; and (2) by adding at the end the following new clauses: (ii) Prices negotiated with pharmacy at point-of-sale (I) In general Subject to subclause (III), for plan years beginning on or after January 1, 2019, negotiated prices for covered part D drugs described in clause (i) provided under a prescription drug plan, including all pharmacy price concessions and all incentive payments and adjustments negotiated with the pharmacy dispensing such drug, shall be provided at the point-of-sale of the covered part D drug. If the negotiated price of such drug, including all pharmacy price concessions and all incentive payments and adjustments negotiated with such pharmacy, is not possible to calculate at the point-of-sale, the PDP sponsor of such plan shall use an estimated negotiated price, including all estimated pharmacy negotiated price concessions and incentive payments and adjustments and taking into account the negotiated price of such drug in the prior year (if available). (II) Application of incentive payments and adjustments For plan years beginning on or after January 1, 2019, in the case that a PDP sponsor uses incentive payments and adjustments with respect to payment to a pharmacy for a covered part D drug, such payments and adjustments shall be determined through the use of a quality measure approved by the Secretary and established by the working group established under clause (iii). (III) No increase in cost sharing Subclause (I) shall not apply in the case where application of such subclause would increase the amount owed by an individual in cost sharing above the amount such individual would have owed in cost sharing without application of such subclause. (IV) Discrepancies between negotiated prices and actual reimbursement In the case that the Secretary determines that the negotiated price of a PDP sponsor applied at the point-of-sale with respect to a covered part D drug for a year dispensed by a pharmacy was not equal to the total reimbursement made to such pharmacy for such drug for such year (taking