; and (2) by adding at the end the following new subsection: (o) Limitation on rebates, price reductions, or other remuneration for certified insulin (1) Limitation (A) In general Subject to subparagraphs (B) and (C), for plan year 2022 and subsequent plan years, a PDP sponsor and a Medicare Advantage organization shall ensure that each prescription drug plan or MA–PD plan offered by the sponsor or organization, and any entity that provides pharmacy benefits management services under a contract with the prescription drug plan or MA–PD plan offered by the sponsor or organization, does not, directly or indirectly, receive from a manufacturer of certified insulin a rebate, reduction in price, or other remuneration with respect to certified insulin that is covered by the plan. (B) Exception The requirement under subparagraph (A) shall not apply to— (i) any such reduction in price that is reflected at the point of sale to the beneficiary; or (ii) any remuneration that is a flat fee-based service fee that a manufacturer of such certified insulin pays to a pharmacy benefit manager for services rendered to the manufacturer that relate to arrangements by the pharmacy benefit manager to provide pharmacy benefit management services to a prescription drug plan or MA–PD plan, if certain conditions established by the Secretary are met, including requirements that the fees are transparent to the prescription drug plan or MA–PD plan. (C) Hold harmless for first 2 years that an insulin is certified In the first 2 plan years during which paragraph (2) applies with respect to a certified insulin, a PDP sponsor and a Medicare Advantage organization shall not, and shall ensure that any entity that provides pharmacy benefits management services under a contract with such sponsor or organization does not— (i) remove such insulin from the formulary applicable to the prescription drug plan or MA–PD plan