; and (3) by striking inclusive and inserting exclusive . (b) Eliminating manufacturers from definition of wholesaler Section 1927(k)(11) of the Social Security Act ( 42 U.S.C. 1396r–8(k)(11) ) is amended— (1) by striking manufacturers, ; and (2) by striking manufacturer’s and . (c) Effective date The amendments made by this section shall apply with respect to covered outpatient drugs dispensed on or after January 1, 2020. 7. Medicaid Improvement Fund Section 1941(b)(1) of the Social Security Act ( 42 U.S.C. 1396w–1(b)(1) ) is amended by striking $6,000,000 and inserting $45,500,000 . 8. Determination of budgetary effects The budgetary effects of this Act, for the purpose of complying with the Statutory Pay-As-You-Go Act of 2010, shall be determined by reference to the latest statement titled Budgetary Effects of PAYGO Legislation for this Act, submitted for printing in the Congressional Record by the Chairman of the House Budget Committee, provided that such statement has been submitted prior to the vote on passage.