To amend title XVIII of the Social Security Act to ensure adequate payment amounts for drugs and biologicals under part B of the Medicare Program.

Amends title XVIII (Medicare) of the Social Security Act to revise the average sales price methodology for payment for drugs and biologicals under Medicare part B (Supplementary Medical Insurance Benefits for Aged and Disabled). Directs the Secretary of Health and Human Services to increase the payment amount for a drug or biological to the extent necessary to ensure that it is in no case less than the widely available market price.

Limits the prompt pay discounts included in the calculation of the manufacturer's average sales price to those discounts furnished to physicians. Excludes such discounts from the average sales price calculation for years after 2004.

[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5179 Introduced in House (IH)]








109th CONGRESS
  2d Session
                                H. R. 5179

  To amend title XVIII of the Social Security Act to ensure adequate 
payment amounts for drugs and biologicals under part B of the Medicare 
                                Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 25, 2006

   Mr. Hall 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 subsequently 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 ensure adequate 
payment amounts for drugs and biologicals under part B of the Medicare 
                                Program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. REVISION OF PAYMENT METHODOLOGY FOR DRUGS AND BIOLOGICALS 
              UNDER MEDICARE PART B.

    (a) Floor of Widely Available Market Price.--Subsection (b) of 
section 1847A of the Social Security Act (42 U.S.C. 1395w-3a) is 
amended--
            (1) in paragraph (1), by inserting ``paragraph (6) and'' 
        after ``Subject to''; and
            (2) by adding at the end the following new paragraph:
            ``(6) Floor of widely available market price.--The 
        Secretary shall increase the payment amount determined under 
        this subsection for a drug or biological to the extent 
        necessary to ensure that such payment amount is in no case less 
        than the widely available market price for the drug or 
        biological (as determined under subsection (d) or by the 
        Secretary).''.
    (b) Treatment of Prompt Pay Discounts.--Subsection (c)(3) of such 
section is amended--
            (1) in the first sentence, by inserting ``furnished to 
        physicians'' after ``prompt pay discounts''; and
            (2) in the second sentence, by inserting ``(other than 
        prompt pay discounts)'' after ``other price concessions''.
    (c) Effective Date.--The amendments made by this section shall 
apply to drugs and biologicals that are furnished on or after January 
1, 2007.
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