Maximizing Drug Coverage for Low-Income Seniors Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 4669 To amend title XVIII of the Social Security Act to provide for intelligent assignment of certain subsidy eligible individuals auto-enrolled under Medicare prescription drug plans and MA–PD plans. IN THE HOUSE OF REPRESENTATIVES OCTOBER 11, 2019 Ms. STEVENS (for herself, Mrs. HAYES, Ms. KUSTER of New Hampshire, and Ms. SEWELL of Alabama) introduced the following bill; which was re- ferred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently de- termined 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 provide for intelligent assignment of certain subsidy eligible indi- viduals auto-enrolled under Medicare prescription drug plans and MA–PD plans. 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 ‘‘Maximizing Drug Cov- 4 erage for Low-Income Seniors Act of 2019’’. 5 VerDate Sep 11 2014 03:00 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4669.IH H4669 kjohnson on DSK79L0C42 with BILLS 2 •HR 4669 IH SEC. 2. PROVIDING FOR INTELLIGENT ASSIGNMENT OF 1 CERTAIN SUBSIDY ELIGIBLE INDIVIDUALS 2 AUTO-ENROLLED UNDER MEDICARE PRE- 3 SCRIPTION DRUG PLANS AND MA–PD PLANS. 4 (a) IN GENERAL.—Section 1860D–1(b)(1) of the So- 5 cial Security Act (42 U.S.C. 1395w–101(b)(1)) is amend- 6 ed— 7 (1) in subparagraph (C)— 8 (A) by inserting after ‘‘PDP region’’ the 9 following: ‘‘or through use of an intelligent as- 10 signment process that is designed to maximize 11 the access of such individual to necessary pre- 12 scription drugs while minimizing costs to such 13 individual and to the program under this part 14 to the greatest extent possible. In the case the 15 Secretary enrolls such individuals through use 16 of an intelligent assignment process, such proc- 17 ess shall take into account the extent to which 18 prescription drugs necessary for the individual 19 are covered in the case of a PDP sponsor of a 20 prescription drug plan that uses a formulary, 21 the use of prior authorization or other restric- 22 tions on access to coverage of such prescription 23 drugs by such a sponsor, and the overall quality 24 of a prescription drug plan as measured by 25 VerDate Sep 11 2014 03:00 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4669.IH H4669 kjohnson on DSK79L0C42 with BILLS 3 •HR 4669 IH quality ratings established by the Secretary’’; 1 and 2 (B) by striking ‘‘Nothing in the previous 3 sentence’’ and inserting ‘‘Nothing in this sub- 4 paragraph’’; and 5 (2) in subparagraph (D)— 6 (A) by inserting after ‘‘PDP region’’ the 7 following: ‘‘or through use of an intelligent as- 8 signment process that is designed to maximize 9 the access of such individual to necessary pre- 10 scription drugs while minimizing costs to such 11 individual and to the program under this part 12 to the greatest extent possible. In the case the 13 Secretary enrolls such individuals through use 14 of an intelligent assignment process, such proc- 15 ess shall take into account the extent to which 16 prescription drugs necessary for the individual 17 are covered in the case of a PDP sponsor of a 18 prescription drug plan that uses a formulary, 19 the use of prior authorization or other restric- 20 tions on access to coverage of such prescription 21 drugs by such a sponsor, and the overall quality 22 of a prescription drug plan as measured by 23 quality ratings established by the Secretary’’; 24 and 25 VerDate Sep 11 2014 03:00 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4669.IH H4669 kjohnson on DSK79L0C42 with BILLS 4 •HR 4669 IH (B) by striking ‘‘Nothing in the previous 1 sentence’’ and inserting ‘‘Nothing in this sub- 2 paragraph’’. 3 (b) EFFECTIVE DATE.—The amendments made by 4 subsection (a) shall apply with respect to plan years begin- 5 ning with plan year 2022. 6 Æ VerDate Sep 11 2014 03:00 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\H4669.IH H4669 kjohnson on DSK79L0C42 with BILLS