Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to: (1) extend the 2006 and 2007 initial enrollment periods for the Medicare prescription drug benefit; (2) suspend the late enrollment penalty through December 31, 2007; and (3) permit Medicare beneficiaries to change enrollment in a prescription drug plan during the first 12 months of enrollment.
Prohibits a PDP sponsor, beginning with 2006, from removing a covered part D drug from the plan formulary, or imposing a restriction or limitation on the coverage of such a drug, other than at the beginning of each plan year, except as the Secretary may permit to take into account new therapeutic uses and newly covered part D drugs.
Requires each PDP sponsor to furnish to each plan enrollee, at the time of each annual coordinated election period, a notice of any changes in the formulary or other part D drug coverage restrictions or limitations that will take effect for the upcoming plan year.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5263 Introduced in House (IH)]
109th CONGRESS
2d Session
H. R. 5263
To amend part D of title XVIII of the Social Security Act to extend the
2006 and 2007 initial enrollment periods for the Medicare prescription
drug benefit and suspend the late enrollment penalty through December
31, 2007, to permit Medicare beneficiaries to change enrollment in a
prescription drug plan during the first 12 months of enrollment, and to
prevent changes in formularies other than at the time of open
enrollment periods and only with advance notice.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 2, 2006
Mrs. Christensen (for herself, Mr. Watt, Ms. Lee, Mr. Owens, Ms.
Millender-McDonald, Mr. Towns, Mr. Conyers, Ms. Norton, Ms. Carson, Mr.
Cleaver, Mr. Fattah, Mr. Payne, Ms. Kilpatrick of Michigan, Ms. Corrine
Brown of Florida, Ms. Moore of Wisconsin, Mr. Meeks of New York, Mr.
Clay, Mr. Wynn, Mr. Al Green of Texas, Ms. Jackson-Lee of Texas, Mr.
Rush, Mr. Jackson of Illinois, Mr. Thompson of Mississippi, Mr. Scott
of Virginia, Mr. Bishop of Georgia, Mr. Lewis of Georgia, Ms. Eddie
Bernice Johnson of Texas, Mr. Hastings of Florida, Mr. Davis of
Alabama, Mr. Rangel, Mrs. Jones of Ohio, Mr. Butterfield, Mr.
Jefferson, Mr. Clyburn, Ms. Watson, Mr. Cummings, Ms. Waters, Mr. Davis
of Illinois, Mr. Scott of Georgia, Ms. McKinney, Mr. Meek of Florida,
and Mr. Ford) 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 part D of title XVIII of the Social Security Act to extend the
2006 and 2007 initial enrollment periods for the Medicare prescription
drug benefit and suspend the late enrollment penalty through December
31, 2007, to permit Medicare beneficiaries to change enrollment in a
prescription drug plan during the first 12 months of enrollment, and to
prevent changes in formularies other than at the time of open
enrollment periods and only with advance notice.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. EXTENSION OF MEDICARE PRESCRIPTION DRUG INITIAL ENROLLMENT
PERIODS FOR 2006 AND 2007; SUSPENSION OF LATE ENROLLMENT
PENALTY THROUGH DECEMBER 31, 2007.
(a) Extension of Medicare Prescription Drug Initial Enrollment
Periods for 2006 and 2007.--Section 1860D-1(b)(1) of the Social
Security Act (42 U.S.C. 1395w-101(b)(1)) is amended--
(1) in subparagraph (B)(iii), by inserting ``subparagraph
(D) and'' after ``Subject to''; and
(2) by adding at the end the following new subparagraph:
``(D) Extension of initial enrollment periods.--For
purposes of subparagraph (B)(iii), in applying section
1851(e)(1), with respect to the annual, coordinated election
period--
``(i) for 2006, such period shall begin on November
15, 2005, and end on November 14, 2006; and
``(ii) for 2007, such period shall begin on
November 15, 2006, and end on November 14, 2007.''.
(b) Suspension of Late Enrollment Penalty Through December 31,
2007.--Section 1860D-13(b)(3)(B) of such Act (42 U.S.C. 1395w-
113(b)(3)(B)) is amended by inserting ``(after December 2007)'' after
``any month''.
SEC. 2. OPEN ENROLLMENT AND DISENROLLMENT IN PRESCRIPTION DRUG PLANS
ALLOWED DURING FIRST 12 MONTHS OF ENROLLMENT.
Section 1860D-1(b)(1) of the Social Security Act (42 U.S.C. 1395w-
101(b)(1)) is amended by adding at the end the following new
subparagraph:
``(D) Open enrollment and disenrollment period for
first 12 months of enrollment.--In establishing the
process under subparagraph (A), in the case of a part D
eligible individual who initially enrolls under section
1860D-1(a) in a prescription drug plan on or after the
date of enactment of this paragraph, the Secretary
shall permit such individual to change such enrollment
into another prescription drug plan once at any time
during the first 12 months of such initial enrollment
(other than during an annual, coordinated election
period referred to in section 1860D-
1(b)(1)(B)(iii)).''.
SEC. 3. LIMITATIONS ON CHANGING PRESCRIPTION DRUG PLAN FORMULARIES;
NOTICE OF CHANGE IN FORMULARY.
(a) Limitation on Removal or Change of Covered Part D Drugs From
the Prescription Drug Plan Formulary.--Section 1860D-4(b)(3)(E) of the
Social Security Act (42 U.S.C. 1395w-104(b)(3)(E)) is amended to read
as follows:
``(E) Removing a drug from formulary or imposing a
restriction or limitation on coverage.--
``(i) Limitation on removal, limitation, or
restriction.--
``(I) In general.--Subject to
subclause (II) and clause (ii),
beginning with 2006, the PDP sponsor of
a prescription drug plan may not remove
a covered part D drug from the plan
formulary or impose a restriction or
limitation on the coverage of such a
drug (such as through the application
of a preferred status, usage
restriction, step therapy, prior
authorization, or quantity limitation)
other than at the beginning of each
plan year except as the Secretary may
permit to take into account new
therapeutic uses and newly covered part
D drugs.
``(II) Special rule for newly
enrolled individuals.--Subject to
clause (ii), in the case of an
individual who enrolls in a
prescription drug plan on or after the
date of enactment of this subparagraph,
the PDP sponsor of such plan may not
remove a covered part D drug from the
plan formulary or impose a restriction
or limitation on the coverage of such a
drug (such as through the application
of a preferred status, usage
restriction, step therapy, prior
authorization, or quantity limitation)
during the period beginning on the date
of such enrollment and ending on
December 31 of the immediately
succeeding plan year except as the
Secretary may permit to take into
account new therapeutic uses and newly
covered part D drugs.
``(ii) Exceptions to limitation on
removal.--Clause (i) shall not apply with
respect to a covered part D drug that--
``(I) is a brand name drug for
which there is a generic drug approved
under section 505(j) of the Food and
Drug Cosmetic Act (21 U.S.C. 355(j))
that is placed on the market during the
period in which there are limitations
on removal or change in the formulary
under subclause (I) or (II) of clause
(i);
``(II) is a brand name drug that
goes off-patent during such period;
``(III) is a drug for which the
Commissioner of Food and Drugs issues a
clinical warning that imposes a
restriction or limitation on the drug
during such period; or
``(IV) has been determined to be
ineffective during such period.
``(iii) Notice of removal under application
of exception to limitation.--The PDP sponsor of
a prescription drug plan shall provide
appropriate notice (such as under subsection
(a)(3)) of any removal or change under clause
(ii) to the Secretary, affected enrollees,
physicians, pharmacies, and pharmacists.''.
(b) Notice of Change in Formulary and Other Restrictions or
Limitations on Coverage.--
(1) In general.--Section 1860D-4(a) of such Act (42 U.S.C.
1395w-104(a)) is amended by adding at the end the following new
paragraph:
``(5) Annual notice of changes in formulary and other
restrictions or limitations on coverage.--Each PDP sponsor
offering a prescription drug plan shall furnish to each
enrollee at the time of each annual coordinated election period
(referred to in section 1860D-1(b)(1)(B)(iii)) for a plan year
a notice of any changes in the formulary or other restrictions
or limitations on coverage of a covered part D drug under the
plan that will take effect for the plan year.''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to annual coordinated election periods beginning
after the date of the enactment of this Act.
<all>
Introduced in House
Introduced in House
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.
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.
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.
Referred to the Subcommittee on Health.
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