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II
116TH CONGRESS
1ST SESSION
S. 2911
To amend title XVIII of the Social Security Act to provide a monthly
out-of-pocket cost sharing maximum for enrollees who incur a significant
portion of costs for covered part D drugs towards the annual out-
of-pocket threshold during a month.
IN THE SENATE OF THE UNITED STATES
NOVEMBER 20, 2019
Mr. CASSIDY (for himself and Mr. MENENDEZ) 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
a monthly out-of-pocket cost sharing maximum for en-
rollees who incur a significant portion of costs for cov-
ered part D drugs towards the annual out-of-pocket
threshold during a month.
Be it enacted by the Senate and House of Representa-
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tives of the United States of America in Congress assembled,
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SECTION 1. SHORT TITLE.
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This Act may be cited as the ‘‘Seniors Prescription
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Drug Relief Act of 2019’’.
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•S 2911 IS
SEC. 2. MONTHLY OUT-OF-POCKET COST SHARING MAX-
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IMUM FOR ENROLLEES WHO INCUR A SIG-
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NIFICANT PORTION OF COSTS TOWARDS AN-
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NUAL OUT-OF-POCKET THRESHOLD.
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(a) STANDARD PRESCRIPTION DRUG COVERAGE.—
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Section 1860D–2(b)(2) of the Social Security Act (42
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U.S.C. 1395w–102(b)(2)) is amended—
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(1) in subparagraph (A), by striking ‘‘and (D)’’
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and inserting ‘‘, (D), and (E)’’;
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(2) in each of subparagraphs (C)(i) and (D)(i),
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by striking ‘‘paragraph (4)’’ and inserting ‘‘para-
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graph (4), and subject to subparagraph (E)’’; and
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(3) by adding at the end the following new sub-
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paragraph:
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‘‘(E) MONTHLY
OUT-OF-POCKET
COST
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SHARING MAXIMUM.—
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‘‘(i) IN GENERAL.—For plan years be-
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ginning on or after January 1, 2022, the
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Secretary shall through regulation estab-
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lish a process to allow an enrollee in a pre-
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scription drug plan who incurs costs (as
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described in paragraph (4)(C)) equal to or
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greater than a significant percentage of
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the annual out-of-pocket threshold speci-
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fied in paragraph (4)(B) within a one
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month time period to choose to pay the
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•S 2911 IS
total amount of such costs owed, in equal
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installments in the remaining months of
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the plan year up to the total amount of
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such annual out-of-pocket threshold.
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‘‘(ii) DEFINITION
OF
SIGNIFICANT
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PERCENT.—For purposes of the process
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described in clause (i), the Secretary shall
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through regulation provide for a definition
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of the term ‘significant percentage’ with
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respect to a percentage of the annual out-
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of-pocket threshold specified in paragraph
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(4)(B) but in no case shall the ‘significant
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percentage’ be less than 50 percent or
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more than 100 percent of the annual out-
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of-pocket threshold.’’.
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(b)
ALTERNATIVE
PRESCRIPTION
DRUG
COV-
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ERAGE.—Section 1860D–2(c) of the Social Security Act
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(42 U.S.C. 1395w–102(c)) is amended by adding at the
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end the following new paragraph:
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‘‘(4) SAME
MONTHLY
OUT-OF-POCKET
COST
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SHARING MAXIMUM.—For plan years beginning on
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or after January 1, 2022, the coverage provides the
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monthly out-of-pocket cost sharing maximum re-
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quired under subsection (b)(2)(E).’’.
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Æ
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