Improving Low-Income Access to Prescription Drugs Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 3029 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 HOUSE OF REPRESENTATIVES MAY 28, 2019 Mr. OLSON (for himself, Ms. BARRAGA´N, Mr. MARCHANT, and Mr. LEWIS) introduced the following bill; which was referred to the Committee on En- ergy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdic- tion of the committee concerned 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 22:11 Jun 07, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3029.IH H3029 kjohnson on DSK79L0C42 with BILLS 2 •HR 3029 IH 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.—The Secretary shall carry 12 out a program to provide transitional coverage for 13 covered part D drugs for LI NET eligible individ- 14 uals in accordance with this subsection. 15 ‘‘(2) LI NET ELIGIBLE INDIVIDUAL DEFINED.— 16 For purposes of this subsection, the term ‘LI NET 17 eligible individual’ means a part D eligible individual 18 who— 19 ‘‘(A) is a subsidy eligible individual; and 20 ‘‘(B) has not yet enrolled in a prescription 21 drug plan or an MA–PD plan, or, who has so 22 enrolled, but with respect to whom coverage 23 under such plan has not yet taken effect. 24 ‘‘(3) TRANSITIONAL COVERAGE.—For purposes 25 of this subsection, the term ‘transitional coverage’ 26 VerDate Sep 11 2014 22:11 Jun 07, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3029.IH H3029 kjohnson on DSK79L0C42 with BILLS 3 •HR 3029 IH means with respect to an LI NET eligible indi- 1 vidual— 2 ‘‘(A) immediate access to covered part D 3 drugs at the point of sale during the period 4 that begins on the first day of the month such 5 individual is determined to be a subsidy eligible 6 individual and ends on the date that coverage 7 under a prescription drug plan or MA–PD plan 8 takes effect with respect to such individual; and 9 ‘‘(B) in the case of an LI NET eligible in- 10 dividual who is a full-benefit dual eligible indi- 11 vidual (as defined in section 1935(c)(6)) or a 12 recipient of supplemental security income bene- 13 fits under title XVI, retroactive coverage (in the 14 form of reimbursement of the amounts that 15 would have been paid under this part had such 16 individual been enrolled in a prescription drug 17 plan or MA–PD plan) of covered part D drugs 18 purchased by such individual during the period 19 that begins on the date that is the later of— 20 ‘‘(i) the date that such individual was 21 first eligible for a low-income subsidy 22 under this part; or 23 VerDate Sep 11 2014 22:11 Jun 07, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3029.IH H3029 kjohnson on DSK79L0C42 with BILLS 4 •HR 3029 IH ‘‘(ii) the date that is 36 months prior 1 to the date such individual enrolls in a pre- 2 scription drug plan or MA–PD plan, 3 and ends on the date that coverage under such 4 plan takes effect. 5 ‘‘(4) PROGRAM ADMINISTRATION.— 6 ‘‘(A) SINGLE POINT OF CONTACT.—The 7 Secretary shall, to the extent feasible, admin- 8 ister the program under this subsection through 9 a contract with a single program administrator. 10 ‘‘(B) BENEFIT DESIGN.—The Secretary 11 shall ensure that the transitional coverage pro- 12 vided to LI NET eligible individuals under this 13 subsection— 14 ‘‘(i) provides access to all covered part 15 D drugs under an open formulary; 16 ‘‘(ii) permits all pharmacies deter- 17 mined by the Secretary to be in good 18 standing to process claims under the pro- 19 gram; 20 ‘‘(iii) is consistent with such require- 21 ments as the Secretary considers necessary 22 to improve patient safety and ensure ap- 23 propriate dispensing of medication; and 24 VerDate Sep 11 2014 22:11 Jun 07, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3029.IH H3029 kjohnson on DSK79L0C42 with BILLS 5 •HR 3029 IH ‘‘(iv) meets such other requirements 1 as the Secretary may establish. 2 ‘‘(5) RELATIONSHIP TO OTHER PROVISIONS OF 3 THIS TITLE; WAIVER AUTHORITY.— 4 ‘‘(A) IN GENERAL.—The following provi- 5 sions shall not apply with respect to the pro- 6 gram under this subsection: 7 ‘‘(i) Paragraphs (1) and (3)(B) of sec- 8 tion 1860D–4(a) (relating to dissemination 9 of general information; availability of infor- 10 mation on changes in formulary through 11 the internet). 12 ‘‘(ii) Subparagraphs (A) and (B) of 13 section 1860D–4(b)(3) (relating to require- 14 ments on development and application of 15 formularies; formulary development). 16 ‘‘(iii) Paragraphs (1)(C) and (2) of 17 section 1860D–4(c) (relating to medication 18 therapy management program). 19 ‘‘(B) WAIVER AUTHORITY.—The Secretary 20 may waive such other requirements of titles XI 21 and this title as may be necessary to carry out 22 the purposes of the program established under 23 this subsection.’’. 24 Æ VerDate Sep 11 2014 22:11 Jun 07, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H3029.IH H3029 kjohnson on DSK79L0C42 with BILLS