PING Act

II 117TH CONGRESS 1ST SESSION S. 1123 To preserve non-interference under the Medicare part D Prescription Drug Benefit program. IN THE SENATE OF THE UNITED STATES APRIL 14, 2021 Mrs. BLACKBURN introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To preserve non-interference under the Medicare part D Prescription Drug Benefit program. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Preserving Innovation 4 for the Next Generation Act’’ or the ‘‘PING Act’’. 5 SEC. 2. FINDINGS. 6 Congress makes the following findings: 7 (1) Since implementation, the Medicare Pre- 8 scription Drug Benefit program under part D of 9 title XVIII of the Social Security Act (42 U.S.C. 10 VerDate Sep 11 2014 05:34 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1123.IS S1123 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1123 IS 1395w–101 et seq.) (referred to in this section as 1 ‘‘Medicare part D’’) has succeeded beyond expecta- 2 tions in providing affordable prescription drug cov- 3 erage for more than 45,000,000 seniors and disabled 4 individuals. 5 (2) The competitive market has kept total 6 Medicare part D costs below original estimates, 7 while still offering beneficiaries steady premiums and 8 a variety of alternative formularies and benefit de- 9 sign. 10 (3) This competitive pricing structure works, in 11 large part, due to the ‘‘non-interference clause’’ 12 under Medicare part D which provides for robust 13 private market negotiation without undue govern- 14 ment interference. 15 (4) The Congressional Budget Office repeatedly 16 has said that government negotiation would have a 17 negligible impact on Medicare part D spending un- 18 less the government also restricted access to medica- 19 tions. 20 (5) To achieve any significant savings, the gov- 21 ernment would need to impose access or coverage re- 22 strictions on medications. In fact, limiting options 23 will likely result in costs shifting to higher spending 24 for other Medicare services and negatively impact 25 VerDate Sep 11 2014 05:34 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1123.IS S1123 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1123 IS the health of seniors without helping to reduce gov- 1 ernment spending. 2 (6) Having a broad range of treatment options 3 is fundamental to providing good care to all pa- 4 tients, but particularly so for the Medicare popu- 5 lation, who are more likely to be affected by multiple 6 chronic conditions. With the advent of personalized 7 medicines and targeted therapies—where the under- 8 lying molecular drivers of disease help identify and 9 direct precise, targeted treatment choices—limiting 10 access reduces the vast potential of breakthrough 11 science to revolutionize care. Therefore, it is impera- 12 tive to ensure beneficiaries have access to a broader 13 range of medicines to best meet their health needs. 14 (7) Medicare beneficiaries would not be better 15 off if Medicare part D drug coverage were adminis- 16 tered by the Federal Government in the same way 17 as the Veterans Administration. Many veterans rely 18 on other sources to supplement their Veterans Ad- 19 ministration drug coverage due to restrictions that 20 limit their access to needed medications. More than 21 half of all veterans supplement their Veterans Ad- 22 ministration benefits with other sources of drug cov- 23 erage, including Medicare part D. A recent Veterans 24 Administration survey shows that approximately 25 VerDate Sep 11 2014 05:34 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1123.IS S1123 kjohnson on DSK79L0C42PROD with BILLS 4 •S 1123 IS 80.4 percent of veterans had both Veterans Adminis- 1 tration and non-Veterans Administration health cov- 2 erage and, among those in Medicare, 33.2 percent 3 have Medicare part D for prescription drug cov- 4 erage. 5 (8) Imposing a restrictive Veterans Administra- 6 tion-type formulary on Medicare part D is unlikely 7 to work for the diverse group of more than 8 45,000,000 beneficiaries enrolled in Medicare part 9 D. Evidence show that seniors would have limited 10 choices and fewer medicines available to them. A re- 11 cent analysis by Xcenda found that of the top 200 12 part D brand name drugs, 74 percent or more were 13 covered across stand-alone prescription drug plans 14 and Medicare Advantage prescription drug plans, 15 compared with 52 percent that could be covered by 16 the Veterans Administration formulary. 17 (9) A national formulary would restrict access 18 to affordable and vital prescriptions many Medicare 19 beneficiaries rely on. Robust patient access to a full 20 range of medicines has been a cornerstone of Medi- 21 care part D. Restricting access to medicines can sig- 22 nificantly reduce adherence. Poorer medication ad- 23 herence, in turn, can lead to worse health outcomes 24 and higher overall spending. 25 VerDate Sep 11 2014 05:34 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1123.IS S1123 kjohnson on DSK79L0C42PROD with BILLS 5 •S 1123 IS (10) Price controls or large penalties to force 1 companies to comply with so-called ‘‘negotiations’’ 2 have resulted in restricted access abroad and threat- 3 en similar restrictions on access in the United 4 States. Research demonstrates that government 5 price setting reduces access for patients and results 6 in fewer or delayed treatment options—nearly 90 7 percent of new medicines launched globally in the 8 past decade are currently available to patients in the 9 United States, only about half are available to pa- 10 tients in other countries like France and Canada. 11 (11) Limiting patient access to medicines con- 12 tradicts the foundational principles of Medicare part 13 D and the value beneficiaries derive from the pro- 14 gram—a recent survey shows that more than 90 15 percent of Medicare beneficiaries are satisfied with 16 their drug coverage and more than 80 percent said 17 it is important to them to have a variety of prescrip- 18 tion drug plans under Medicare part D from which 19 to choose. 20 SEC. 3. SENSE OF THE SENATE. 21 It is the sense of the Senate that non-interference in 22 the Medicare part D Prescription Drug Benefit program 23 under section 1860D–11(i) of the Social Security Act (42 24 U.S.C. 1395w–111(i)) should not be repealed. 25 VerDate Sep 11 2014 05:34 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1123.IS S1123 kjohnson on DSK79L0C42PROD with BILLS 6 •S 1123 IS SEC. 4. PROHIBITION ON CMI TESTING OF MODELS THAT 1 WOULD REPEAL NONINTERFERENCE. 2 Section 1115A(b) of the Social Security Act (42 3 U.S.C. 1315a(b)) is amended by adding at the end the 4 following new paragraph: 5 ‘‘(5) PROHIBITION ON TESTING OF MODELS 6 THAT WOULD REPEAL NONINTERFERENCE.—The 7 CMI shall not test any model that would repeal or 8 require a waiver of section 1860D–11(i).’’. 9 Æ VerDate Sep 11 2014 05:34 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\S1123.IS S1123 kjohnson on DSK79L0C42PROD with BILLS