[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3000 Introduced in Senate (IS)]
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116th CONGRESS
1st Session
S. 3000
To amend title XVIII of the Social Security Act to allow PDP sponsors
of prescription drug plans and Medicare Advantage organizations
offering MA-PD plans to share with enrollees a portion of savings from
switching to lower cost therapeutic alternative medications.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 9, 2019
Mr. Cassidy (for himself and Ms. Hassan) 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 allow PDP sponsors
of prescription drug plans and Medicare Advantage organizations
offering MA-PD plans to share with enrollees a portion of savings from
switching to lower cost therapeutic alternative medications.
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 ``Patient Shared Savings Act''.
SEC. 2. ALLOWING PRESCRIPTION DRUG PLANS AND MA-PD PLANS TO SHARE WITH
ENROLLEES A PORTION OF SAVINGS FROM SWITCHING TO LOWER
COST THERAPEUTIC ALTERNATIVE MEDICATIONS.
(a) In General.--Section 1860D-4 of the Social Security Act (42
U.S.C. 1395w-104) is amended--
(1) by redesignating subsection (m) (relating to program
integrity transparency measures), as added by section 6063(c)
of the Substance Use-Disorder Prevention that Promotes Opioid
Recovery and Treatment for Patients and Communities Act (Public
Law 115-271), as subsection (n); and
(2) by adding at the end the following new subsection:
``(o) Sharing With Enrollees a Portion of Savings From Switching to
a Lower Cost Therapeutic Alternative Medication.--
``(1) In general.--For plan years beginning on or after
January 1, 2021, a PDP sponsor of a prescription drug plan may
have a program under which the PDP sponsor shares with an
enrollee in the plan a portion of savings to the PDP sponsor as
a result of the enrollee switching from a covered part D drug
the enrollee is taking on an ongoing basis to a lower cost
therapeutic alternative covered part D drug.
``(2) Requirements.--If a PDP sponsor implements a program
described in paragraph (1), the following requirements shall
apply with respect to the program:
``(A) Requirements with respect to enrollees.--The
enrollee--
``(i) must have been taking the covered
part D drug on an ongoing basis for at least 2
months as confirmed by claims analysis by the
PDP sponsor prior to switching to the lower
cost therapeutic alternative covered part D
drug; and
``(ii) must have agreed to make such switch
after consulting with their physician.
``(B) Requirements with respect to pdp sponsors.--
The PDP sponsor must--
``(i) make available a shared savings
report with therapeutic alternatives to
eligible enrollees through Evidence of Benefits
or other information sent to enrollees, or
provide contracted providers with access to
tools that include therapeutic alternatives and
shared savings at the point of care;
``(ii) ensure that the total amount of
savings shared with an enrollee with respect to
the switch to a particular lower cost
therapeutic alternative covered part D drug
does not exceed an amount equal to 10 percent
of the annualized net savings to the PDP
sponsor as a result of the enrollee making such
switch;
``(iii) only share such savings after the
PDP sponsor confirms, based on claims analysis,
that--
``(I) the enrollee has switched to
the lower cost therapeutic alternative
covered part D drug; and
``(II) the switch does not result
in an increased cost to the program
under this part;
``(iv) provide a tangible reward or
incentive for the amount of such shared
savings, which--
``(I) shall directly benefit the
enrollee;
``(II) such sponsor may not--
``(aa) use to reduce plan
premiums for the enrollee; or
``(bb) direct an enrollee
to use to pay such premiums;
and
``(III) may be in the form of a
monetary rebate, gift card, discount
coupon, or other item consistent with
the President's Executive Order on
Protecting and Improving Medicare for
Our Nation's Seniors, issued on October
3, 2019; and
``(v) provide an annual report to the
Secretary, with respect to the preceding plan
year, on the number of enrollees who receive
shared savings under this subsection as a
result of switching to a lower cost therapeutic
alternative covered part D drug, the total
amount of such savings shared with the enrollee
and in what form, and the total savings to the
PDP sponsor as a result of enrollees making
such switch.
``(3) Authority to provide with respect to certain sub-
populations or geographic areas.--A PDP sponsor may provide
shared savings pursuant to this subsection for only a certain
sub-population of enrollees or a geographically limited
population of enrollees if the Secretary determines, based on a
showing by the PDP sponsor, that the PDP sponsor is not
discriminating based on the health status of enrollees.''.
(b) Exclusion From Anti-Kickback Prohibition.--Section 1128B(b)(3)
of the Social Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--
(1) in subparagraph (J)--
(A) by moving such subparagraph 2 ems to the left;
and
(B) by striking ``and'' at the end;
(2) in subparagraph (K)--
(A) by moving such subparagraph 2 ems to the left;
and
(B) by striking the period at the end and inserting
``; and''; and
(3) by adding at the end the following new subparagraph:
``(L) any shared savings provided under section 1860D-
4(o).''.
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