Improving Low Income Access to Prescription Drugs Act of 2019

II 116TH CONGRESS 1ST SESSION S. 1999 To amend title XVIII of the Social Security Act to provide transitional coverage and retroactive Medicare part D coverage for certain low-income beneficiaries. IN THE SENATE OF THE UNITED STATES JUNE 27, 2019 Mr. CASEY (for himself and Mr. DAINES) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to provide transitional coverage and retroactive Medicare part D coverage for certain low-income beneficiaries. 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 ‘‘Improving Low Income 4 Access to Prescription Drugs Act of 2019’’. 5 VerDate Sep 11 2014 00:35 Jul 02, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1999.IS S1999 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 1999 IS SEC. 2. TRANSITIONAL COVERAGE AND RETROACTIVE 1 MEDICARE PART D COVERAGE FOR CERTAIN 2 LOW-INCOME BENEFICIARIES. 3 Section 1860D–14 of the Social Security Act (42 4 U.S.C. 1395w–114) is amended— 5 (1) by redesignating subsection (e) as sub- 6 section (f); and 7 (2) by adding after subsection (d) the following 8 new subsection: 9 ‘‘(e) LIMITED INCOME NEWLY ELIGIBLE TRANSI- 10 TION PROGRAM.— 11 ‘‘(1) IN GENERAL.—Beginning not later than 12 January 1, 2021, the Secretary shall carry out a 13 program to provide transitional coverage for covered 14 part D drugs for LI NET eligible individuals in ac- 15 cordance with this subsection. 16 ‘‘(2) LI NET ELIGIBLE INDIVIDUAL DEFINED.— 17 For purposes of this subsection, the term ‘LI NET 18 eligible individual’ means a part D eligible individual 19 who— 20 ‘‘(A) meets the requirements of clauses (ii) 21 and (iii) of subsection (a)(3)(A); and 22 ‘‘(B) has not yet enrolled in a prescription 23 drug plan or an MA–PD plan, or, who has so 24 enrolled, but with respect to whom coverage 25 under such plan has not yet taken effect. 26 VerDate Sep 11 2014 00:35 Jul 02, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1999.IS S1999 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 1999 IS ‘‘(3) TRANSITIONAL COVERAGE.—For purposes 1 of this subsection, the term ‘transitional coverage’ 2 means with respect to an LI NET eligible indi- 3 vidual— 4 ‘‘(A) immediate access to covered part D 5 drugs at the point of sale during the period 6 that begins on the first day of the month such 7 individual is determined to meet the require- 8 ments of clauses (ii) and (iii) of subsection 9 (a)(3)(A) and ends on the date that coverage 10 under a prescription drug plan or MA–PD plan 11 takes effect with respect to such individual; and 12 ‘‘(B) in the case of an LI NET eligible in- 13 dividual who is a full-benefit dual eligible indi- 14 vidual (as defined in section 1935(c)(6)) or a 15 recipient of supplemental security income bene- 16 fits under title XVI, retroactive coverage (in the 17 form of reimbursement of the amounts that 18 would have been paid under this part had such 19 individual been enrolled in a prescription drug 20 plan or MA–PD plan) of covered part D drugs 21 purchased by such individual during the period 22 that begins on the date that is the later of— 23 VerDate Sep 11 2014 00:35 Jul 02, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1999.IS S1999 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 1999 IS ‘‘(i) the date that such individual was 1 first eligible for a low-income subsidy 2 under this part; or 3 ‘‘(ii) the date that is 36 months prior 4 to the date such individual enrolls in a pre- 5 scription drug plan or MA–PD plan, 6 and ends on the date that coverage under such 7 plan takes effect. 8 ‘‘(4) PROGRAM ADMINISTRATION.— 9 ‘‘(A) SINGLE POINT OF CONTACT.—The 10 Secretary shall, to the extent feasible, admin- 11 ister the program under this subsection through 12 a contract with a single program administrator. 13 ‘‘(B) BENEFIT DESIGN.—The Secretary 14 shall ensure that the transitional coverage pro- 15 vided to LI NET eligible individuals under this 16 subsection— 17 ‘‘(i) provides access to all covered part 18 D drugs under an open formulary; 19 ‘‘(ii) permits all pharmacies deter- 20 mined by the Secretary to be in good 21 standing to process claims under the pro- 22 gram; 23 ‘‘(iii) is consistent with such require- 24 ments as the Secretary considers necessary 25 VerDate Sep 11 2014 00:35 Jul 02, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1999.IS S1999 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 1999 IS to improve patient safety and ensure ap- 1 propriate dispensing of medication; and 2 ‘‘(iv) meets such other requirements 3 as the Secretary may establish. 4 ‘‘(5) RELATIONSHIP TO OTHER PROVISIONS OF 5 THIS TITLE; WAIVER AUTHORITY.— 6 ‘‘(A) IN GENERAL.—The following provi- 7 sions shall not apply with respect to the pro- 8 gram under this subsection: 9 ‘‘(i) Paragraphs (1) and (3)(B) of sec- 10 tion 1860D–4(a) (relating to dissemination 11 of general information; availability of infor- 12 mation on changes in formulary through 13 the internet). 14 ‘‘(ii) Subparagraphs (A) and (B) of 15 section 1860D–4(b)(3) (relating to require- 16 ments on development and application of 17 formularies; formulary development). 18 ‘‘(iii) Paragraphs (1)(C) and (2) of 19 section 1860D–4(c) (relating to medication 20 therapy management program). 21 ‘‘(B) WAIVER AUTHORITY.—The Secretary 22 may waive such other requirements of title XI 23 and this title as may be necessary to carry out 24 VerDate Sep 11 2014 00:35 Jul 02, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1999.IS S1999 pamtmann on DSKBFK8HB2PROD with BILLS 6 •S 1999 IS the purposes of the program established under 1 this subsection.’’. 2 Æ VerDate Sep 11 2014 00:35 Jul 02, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\S1999.IS S1999 pamtmann on DSKBFK8HB2PROD with BILLS