[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2405 Introduced in Senate (IS)]
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118th CONGRESS
1st Session
S. 2405
To amend title XVIII of the Social Security Act to assure pharmacy
access and choice for Medicare beneficiaries.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 20, 2023
Mr. Thune (for himself, Mr. Brown, Mr. Barrasso, and Ms. Stabenow)
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 assure pharmacy
access and choice for Medicare beneficiaries.
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 ``Strengthening Pharmacy Access for
Seniors Act''.
SEC. 2. ASSURING PHARMACY ACCESS AND CHOICE FOR MEDICARE BENEFICIARIES.
Section 1860D-4(b)(1) of the Social Security Act (42 U.S.C. 1395w-
104(b)(1)) is amended by adding at the end the following new
subparagraph:
``(F) Limited access drugs.--
``(i) Limitation on restrictions or limits
on access.--For each plan year (beginning with
plan year 2026), a PDP sponsor offering a
prescription drug plan or pharmacy benefit
manager--
``(I) may not restrict or limit
access to any covered part D drug to a
subset of their network pharmacies,
other than with respect to a limited
access drug, as defined in clause (v);
and
``(II) shall record in writing the
rationale for why a covered part D drug
meets the definition of a limited
access drug under clause (v) and
maintain written records of any such
rationales, if such plan restricts or
limits access to a limited access drug
to a subset of network pharmacies.
``(ii) Annual submission of information to
the secretary on limited access drugs.--For
each plan year (beginning with plan year 2026),
each PDP sponsor offering a prescription drug
plan shall submit to the Secretary, at a time
and in a manner specified by the Secretary,
with respect to each prescription drug plan
offered by the sponsor during such plan year--
``(I) a list of all covered part D
drugs that the PDP sponsor designated
as a limited access drug;
``(II) the written rationales for
why any covered part D drugs listed
under subclause (I) meet the definition
of a limited access drug;
``(III) the requirements imposed on
network pharmacies to ensure
appropriate handling and dispensing of
the covered part D drugs listed under
subclause (I);
``(IV) the percentages of covered
part D drugs listed under subclause (I)
that are dispensed through retail
pharmacies, specialty pharmacies, mail
order pharmacies, or other dispensing
channels as defined by the PDP sponsor,
respectively, during the most recent
plan year for which such data are
available;
``(V) the annual percentage of
covered part D drugs listed under
subclause (I) that are dispensed
through pharmacies wholly or partially
owned by, or otherwise affiliated with
(such as through common ownership), the
plan or pharmacy benefit manager; and
``(VI) any other information
determined appropriate by the
Secretary.
``(iii) Pharmacy access to limited access
drug information.--For plan years beginning
with plan year 2026, upon the request of a
network pharmacy, a PDP sponsor of a
prescription drug plan (or a pharmacy benefit
manager acting on behalf of such sponsor) shall
present such pharmacy, on a timely basis (as
determined by the Secretary), with information
specific to any covered part D drug listed
under subclause (II) of clause (i) of this
subparagraph, along with the rationale for its
designation as a limited access drug (as
described in subclause (II) of clause (ii)) and
the requirements imposed with respect to such
drug (as described in subclause (III) of clause
(ii)). Any PDP sponsor or pharmacy benefit
manager that provides false information upon
such a request or that fails to provide the
information requested on a timely basis shall
be found in violation of this subsection.
``(iv) HHS annual report on limited access
drugs.--Not later than December 31, 2027, and
annually thereafter, the Secretary shall submit
to the Committee on Finance of the Senate, and
the Committee on Ways and Means and the
Committee on Energy and Commerce of the House
of Representatives a report on compliance by
PDP sponsors with the requirements under this
subparagraph. Each such report shall include--
``(I) a description of the
patterns, trends, variations, and
rationales for the designation by PDP
sponsors of certain covered part D
drugs as limited access drugs described
in clause (v), and the implications of
such designations on beneficiary access
to such covered part D drugs;
``(II) a description of the
information submitted to the Secretary
under clause (ii) (in a manner that
does not disclose the identity of a
pharmacy, a PDP sponsor, a prescription
drug plan, or pharmacy benefit manager,
or any proprietary pricing
information); and
``(III) any other information
determined appropriate by the
Secretary.
``(v) Limited access drug defined.--In this
subparagraph, the term `limited access drug'
means a covered part D drug that meets at least
one of the following:
``(I) The Food and Drug
Administration has restricted
distribution of such covered part D
drug to certain facilities or
physicians.
``(II) The dispensing of such
covered part D drug requires
extraordinary special handling,
provider coordination, or patient
education that cannot be met by a
network pharmacy.''.
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