in consultation with relevant stakeholders. (VII) Definitions In this clause: (aa) Quality measure The term quality measure means criteria used by a PDP sponsor (including an entity that contracts with such sponsor, such as a pharmacy benefit manager) to determine the amount or applicability of incentive payments and pharmacy price concessions. (bb) PDP sponsor The term PDP sponsor includes an MA organization offering an MA–PD plan under part C and an entity that contracts with such sponsor or organization, such as a pharmacy benefit manager. (iii) Audits of PDP sponsors and negotiated price (I) In general Beginning January 1, 2021, the Secretary shall conduct annual audits of PDP sponsors by reviewing a representative sample of claims between PDP sponsors or other intermediary contracting organizations and all pharmacy types and those pharmacies’ lowest actual acquisition and dispensing costs to assess whether reimbursement for individual network pharmacies is below the pharmacy’s lowest actual cost of acquiring and dispensing covered part D drugs and providing pharmacy services necessary for dispensing such drugs. In conducting such audits, the Secretary shall focus on determining whether or not the requirements under clause (ii) are negatively impacting network pharmacy participation in the program under this part and beneficiary access to pharmacy providers. Such audits shall occur not less than annually and when requested by the Medicare Pharmaceutical and Technology Ombudsman. (II) Appeal If a network pharmacy believes that a PDP sponsor has reimbursed for a covered part D drug below the pharmacy’s lowest actual acquisition and dispensing costs, the pharmacy may appeal the reimbursement, in writing, to the Medicare Pharmaceutical and Technology Ombudsman within 60 days following notification of the reimbursement and provide necessary documentation to support its claim. (III) Annual report to congress Not later than January 1, 2022, and annually thereafter, the Secretary shall submit to Congress a report