Medicare Prescription Drug Cost Equalization Act

Medicare Prescription Drug Cost Equalization Act - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to: (1) require application to specialty tier drugs (very high cost and unique items) of the process for exception from the tiered cost-sharing for drugs included within a formulary; and (2) limit to 25% the Medicare cost-sharing for such specialty tier drugs.

(Under an exception, a nonpreferred drug could be covered under the terms applicable for preferred drugs if the prescribing physician determines that the preferred drug for treatment of the same condition either would not be as effective for the individual, or would have adverse effects for the individual, or both. )

[Congressional Bills 110th Congress]
[From the U.S. Government Printing Office]
[H.R. 6684 Introduced in House (IH)]







110th CONGRESS
  2d Session
                                H. R. 6684

To amend part D of title XVIII of the Social Security Act to apply the 
 exceptions process for tiered formulary drugs to specialty tier drugs 
and to limit to 25 percent the Medicare cost-sharing for specialty tier 
                                 drugs.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 31, 2008

Mr. Ellsworth 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 apply the 
 exceptions process for tiered formulary drugs to specialty tier drugs 
and to limit to 25 percent the Medicare cost-sharing for specialty tier 
                                 drugs.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Prescription Drug Cost 
Equalization Act''.

SEC. 2. APPLICATION OF EXCEPTIONS PROCEDURES FOR PRESCRIPTION DRUG PLAN 
              TIERED COST-SHARING STRUCTURE TO SPECIALTY TIERS.

    (a) In General.--Section 1860D-4(g)(2) of the Social Security Act 
(42 U.S.C. 1395w-104(g)(2)) is amended by adding at the end the 
following new sentence: ``The exceptions process under this paragraph 
shall apply to drugs included in a tier of a formulary solely for very 
high cost and unique items (commonly referred to as a specialty tier) 
in the same manner as such process applies to any other drugs.''.
    (b) Effective Date.--The provisions of this section shall apply to 
PDP sponsors and MA organizations for plan years beginning on or after 
the date of the enactment of this Act.

SEC. 3. LIMITING TO 25 PERCENT THE MEDICARE COST-SHARING FOR SPECIALTY 
              TIER DRUGS.

    (a) In General.--Section 1860D-2(b)(2)(B) of the Social Security 
Act (42 U.S.C. 1395w-102(b)(2)(B)) is amended by inserting before the 
period the following: ``and so long as the tiered copayment for a tier 
solely for very high cost and unique items (commonly referred to as a 
specialty tier) does not exceed 25 percent''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to plan years beginning on or after the date of the 
enactment of this Act.
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