 340B ADR Panel should be
                                               formal review of evidence and                           set forth below.                                      comprised of a set number of voting
                                               procedure. Rather, it is an                                                                                   members to maintain consistency and
                                                                                                       § 10.3   Definitions.
                                               administrative process that is designed                                                                       transparency across each claim that is
                                               to assist covered entities and                            HHS is proposing to add the following               reviewed, whether HHS should retain
                                               manufacturers in resolving disputes                     definitions: ‘‘Administrative Dispute                 the flexibility to appoint a requisite
                                               regarding overcharging, duplicate                       Resolution Process,’’ ‘‘Administrative                number of voting members based on the
                                               discounts, or diversion. Historically,                  Dispute Resolution Panel (340B ADR                    complexity of the claim and other
                                               HHS has encouraged manufacturers and                    Panel),’’ ‘‘claim,’’ and ‘‘consolidated               factors, and whether the 340B ADR
                                               covered entities to work with each other                claim.’’                                              Panel should include at least one OPA
                                               to attempt to resolve disputes in good                  Subpart C—Administrative Dispute                      staff member as a voting member or
                                               faith. The ADR process as proposed in                   Resolution                                            whether the inclusion of an OPA staff
                                               this rule is not intended to replace these                                                                    member as an ex-officio, non-voting
                                                                                                       § 10.20 340B Administrative Dispute                   member is sufficient to ensure
                                               good faith efforts, but should be
                                                                                                       Resolution Panel                                      adherence to 340B policies and
                                               considered as a last resort in the event
                                               good faith efforts to resolve disputes                     (a) Members of the 340B ADR Panel.                 procedures.
                                               have not been successful. In addition,                     As required by section                                (b) Conflicts of interest.
                                               covered entities and manufacturers                      340B(d)(3)(B)(i), regulations                            To ensure fairness and objectiveness,
                                               should carefully evaluate whether the                   promulgated by the Secretary shall                    HHS proposes that each 340B ADR
                                               ADR process is appropriate for de                       designate or establish a decision-making              Panel member be screened prior to
                                               minimis claims given the investment of                  official or body within HHS to review                 reviewing a claim and not allowed to
                                               the time and resources required of the                  and make a binding decision for claims                conduct a review if any conflicts of
                                               parties involved.                                       filed by covered entities and                         interest exist. For example, the
                                                  In 2010, HHS issued an advanced                      manufacturers. HHS proposes to                        individual would not review a claim if
                                               notice of proposed rulemaking                           establish a decision-making body                      he or she has a conflict of interest with
                                               (ANPRM) that requested comments on                      (referred to as the ‘‘340B ADR Panel’’ or             respect to the parties involved in the
                                               the development of an ADR process (75                   ‘‘Panel’’) to review and resolve such                 claim or the subject matter of the claim.
                                               FR 57233, September 20, 2010). The                      claims.                                               HHS proposes that individuals be
                                               ANPRM specifically requested                               The proposed 340B ADR Panel will                   screened for conflicts of interest in
                                               comments on: (1) Administrative                         ensure an unbiased and fair review of                 accordance with U.S. Office of
                                               procedures, (2) existing models, (3)                    the claims, and reduce the individual                 Government Ethics policies and
                                               threshold requirements, (4) hearings, (5)               burden associated with having a single                procedures applicable to Federal
                                               decision-making officials or bodies, (6)                decision-making official who is solely                employees. Conflicts of interest may
                                               appropriate appeals procedures, (7)                     responsible for reviewing and resolving               include the following: (1) Financial
                                               deadlines, (8) discovery procedures, (9)                claims. The proposed 340B ADR Panel                   interest; (2) family or close relation to a
                                               manufacturer audits, (10) consolidation                 will include three members, chosen                    party involved; and (3) current or former
                                               of manufacturer claims, (11) covered                    from a roster of eligible individuals                 business or employment relation to a
                                               entity consolidation of claims; (12)                    alternating from claim to claim, and one              party. The specific procedures for
                                               claims by organizations representing                    ex-officio, non-voting member chosen                  screening members of the panel prior to
                                               covered entities, and (13) integration of               from the staff of OPA to facilitate the               their service on the 340B ADR Panel
                                               dispute resolution with other 340B                      review and resolution of claims within                will be detailed in future guidance.
                                               requirements added by the Affordable                    a reasonable time frame. The proposed                    (c) Duties of the 340B ADR Panel.
                                               Care Act. HHS received 14 comments on                   roster of eligible individuals will be                   In subsection (c), HHS proposes that
                                               the ANPRM. The comments received                        comprised of Federal employees (e.g.,                 once the 340B ADR Panel receives the
                                               were considered in the development of                   employees of CMS or the U.S.                          claim, the 340B ADR Panel will
                                               this proposed rule.                                     Department of Veterans Affairs) with                  consider all documentation provided by
                                                                                                                                                             the parties and may request additional
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                                                  HHS encourages all stakeholders to                   demonstrated expertise or familiarity
                                               provide written comments on this                        with the 340B Program. The ADR panel                  information or clarification from any
                                               NPRM. This proposed regulation, when                    will not be compensated.                              party involved with the claim. HHS also
                                               finalized, will replace the 340B                           HHS proposes that for each filed                   proposes that the 340B ADR Panel
                                               Program’s guidelines on the informal                    claim that is reviewed, HSB will review               review claims in a session closed to the
                                               dispute resolution process developed to                 the qualifications of individuals on the              parties involved, including any
                                               resolve disputes between covered                        340B ADR Panel roster and select those                associations or organizations, or legal
                                               entities and manufacturers, which was                   with expertise or familiarity with the                counsel representing the parties.


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                                                                       Federal Register / Vol. 81, No. 156 / Friday, August 12, 2016 / Proposed Rules                                         53383

                                                 In this subsection, HHS also proposes                 covered entity and/or manufacturer                    diversion (section 340B(a)(5)(B) of the
                                               that the 340B ADR Panel may consult                     until the 340B ADR Panel’s final agency               PHSA) and/or duplicate discounts
                                               with subject matter experts within OPA                  decision is issued.                                   (section 340B(a)(5)(A) of the PHSA) and
                                               regarding 340B program requirements                                                                           (2) the covered entity’s written response
                                                                                                       Covered Entity Claims
                                               while reviewing a claim. The 340B ADR                                                                         to the manufacturer’s audit finding(s).
                                               Panel will provide a final decision only                   In section 10.21(b)(2), HHS proposes               HHS may also request that the
                                               with respect to the claim. HHS proposes                 that to be eligible for the ADR process,              manufacturer submit a written summary
                                               that the 340B ADR Panel’s final decision                each claim filed by a covered entity                  of attempts to work in good faith to
                                               must represent the decision of a                        must include documents sufficient to                  resolve the claim with the covered
                                               majority of the Panel members but need                  demonstrate a covered entity’s claim                  entity.
                                               not be unanimous.                                       that it has been overcharged by a                        (c) Consolidation of claims.
                                                                                                       manufacturer, along with any such                        In subsection (c), HHS proposes that,
                                               § 10.21 Claims                                          documentation as may be requested by                  if requested, covered entities or
                                                  (a) Claims permitted.                                HSB to evaluate the veracity of the                   manufacturers may be permitted to
                                                  Section 7102 of the Affordable Care                  claim. Such documentation may                         consolidate their individual claims.
                                               Act added section 340B(d)(3) of the                     include: (1) A 340B purchasing account                Section 340B(d)(3)(B)(vi) of the PHSA
                                               PHSA, which instructs the Secretary to                  invoice which shows the purchase price                permits ‘‘multiple covered entities to
                                               establish and implement a binding ADR                   by national drug code (NDC), less any                 jointly assert claims of overcharges by
                                               process to resolve certain 340B Program                 taxes and fees; (2) the 340B ceiling price            the same manufacturer for the same
                                               statutory violations. Section                           for the drug during the quarter(s)                    drug or drugs in one administrative
                                               340B(d)(3)(A) of the PHSA specifies that                corresponding to the time period(s) of                proceeding. . . .’’ HHS proposes that
                                               the ADR process is to be used to resolve:               the claim; and (3) documentation of the               for consolidated claims, the claim must
                                               (1) Claims by covered entities that they                attempts made to purchase the drug via                list each covered entity and include
                                               have been overcharged by                                a 340B account at the ceiling price,                  documentation and/or information from
                                               manufacturers for drugs purchased                       which resulted in the instance of                     each covered entity demonstrating that
                                               under this section and (2) claims by                    overcharging. HHS believes that these                 the covered entity meets all of the
                                               manufacturers, after a manufacturer has                 documents are readily available to a                  requirements for filing a claim with
                                               conducted an audit of a covered entity,                 covered entity through the usual course               HHS and that a letter requesting
                                               as authorized by section 340B(a)(5)(C) of               of business and should not be overly                  consolidation of claims must also
                                               the PHSA, that a covered entity has                     burdensome to produce, however HHS                    accompany the claim and must
                                               violated the prohibitions against                       requests public comment on the                        document that each covered entity
                                               duplicate discounts and diversion                       feasibility or producing the                          consents to the consolidation of the
                                               (sections 340B(a)(5)(A) and (B) of the                  documentation as proposed. HHS may                    claim.
                                               PHSA).                                                  also request that the covered entity                     Pursuant to section 340B(d)(3)(B)(vi)
                                                  (b) Requirements for filing a claim.                 provide it with a written summary of                  of the PHSA, consolidated claims are
                                                  In subsection (b), HHS proposes that                 attempts to work in good faith to resolve             also permitted on behalf of covered
                                               the covered entity and the manufacturer                 the instance of overcharging with the                 entities by associations or organizations
                                               meet certain requirements for filing a                  manufacturer at issue.                                representing their interests. Therefore,
                                               claim. These proposed requirements                         Pursuant to section 340B(d)(1)(B) of               HHS proposes that the covered entities
                                               will ensure that a claim of the type                    the PHSA, HHS is developing a system                  must be members of the association or
                                               specified in section 340B(d)(3)(A) of the               to verify the ceiling price of a 340B drug            the organization representing them and
                                               PHSA is the subject of the dispute.                     and allow covered entities to access and              that each covered entity must meet the
                                                  The Department is proposing that                     verify the ceiling price. Until such                  requirements listed in subsection (b) for
                                               covered entities and manufacturers file                 system is developed, HHS has access to                filing a claim with HSB. The proposed
                                               a written claim, based on the facts                     ceiling price data and will ensure that               consolidated claim must assert
                                               available, to HSB within 3 years of the                 the 340B ADR panel will also have                     overcharging by the same manufacturer
                                               date of the sale (or payment) at issue in               access as they evaluate any particular                for the same drug(s), and the
                                               the alleged violation and that any claim                claim. Covered entities will be able to               organization or association will be
                                               not filed within 3 years shall be time                  access ceiling price information through              responsible for filing the claim. HHS
                                               barred. The proposed requirement that a                 this system, which may lessen the                     also proposes requiring that a letter
                                               claim be filed within 3 years is                        burden in submitting the information                  requesting consolidation of claims must
                                               consistent with the record retention                    accompanying a claim.                                 accompany the claim and must
                                               expectations for the 340B Program and                                                                         document that each covered entity
                                               will ensure that covered entities and                   Manufacturer Claims                                   consents to the organization or
                                               manufacturers have access to relevant                     In section 10.21(b)(3), HHS proposes                association asserting a claim on its
                                               records needed to review and respond                    that to be eligible for the 340B ADR                  behalf.
                                               to claims. This proposal ensures                        process, each claim filed by a                           Similarly, at the request of two or
                                               documents must be submitted with each                   manufacturer must include documents                   more manufacturers, section
                                               claim to verify that the alleged violation              sufficient to demonstrate a                           340B(d)(3)(B)(v) of the PHSA permits
                                               is not time barred. This proposed                       manufacturer’s claim that a covered                   the consolidation of claims brought by
                                               requirement will prevent a party from                   entity has violated the prohibition on                more than one manufacturer against the
                                                                                                       diversion and/or duplicate discount,                  same covered entity if consolidation is
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                                               asserting a claim that is stale. HHS
                                               requests public comment concerning the                  along with any such documentation as                  consistent with the statutory goals of
                                               3 year limitation on claims submission.                 may be requested by HSB to evaluate                   fairness and economy of resources. This
                                                  HHS is also proposing that once a                    the veracity of the claim. Such                       NPRM proposes that the claim must list
                                               claim is submitted and the opposing                     documentation may include: (1) A final                each manufacturer and include
                                               party has been notified of the claim, any               audit report which indicates that the                 documentation and/or information from
                                               file, document, or record associated                    manufacturer audited the covered entity               each manufacturer demonstrating that
                                               with a claim be maintained by the                       for compliance with the prohibition on                the manufacturer meets the


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                                               53384                   Federal Register / Vol. 81, No. 156 / Friday, August 12, 2016 / Proposed Rules

                                               requirements listed in subsection (b) for               in the statute (i.e., overcharging,                   This NPRM proposes that such covered
                                               filing a claim with HSB. HHS also                       duplicate discount, or diversion), or if              entity information requests be facilitated
                                               proposes that a letter requesting                       the alleged violation occurred more than              by the 340B ADR Panel. HHS proposes
                                               consolidation of claims must be                         3 years before the date of filing the                 that a covered entity must submit a
                                               submitted with the claim and must                       claim.                                                written request for information to the
                                               document that each manufacturer                            HHS proposes that HSB will make a                  340B ADR Panel no later than 20
                                               consents to the consolidation of the                    determination as to whether all                       business days after the entity was
                                               claims. The statutory authority for                     requirements are met and provide                      notified by HSB that the claim would
                                               implementing the 340B ADR process                       written notice to all parties within 20               move forward for the ADR Panel’s
                                               does not permit consolidated claims on                  business days after receiving the claim               review. The 340B ADR Panel will
                                               behalf of manufacturers by associations                 and any subsequently requested
                                                                                                                                                             review the information/document
                                               or organizations representing their                     information, which will be transmitted
                                                                                                                                                             request to ensure that it is reasonable
                                               interests. Therefore, HHS is not                        via both hard copy and email. If HSB
                                                                                                                                                             and within the scope of the asserted
                                               proposing this option in this NPRM.                     determines the claim includes all
                                                  With regard to the consolidation of                                                                        claim. The 340B ADR Panel will notify
                                                                                                       necessary documentation and meets the
                                               claims by manufacturers against a                       requirements for filing a claim, the                  the covered entity in writing if any
                                               covered entity, HHS is seeking specific                 claim will be forwarded to the 340B                   request is deemed reasonable and
                                               comment on the grounds under which                      ADR Panel for review. HSB would                       within the scope of the asserted claim
                                               consolidation would be consistent with                  provide additional information on the                 and permit the covered entity to submit
                                               the statutory goals of fairness and                     340B ADR process to all parties at that               a revised information/document
                                               economy of resources, as required by                    time, including contact information for               request, if it is not.
                                               section 340B(d)(3)(B)(v) of the PHSA. In                requested follow-up communications                       In this section, HHS proposes that the
                                               addition, while HHS is proposing, as                    and an approximate timeframe for the                  340B ADR Panel will consider relevant
                                               required by the 340B statute, an ADR                    340B ADR Panel’s review.                              factors, such as the scope of the
                                               process that allows manufacturers to                       HHS proposes that if the claim does                information/document request, whether
                                               consolidate claims against a covered                    not move forward for review by the ADR                there are consolidated claims, or the
                                               entity, we recognize the operational                    Panel, written notice will be sent by                 involvement of one or more third parties
                                               challenges presented by the statutory                   HSB to the parties involved that                      in distributing drugs on behalf of the
                                               requirement for a manufacturer to first                 includes the basis for the decision and               manufacturer and that once reviewed,
                                               audit the covered entity. HHS is,                       will advise the party that they may                   the 340B ADR Panel will submit the
                                               therefore, seeking comment on how                       revise and refile the claim if the party              information/document request to the
                                               manufacturers requesting a consolidated                 has new information to support the
                                               claim against a covered entity can                                                                            manufacturer, which must respond
                                                                                                       alleged statutory violation.
                                               satisfy the audit requirement.                                                                                within 20 business days.
                                                                                                          (e) Responding to a submitted claim.
                                                  (d) Deadlines and procedures for                        In subsection (e), HHS proposes that                  HHS also proposes that the
                                               filing a claim.                                         once the parties have been notified by                manufacturer must fully respond in
                                                  In subsection (d), HHS proposes that                 HSB that the claim has met the                        writing to the information request and
                                               covered entities and manufacturers file                 requirements in subsection (b) and will               submit its response to the 340B ADR
                                               a claim with HSB demonstrating that                     move forward for review by the 340B                   Panel by the stated deadline and that
                                               they satisfy the requirements described                 ADR Panel, the opposing party will                    the manufacturer is responsible for
                                               in subsection (b) and that the party                    have 20 business days to submit a                     obtaining relevant information/
                                               filing a claim must send written notice                 written response to the allegation to the             documents from wholesalers or other
                                               to the opposing party regarding the                     340B ADR Panel and the party who filed                third parties that may facilitate sales or
                                               claim within 3 business days of                         the claim. Subsequent requests for                    distribution of its drugs to covered
                                               submitting the claim and the party must                 information regarding the claim would                 entities. HHS proposes that if a
                                               submit confirmation of the opposing                     be made by the 340B ADR Panel as                      manufacturer anticipates it will not be
                                               party’s receipt or acknowledgement of                   needed, and the 340B ADR Panel will                   able to fully respond by the deadline,
                                               receipt within 3 business days. HHS                     consider any additional information that              the manufacturer may request one
                                               also proposes that the written notice to                was provided by the parties involved.                 extension in writing within 15 business
                                               the opposing party must include a                       However, if an opposing party does not                days. The extension request that is
                                               summary of the documents submitted as                   respond to a request for information
                                               part of the claim.                                                                                            submitted to the 340B ADR Panel must
                                                                                                       from HSB or the 340B ADR Panel or                     include any available information, the
                                                  HHS proposes that HSB will review                    otherwise elects not to participate in the
                                               the information submitted as part of the                                                                      reason why the deadline is not feasible,
                                                                                                       340B ADR process, the 340B ADR Panel                  and outline a proposed timeline for
                                               claim to verify that the requirements for               will make a decision on the claim based
                                               filing a claim have been met. HSB                                                                             fully responding to the information
                                                                                                       on the information submitted in the                   request. The 340B ADR Panel will
                                               would contact the initiating party once                 claim.
                                               the claim has been received and may                                                                           review the extension request and notify
                                               request additional information before                   § 10.22 Covered entity information                    both the manufacturer and the covered
                                               accepting a claim for review by the 340B                requests.                                             entity in writing as to whether the
                                               ADR Panel. If additional information is                   Pursuant to section 340B(d)(3)(B)(iii)              request for an extension is granted and
                                               requested, the party filing the claim will              of the PHSA, regulations promulgated                  the date of the new deadline. If a
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                                               have 20 business days of receipt of the                 by the Secretary for the 340B ADR                     manufacturer does not respond to a
                                               request to respond. Claims will not                     process will establish procedures by                  request for information from HSB or the
                                               move forward for review by the 340B                     which a covered entity may discover or                340B ADR Panel, HHS proposes that the
                                               ADR Panel if the initiating party does                  obtain information and documents from                 340B ADR Panel will make a decision
                                               not respond to the request for additional               manufacturers and third parties relevant              on the claim based on the information
                                               information or if a party files a claim for             to a claim that the covered entity has                submitted in the claim package that
                                               any purpose other than those specified                  been overcharged by the manufacturer.                 moved forward for review.


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                                                                       Federal Register / Vol. 81, No. 156 / Friday, August 12, 2016 / Proposed Rules                                          53385

                                               § 10.23    Final agency decision                        III. Regulatory Impact Analysis                       Executive Order 12866. This proposed
                                                                                                          HHS has examined the effects of this               rule creates a framework for the
                                                  In § 10.23, HHS proposes that the                                                                          Department to resolve certain disputed
                                               340B ADR Panel review the documents                     proposed rule as required by Executive
                                                                                                       Order 12866 on Regulatory Planning                    claims regarding manufacturers
                                               submitted by the parties and determine                                                                        overcharging covered entities and
                                               if there is adequate support to conclude                and Review (September 30, 1993),
                                                                                                       Executive Order 13563 on Improving                    disputed claims of diversion and
                                               that a violation as described in                                                                              duplicate discounts by covered entities
                                               subsection (a)(1) or (2) of § 10.21 has                 Regulation and Regulatory Review
                                                                                                       (January 8, 2011), the Regulatory                     audited by manufacturers under the
                                               occurred. The 340B ADR Panel will                                                                             340B Program. HHS does not anticipate
                                               prepare a draft agency decision letter,                 Flexibility Act (September 19, 1980,
                                                                                                                                                             the introduction of an administrative
                                               which includes the 340B ADR Panel’s                     Pub. L. 96–354), the Unfunded
                                                                                                                                                             dispute resolution process to result in
                                               findings and conclusions regarding the                  Mandates Reform Act of 1995 (Pub. L.
                                                                                                                                                             significant economic impacts.
                                               alleged violation. HHS is proposing a                   104–4), and Executive Order 13132 on
                                               process whereby the 340B ADR Panel’s                    Federalism (August 4, 1999).                          The Regulatory Flexibility Act
                                               draft agency decision letter will be sent               Executive Orders 12866 and 13563                         The Regulatory Flexibility Act (5
                                               to all parties, and the parties involved                                                                      U.S.C. 601 et seq.) (RFA) and the Small
                                               will have 20 business days to respond                      Executive Orders 12866 and 13563                   Business Regulatory Enforcement and
                                               to the 340 ADR Panel. HHS is seeking                    direct agencies to assess all costs and               Fairness Act of 1996, which amended
                                               specific comments on this process and                   benefits of available regulatory                      the RFA, require HHS to analyze
                                               whether this proposed process will                      alternatives and, if regulation is                    options for regulatory relief of small
                                               facilitate or hinder the fair, efficient,               necessary, to select regulatory                       businesses. If a rule has a significant
                                               and timely resolution of claims.                        approaches that maximize net benefits                 economic effect on a substantial number
                                                                                                       (including potential economic,                        of small entities, HHS must specifically
                                                  HHS also proposes that once the                      environmental, public health and safety
                                               parties have reviewed and submitted                                                                           consider the economic effect of the rule
                                                                                                       effects, distributive impacts, and                    on small entities and analyze regulatory
                                               comments to the draft agency decision                   equity). Executive Order 13563 is
                                               letter, the 340B ADR Panel will prepare                                                                       options that could lessen the impact of
                                                                                                       supplemental to and reaffirms the                     the rule. HHS will use an RFA threshold
                                               and submit its final agency decision                    principles, structures, and definitions
                                               letter to all parties in the dispute, which                                                                   of at least a 3 percent impact on at least
                                                                                                       governing regulatory review as                        5 percent of small entities.
                                               may incorporate rebuttals from the                      established in Executive Order 12866,                    The proposed rule would affect drug
                                               parties that were considered by the                     emphasizing the importance of                         manufacturers (North American
                                               340B ADR Panel to help inform the final                 quantifying both costs and benefits, of               Industry Classification System code
                                               agency decision. The final agency                       reducing costs, harmonizing rules, and                325412: Pharmaceutical Preparation
                                               decision made by 340B ADR Panel will                    promoting flexibility. Section 3(f) of                Manufacturing). The small business size
                                               conclude the administrative resolution                  Executive Order 12866 defines a                       standard for drug manufacturers is 750
                                               process; however, HHS proposes that                     ‘‘significant regulatory action’’ as an               employees. Approximately 600 drug
                                               the final agency decision letter also be                action that is likely to result in a rule:            manufacturers participate in the 340B
                                               submitted to HSB to take enforcement                    (1) Having an annual effect on the                    Program. While it is possible to estimate
                                               action or apply sanctions, as                           economy of $100 million or more in any                the impact of the proposed rule on the
                                               appropriate. For example, if the 340B                   one year, or adversely and materially                 industry as a whole, the data necessary
                                               ADR Panel makes a decision that a                       affecting a sector of the economy,                    to project changes for specific
                                               covered entity has violated the                         productivity, competition, jobs, the                  manufacturers or groups of
                                               prohibition against diversion, HSB may                  environment, public health or safety, or              manufacturers is not available, as HRSA
                                               require, as a sanction, that the covered                State, local, or tribal governments or                does not collect the information
                                               entity repay the affected manufacturer.                 communities (also referred to as                      necessary to assess the size of an
                                               If the 340B ADR Panel makes a decision                  ‘‘economically significant’’); (2) creating           individual manufacturer that
                                               that a manufacturer overcharged a                       a serious inconsistency or otherwise                  participates in the 340B Program. The
                                               covered entity, HSB may require, as a                   interfering with an action taken or                   proposed rule would also affect health
                                               sanction, that the manufacturer refund                  planned by another agency; (3)                        care providers. For purposes of the RFA,
                                               or issue a credit to the affected covered               materially altering the budgetary                     HHS considers all health care providers
                                               entity. In both cases, HSB will work                    impacts of entitlement grants, user fees,             to be small entities either by virtue of
                                               with the party in violation on any                      or loan programs or the rights and                    meeting the Small Business
                                               remedy and corrective action.                           obligations of recipients thereof; or (4)             Administration (SBA) size standard for
                                                  HHS proposes that the 340B ADR                       raising novel legal or policy issues                  a small business, or for being a
                                               Panel’s final agency decision letter will               arising out of legal mandates, the                    nonprofit organization that is not
                                               be binding upon the parties involved,                   President’s priorities, or the principles             dominant in its market. The current
                                               unless invalidated by an order of a court               set forth in the Executive Order. A                   SBA size standard for health care
                                               of competent jurisdiction in accordance                 regulatory impact analysis must be                    providers ranges from annual receipts of
                                               with section 340B(d)(3)(C) of the PHSA.                 prepared for major rules with                         $7 million to $35.5 million. As of July
                                               HHS may, at its sole discretion, publish                economically significant effects ($100                1, 2016, over 12,000 covered entities
                                               a summary of the claims that have gone                  million or more in any one year), and                 participate in the 340B Program, which
                                               through the 340B ADR process on the                     a ‘‘significant’’ regulatory action is
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                                                                                                                                                             represent safety-net healthcare
                                               HRSA Web site, including the names of                   subject to review by the Office of                    providers across the country.
                                               the parties and the nature of the 340B                  Management and Budget (OMB).                             The proposed rule introduces an
                                               ADR Panel’s findings (e.g.,                                This proposed rule is not likely to                administrative mechanism to review
                                               overcharging, duplicate discount, or                    have economic impacts of $100 million                 claims by manufacturers that covered
                                               diversion). HHS will consider issuing                   or more in any one year; therefore, it has            entities have violated certain statutory
                                               future subregulatory guidance on this                   not been designated an ‘‘economically                 obligations and claims by covered
                                               topic as necessary.                                     significant’’ rule under section 3(f)(1) of           entities that have been overcharged for


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                                               53386                   Federal Register / Vol. 81, No. 156 / Friday, August 12, 2016 / Proposed Rules

                                               covered outpatient drugs by                             on the distribution of power and                        For the reasons set forth in the
                                               manufacturers. The documentation                        responsibilities among the various                    preamble, the Department of Health and
                                               required as part of this administrative                 levels of government.’’ The proposals in              Human Services proposes to amend 42
                                               process are documents that                              this notice of proposed rulemaking, if                CFR part 10 as follows:
                                               manufacturers and covered entities are                  implemented, would not adversely
                                               already required to maintain as part of                 affect the following family elements:                 PART 10—340B DRUG PRICING
                                               their participation in the 340B Program.                family safety, family stability, marital              PROGRAM
                                               HHS expects that this documentation                     commitment; parental rights in the
                                               would be sufficiently available prior to                                                                      ■ 1. The authority citation for part 10 is
                                                                                                       education, nurture, and supervision of
                                               submitting a claim. Therefore, the                                                                            revised to read as follows:
                                                                                                       their children; family functioning,
                                               collection of this information would not                disposable income, or poverty; or the                   Authority: Sec. 340B of the Public Health
                                               result in an economic impact or create                  behavior and personal responsibility of               Service Act (42 U.S.C. 256b), as amended.
                                               additional administrative burden on                     youth, as determined under section                    ■ 2. Amend § 10.3 by adding definitions
                                               these businesses.                                       654(c) of the Treasury and General                    for ‘‘Administrative Dispute Resolution
                                                  HHS believes the proposed                            Government Appropriations Act of                      (ADR) process’’,’’ Administrative
                                               administrative dispute resolution                       1999. HHS invites additional comments                 Dispute Resolution Panel (340B ADR
                                               process will provide a cost-efficient                   on the impact of this proposed rule from              Panel)’’, ‘‘Claim’’, and ‘‘Consolidated
                                               option for resolving claims that would                  affected stakeholders.                                claim’’ to read as follows:
                                               otherwise remain unresolved or require
                                               litigation. The proposed rule provides                  Paperwork Reduction Act                               § 10.3    Definitions.
                                               an option to consolidate claims by                         The Paperwork Reduction Act of 1995                *     *     *      *   *
                                               similar situated entities, and covered                  (44 U.S.C. 3507(d)) requires that OMB                    Administrative Dispute Resolution
                                               entities may have claims asserted on                    approve all collections of information                (ADR) process means a process used to
                                               their behalf by associations or                         by a Federal agency from the public                   resolve claims by covered entities that
                                               organizations which could reduce costs.                 before they can be implemented. This                  may have been overcharged for 340B
                                               HHS has determined, and the Secretary                   proposed rule will not have a significant             drugs purchased by manufacturers, and
                                               certifies that this final rule will not have            impact on the current reporting and                   claims by manufacturers of 340B drugs,
                                               a significant economic impact on a                      recordkeeping burden for manufacturers                after a manufacturer has conducted an
                                               substantial number of small health care                 or covered entities under the 340B                    audit of a covered entity, that a covered
                                               providers or a significant impact on the                Program. Based on current experience                  entity may have violated the
                                               operations of a substantial number of                   with the informal ADR process offered                 prohibitions against duplicate discounts
                                               small manufacturers; therefore we are                   by the 340B Program, there have only                  or diversion.
                                               not preparing an analysis of impact for                 been four requests for informal dispute                  Administrative Dispute Resolution
                                               the purposes of the RFA. HHS estimates                  resolution since the inception of the                 Panel (340B ADR Panel) means a
                                               that the economic impact on small                       Program. Of the four dispute resolution               decision-making body within the
                                               entities and small manufacturers will be                requests, two were terminated by HRSA                 Department that reviews and makes a
                                               minimal and less than 3 percent. HHS                    due to non-participation by one of the                binding decision for claims brought
                                               welcomes comments concerning the                        parties, another was dismissed due to                 under the ADR Process.
                                               impact of this proposed rule on small                   lack of sufficient evidence, and the last             *     *     *      *   *
                                               manufacturers and small health care                     was terminated because the parties                       Claim means an allegation made by or
                                               providers.                                              disputed the existence of any attempt of              on behalf of a covered entity or by a
                                               Unfunded Mandates Reform Act                            good faith resolution. The relatively                 manufacturer for purposes of the ADR
                                                                                                       small number is attributed to the                     Process.
                                                 Section 202(a) of the Unfunded                        success of parties’ attempts to resolve                  Consolidated claim means the
                                               Mandates Reform Act of 1995 requires                    issues in good faith. Due to this very                submittal of joint claims by covered
                                               that agencies prepare a written                         small number of informal dispute                      entities (or their membership
                                               statement, which includes an                            resolution requests, there has been very              organization or association) or
                                               assessment of anticipated costs and                     limited experience to date with dispute               manufacturers to the 340B ADR Panel
                                               benefits, before proposing ‘‘any rule that              resolution record keeping. Changes                    asserting the same allegation against the
                                               includes any Federal mandate that may                   proposed in this rulemaking would not                 same party.
                                               result in the expenditure by State, local,              result in significant reporting or                    *     *     *      *   *
                                               and Tribal governments, in the                          recordkeeping burden. Comments are                    ■ 3. Revise subpart C to read as follows:
                                               aggregate, or by the private sector, of                 welcome on the accuracy of this
                                               $100 million or more (adjusted annually                 statement.                                            Subpart C—Administrative Dispute
                                               for inflation) in any one year.’’ In 2014,                                                                    Resolution
                                               that threshold level was approximately                    Dated: May 24, 2016.
                                               $155 million. HHS does not expect this                  James Macrae,                                         Sec.
                                               proposed rule to exceed the threshold.                  Acting Administrator, Health Resources and            10.20 Administrative Dispute Resolution
                                                                                                       Services Administration.                                   Panel.
                                               Executive Order 13132—Federalism                          Approved: June 7, 2016.
                                                                                                                                                             10.21 Claims.
                                                                                                                                                             10.22 Covered entity information requests.
                                                  HHS has reviewed this proposed rule                  Sylvia M. Burwell,                                    10.23 Final agency decision.
                                               in accordance with Executive Order
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                                                                                                       Secretary. Department of Health and Human
                                               13132 regarding federalism, and has                     Services.                                             § 10.20    Administrative Dispute Resolution
                                               determined that it does not have                                                                              Panel.
                                               ‘‘federalism implications.’’ This                       List of Subjects in 42 CFR Part 10                      The Secretary shall establish a
                                               proposed rule would not ‘‘have                            Biologics, Business and industry,                   decision-making body known as the
                                               substantial direct effects on the States,               Diseases, Drugs, Health, Health care,                 Administrative Dispute Resolution
                                               or on the relationship between the                      Health facilities, Hospitals, 340B drug               Panel (340B ADR Panel) to review and
                                               national government and the States, or                  pricing program.                                      make a binding final agency decision


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                                                                       Federal Register / Vol. 81, No. 156 / Friday, August 12, 2016 / Proposed Rules                                          53387

                                               regarding claims filed by covered                          (b) Requirements for filing a claim. (1)              (d) Deadlines and procedures for
                                               entities and manufacturers.                             A covered entity or manufacturer must                 filing a claim. (1) Covered entities and
                                                 (a) Members of the 340B ADR Panel.                    file a claim for administrative dispute               manufacturers must file claims in
                                               (1) The Health Resources and Services                   resolution in writing to HRSA within 3                writing to HRSA. A claim must include
                                               Administration (HRSA) shall:                            years of the date of the alleged violation.           all of the requirements in paragraph (b)
                                                 (A) Select three voting members of the                Any file, document, or record associated              of this section. Additional information
                                               340B ADR Panel from a roster of eligible                with the claim that is the subject of a               to substantiate a claim may be
                                               individuals and one ex-officio, non-                    dispute must be maintained by the                     submitted.
                                               voting member from the staff of HRSA’s                  covered entity and manufacturer until
                                                                                                                                                                (2) The party filing the claim must
                                               Office of Pharmacy Affairs (OPA);                       the final agency decision letter is issued
                                                                                                                                                             notify the opposing party in writing
                                                 (B) Alternate the individuals on the                  by the 340B ADR Panel.
                                                                                                          (2) A covered entity filing a claim                within 3 business days of the date the
                                               340B ADR Panel for each claim;
                                                 (C) Remove an individual from the                     described in paragraph (a)(1) of this                 claim was filed and must provide
                                               340B ADR Panel for cause; and                           section must provide documents                        documentation of such notification to
                                                 (D) Appoint replacement members                       sufficient to demonstrate its claim that              HRSA. The written notice to the
                                               should an individual be unable to                       it has been overcharged by a                          opposing party must include a summary
                                               complete his or her duties.                             manufacturer, along with any such other               of the documents submitted as part of
                                                 (2) No member of the 340B ADR Panel                   documentation as may be requested by                  the claim.
                                               may have a conflict of interest, as                     HRSA.                                                    (3) HRSA will review all information
                                               defined in subsection (b) of this section.                 (3) A manufacturer filing a claim                  submitted by the party filing the claim
                                                 (b) Conflicts of interest. All members                under paragraph (a)(2) of this section                and will make a determination as to
                                               of the 340B ADR Panel will be screened                  must provide documents sufficient to                  whether all requirements are met and
                                               for conflicts of interest prior to                      demonstrate its claim that a covered                  provide written notice to all parties
                                               reviewing a claim. Conflicts of interest                entity has violated the prohibition on                within 20 business days after receiving
                                               may include:                                            diversion and/or duplicate discount,                  the claim and any subsequently
                                                 (1) Financial interest in a party                     along with any such documentation as                  requested information.
                                               involved, a subsidiary of a party                       may be requested by HRSA.
                                                                                                          (c) Consolidation of claims. (1) Two or               (A) Claims that move forward for
                                               involved, or in the claim before the
                                                                                                       more covered entities may jointly file                review. If HRSA finds that the party
                                               340B ADR Panel;
                                                                                                       claims of overcharges by the same                     filing the claim submitted all required
                                                 (2) Family or close relation to a party
                                                                                                       manufacturer for the same drug or drugs               documentation and thereby meets the
                                               involved; and
                                                                                                       if each covered entity that could file a              requirements described in paragraph (b)
                                                 (3) Current or former business or
                                               employment relation to a party.                         claim against the manufacturer consents               of this section, written notification will
                                                 (c) Duties of the 340B ADR Panel. The                 to the jointly filed claim, and meets the             be sent to both the manufacturer and
                                               340B ADR Panel will:                                    minimum requirements, including                       covered entity advising that the claim
                                                 (1) Review and evaluate documents or                  submission of the required                            will be forwarded to the 340B ADR
                                               information submitted by covered                        documentation, described in paragraph                 Panel for review.
                                               entities and manufacturers;                             (b) of this section.                                     (B) Claims that do not move forward
                                                 (2) Request additional information or                    (2) An association or organization                 for review. If HRSA finds that the claim
                                               clarification of an issue from any or all               may file claims of overcharges by the                 does not meet the requirements
                                               parties to make a final decision;                       same manufacturer for the same drug or                described in paragraph (b) of this
                                                 (3) Evaluate a claim in a separate                    drugs on behalf of multiple covered                   section, written notification will be sent
                                               session from the parties involved;                      entities if each covered entity                       to both the manufacturer and covered
                                                 (4) Consult with OPA regarding any                    represented could file a claim against                entity detailing the reasons that the
                                               inquiries or concerns while reviewing a                 the manufacturer, is a member of the                  claim did not move forward. A claim
                                               claim; and                                              association or organization, meets the                will not move forward for review by the
                                                 (5) Make a final agency decision on                   requirements described in paragraph (b)               340B ADR Panel if the claim does not
                                               each claim that will be communicated                    of this section, including submission of              meet the requirements in paragraph (b)
                                               to HRSA for appropriate enforcement.                    the required documentation, and each                  of this section. That same claim may
                                                                                                       covered entity has agreed to                          only be resubmitted if new information
                                               § 10.21   Claims.                                       representation by the association or                  is presented to support the alleged
                                                 (a) Claims permitted. The ADR                         organization on its behalf.                           statutory violation.
                                               process is limited to the following:                       (3) A manufacturer or manufacturers
                                                 (1) Claims by a covered entity that it                may request to consolidate claims                        (e) Responding to a submitted claim.
                                               has been overcharged, as defined in                     brought by more than one manufacturer                 Upon receipt of notification that a claim
                                               § 10.11(b), by a manufacturer for a                     against the same covered entity if each               will move forward to the 340B ADR
                                               covered outpatient drug; and                            manufacturer could individually file a                Panel for review, the party in alleged
                                                 (2) Claims by a manufacturer, after it                claim against the covered entity,                     violation will have 20 business days to
                                               has conducted an audit of a covered                     consents to the jointly filed claim, meets            submit a written response to the 340B
                                               entity pursuant to section 340B(a)(5)(C)                the requirements described in paragraph               ADR Panel. If an opposing party does
                                               of the PHSA, that the covered entity has                (b) of this section for that claim, and the           not respond to a request for information
                                               violated section 340B(a)(5)(A) of the                   340B ADR Panel determines that such                   from HRSA or the 340B ADR Panel, or
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                                               PHSA, regarding the prohibition of                      consolidation is appropriate and                      elects not to participate in the 340B
                                               duplicate discounts, or section                         consistent with the goals of fairness and             ADR process, the 340B ADR Panel will
                                               340B(a)(5)(B) of the PHSA, regarding the                economy of resources. The 340B ADR                    make a decision on the claim based on
                                               prohibition of the resale or transfer of                Panel will not permit joint claims filed              the information submitted in the claim.
                                               covered outpatient drugs to a person                    on behalf of manufacturers by                         The 340B ADR Panel will consider any
                                               who is not a patient of the covered                     associations or organizations                         additional information that was
                                               entity.                                                 representing their interests.                         provided by the parties involved.


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                                               53388                   Federal Register / Vol. 81, No. 156 / Friday, August 12, 2016 / Proposed Rules

                                               § 10.22 Covered entity information                         (b) The 340B ADR Panel will review                 FOR FURTHER INFORMATION CONTACT:      Scot
                                               requests.                                               the responses of all parties in producing             Stone, Scot.Stone@fcc.gov, Wireless
                                                  (a) A covered entity must submit a                   the final agency decision letter.                     Telecommunications Bureau, (202) 418–
                                               written request for additional                             (1) The final agency decision letter               0638, or TTY (202) 418–7233.
                                               information necessary to support its                    will represent the decision of a majority             SUPPLEMENTARY INFORMATION: This is a
                                               claim to the 340B ADR Panel within 20                   of the 340B ADR Panel’s findings                      summary of the Commission’s Notice of
                                               business days of the claim acceptance                   regarding the claim and discuss the                   Proposed Rulemaking (NPRM), adopted
                                               date. The 340B ADR Panel will review                    findings supporting the decision.                     July 27, 2016 and released July 28, 2016.
                                               the information request and notify the                     (2) The 340B ADR Panel will submit                 The full text of this document is
                                               covered entity if the information request               the binding final agency decision letter              available for public inspection and
                                               is beyond the scope of the claim and                    to all parties, and to HRSA, as                       copying during regular business hours
                                               will permit the covered entity to                       necessary, for appropriate enforcement                in the FCC Reference Center, Federal
                                               resubmit a revised information request                  action.                                               Communications Commission, 445 12th
                                               if necessary.                                           [FR Doc. 2016–18969 Filed 8–11–16; 8:45 am]           Street SW., Room CY–A257,
                                                  (b) The 340B ADR Panel will submit                   BILLING CODE 4165–15–P                                Washington, DC 20554. The complete
                                               the covered entity’s information request                                                                      text may be purchased from the
                                               to the manufacturer who must respond                                                                          Commission’s copy contractor, 445 12th
                                               to the request within 20 business days.                 FEDERAL COMMUNICATIONS                                Street, SW., Room CY–B402,
                                                  (c) The manufacturer must fully                      COMMISSION                                            Washington, DC 20554. This document
                                               respond, in writing, to an information                                                                        will also be available via ECFS at http://
                                                                                                       47 CFR Part 97                                        fjallfoss.fcc.gov/ecfs/. Documents will
                                               request from the 340B ADR Panel by the
                                                                                                                                                             be available electronically in ASCII,
                                               response deadline.                                      [WT Docket No. 16–239; FCC 16–96]                     Microsoft Word, and/or Adobe Acrobat.
                                                  (1) A manufacturer is responsible for                                                                      Alternative formats are available for
                                               obtaining relevant information from any                 Amateur Radio Service Rules To
                                                                                                                                                             people with disabilities (Braille, large
                                               wholesaler or other third party that may                Permit Greater Flexibility in Data
                                                                                                                                                             print, electronic files, audio format) by
                                               facilitate the sale or distribution of its              Communications
                                                                                                                                                             sending an email to fcc504@fcc.gov or
                                               drugs to covered entities.                              AGENCY:  Federal Communications                       calling the Commission’s Consumer and
                                                  (2) If a manufacturer anticipates that               Commission.                                           Governmental Affairs Bureau at (202)
                                               it will not be able to respond to the                   ACTION: Proposed rule.                                418–0530 (voice), (202) 418–0432
                                               information request by the deadline, it                                                                       (TTY).
                                               can request one extension by notifying                  SUMMARY:    In this document, the Federal
                                               the 340B ADR Panel in writing within                                                                          I. Introduction
                                                                                                       Communications Commission
                                               15 business days of receipt of the                      (Commission) seeks comment on                            1. In the NPRM, we propose, in
                                               request.                                                proposed amendments regarding                         response to a petition for rulemaking
                                                  (3) A request to extend the deadline                 technical standards applicable to data                filed by the AmericanRadio Relay
                                               must include the reason why the current                 communications that may be                            League, Inc. (ARRL), to amend part 97
                                               deadline is not feasible and must                       transmitted in the Amateur Radio                      of the Commission’s rules regarding
                                               outline the proposed timeline for fully                 Service. Specifically, we propose to                  technical standards applicable to data
                                               responding to the information request.                  remove limitations on the symbol rate                 communications that may be
                                                  (4) The 340B ADR Panel may approve                   (also known as the baud rate) applicable              transmitted in the Amateur Radio
                                               or disapprove the request for an                        to data emissions in certain amateur                  Service. Specifically, we propose to
                                               extension of time and will notify all                   bands. We believe that this rule change               remove limitations on the symbol rate
                                               parties in writing of its decision.                     will allow amateur service licensees to               (also known as baud rate)—the rate at
                                                                                                       use modern digital emissions, thereby                 which the carrier waveform amplitude,
                                               § 10.23   Final agency decision.                        better fulfilling the purposes of the                 frequency, and/or phase is varied to
                                                  (a) The 340B ADR Panel will review                   amateur service and enhancing its                     transmit information—applicable to
                                               documents submitted by the parties and                  usefulness.                                           data emissions in certain amateur
                                               determine if there is adequate support to                                                                     bands. We believe that this rule change
                                                                                                       DATES:  Submit comments on or before                  will allow amateur service licensees to
                                               conclude that a violation as described in               October 11, 2016, and reply comments
                                               paragraph (a)(1) or (2) of § 10.21 has                                                                        use modern digital emissions, thereby
                                                                                                       are due on or before November 10, 2016.               better fulfilling the purposes of the
                                               occurred.
                                                                                                       ADDRESSES: You may submit comments,                   amateur service and enhancing its
                                                  (1) The 340B ADR Panel will prepare                  identified by WT Docket No. 16–239, by                usefulness.
                                               a draft agency decision letter based on                 any of the following methods:
                                               its review and evaluation of all                          • Federal Communications                            II. Background
                                               documents submitted by the parties,                     Commission’s Web site: http://                           2. The limitations on radioteletype
                                               including documents provided as                         apps.fcc.gov/ecfs/. Follow the                        (RTTY) and data transmissions below
                                               required in paragraph (b) of § 10.21,                   instructions for submitting comments.                 450 MHz vary depending on the
                                               information requests in support of a                      • Mail: Federal Communications                      frequency band, and on whether the
                                               claim, and responses to a claim.                        Commission, 445 12th Street SW.,                      digital code used to encode the signal
                                                  (2) The draft agency decision letter                                                                       being transmitted is one of the codes
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                                                                                                       Washington, DC 20554.
                                               will be sent to all parties and will                      • People with Disabilities: Contact the             specified in section 97.309(a) of the
                                               include the 340B ADR Panel’s                            FCC to request reasonable                             Commission’s rules—Baudot, AMTOR,
                                               preliminary findings regarding the                      accommodations (accessible format                     and ASCII (the ‘‘specified digital
                                               alleged violation.                                      documents, sign language interpreters,                codes’’). Section 97.307(f) limits the
                                                  (3) All parties will have 20 business                CART, etc.) by email: FCC504@fcc.gov                  symbol rate for the specified digital
                                               days to respond to the 340B ADR                         or phone: 202–418–0530 or TTY: 202–                   codes, and the bandwidth for
                                               Panel’s draft agency decision letter.                   418–0432.                                             unspecified digital codes, as follows:


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Document Created: 2018-02-09 11:33:19
Document Modified: 2018-02-09 11:33:19
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionProposed Rules
ActionNotice of proposed rulemaking.
DatesSubmit written comments on or before October 11, 2016.
ContactCAPT Krista Pedley, Director, OPA, HSB HRSA, 5600 Fishers Lane, Mail Stop 08W05A, Rockville, MD 20857, or by telephone at 301-594-4353.
FR Citation81 FR 53381 
RIN Number0906-AA90
CFR AssociatedBiologics; Business and Industry; Diseases; Drugs; Health; Health Care; Health Facilities; Hospitals and 340b Drug Pricing Program

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