1. Short title This Act may be cited as the Stopping the Pharmaceutical Industry from Keeping drugs Expensive Act or the SPIKE Act . 2. Drug manufacturer price transparency Title XI of the Social Security Act ( 42 U.S.C. 1301 et seq.) is amended by inserting after section 1128K the following new section: 1128L. Drug manufacturer price transparency (a) In general With respect to each year, beginning with 2021, the Secretary shall, at least once during such year, determine if there is a triggered SPIKE increase (in accordance with subsection (b)) with respect to an applicable drug (as defined in subsection (f)(1)). If the Secretary determines, with respect to a year, there is such an increase with respect to an applicable drug, the manufacturer of the applicable drug shall submit to the Secretary the justification described in subsection (c), subject to subsection (b)(3), for each such triggered SPIKE increase in accordance with the timing described in subsection (d). (b) Triggered SPIKE increase (1) In general A triggered SPIKE increase occurs, with respect to an applicable drug and year (beginning with 2021), in any of the following cases: (A) If there is a 10 percent (or $10,000) increase with respect to the wholesale acquisition cost (or alternative cost measure specified by the Secretary under paragraph (2)) of such drug during any 12-month period beginning and ending within the lookback period that is the 5-year period preceding 2021 or 2022, respectively. (B) If there is a 25 percent (or $25,000) increase with respect to the wholesale acquisition cost (or such alternative cost measure) of such drug during any 36-month period beginning and ending within such respective lookback period. (C) In the case of such a drug that is first covered under title XVIII with respect to such year, if the estimated cost or spending under such title per individual or per user of such drug (as estimated by the Secretary) for such year (or per course of treatment, as defined by the Secretary) is at least $26,000. (2)