Real-Time Beneficiary Drug Cost Bill

I 116TH CONGRESS 1ST SESSION H. R. 3415 To amend title XVIII of the Social Security Act to require prescription drug plan sponsors to include real-time benefit information as part of such sponsor’s electronic prescription program under the Medicare pro- gram. IN THE HOUSE OF REPRESENTATIVES JUNE 21, 2019 Ms. SLOTKIN (for herself and Mr. ARRINGTON) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subse- quently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to require prescription drug plan sponsors to include real-time ben- efit information as part of such sponsor’s electronic pre- scription program under the Medicare 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 ‘‘Real-Time Beneficiary 4 Drug Cost Bill’’. 5 VerDate Sep 11 2014 20:27 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3415.IH H3415 jbell on DSK3GLQ082PROD with BILLS 2 •HR 3415 IH SEC. 2. REQUIRING PRESCRIPTION DRUG PLAN SPONSORS 1 TO INCLUDE REAL-TIME BENEFIT INFORMA- 2 TION AS PART OF SUCH SPONSOR’S ELEC- 3 TRONIC PRESCRIPTION PROGRAM UNDER 4 THE MEDICARE PROGRAM. 5 Section 1860D–4(e)(2) of the Social Security Act (42 6 U.S.C. 1395w–104(e)(2)) is amended— 7 (1) in subparagraph (D), by striking ‘‘To the 8 extent’’ and inserting ‘‘Except as provided in sub- 9 paragraph (F), to the extent’’; and 10 (2) by adding at the end the following new sub- 11 paragraph: 12 ‘‘(F) REAL-TIME BENEFIT INFORMA- 13 TION.— 14 ‘‘(i) IN GENERAL.—Not later than 15 January 1, 2021, the program shall pro- 16 vide for the real-time electronic trans- 17 mission to prescribing health care profes- 18 sionals, using technology capable of inte- 19 grating with such professionals’ electronic 20 prescribing and electronic health record 21 systems, of individual-specific formulary 22 and benefit information under a prescrip- 23 tion drug plan with respect to an indi- 24 vidual enrolled in such plan. Such informa- 25 tion shall include, with respect to the pre- 26 VerDate Sep 11 2014 02:28 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3415.IH H3415 jbell on DSK3GLQ082PROD with BILLS 3 •HR 3415 IH scribing of a covered part D drug to such 1 individual, the following: 2 ‘‘(I) A description of any clini- 3 cally appropriate alternatives to such 4 drug included in the formulary of 5 such plan. 6 ‘‘(II) Information relating to ap- 7 plicable cost-sharing requirements for 8 such drug and such alternatives, in- 9 cluding a description of any variance 10 in such requirements based on the 11 pharmacy dispensing such drug or 12 such alternatives. 13 ‘‘(III) Information relating to 14 any prior authorization or other utili- 15 zation management requirements ap- 16 plicable to such drug and such alter- 17 natives within the formulary of such 18 plan. 19 ‘‘(ii) SPECIAL RULE FOR 2021.—The 20 program shall be deemed to be in compli- 21 ance with clause (i) for 2021 if the pro- 22 gram complies with the provisions of sec- 23 tion 423.160(b)(7) of title 42, Code of 24 VerDate Sep 11 2014 02:28 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3415.IH H3415 jbell on DSK3GLQ082PROD with BILLS 4 •HR 3415 IH Federal Regulations (or a successor regula- 1 tion), for such year.’’. 2 Æ VerDate Sep 11 2014 02:28 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\H3415.IH H3415 jbell on DSK3GLQ082PROD with BILLS