Text: H.R.2624 — 114th Congress (2015-2016)All Information (Except Text)

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Introduced in House (06/03/2015)


114th CONGRESS
1st Session
H. R. 2624


To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D, and for other purposes.


IN THE HOUSE OF REPRESENTATIVES

June 3, 2015

Mr. Johnson of Georgia (for himself and Mr. McKinley) 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 allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D, and for other purposes.

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 “Part D Beneficiary Appeals Fairness Act”.

SEC. 2. Fair exceptions process for drug in tiers under Medicare part D.

Section 1860D–4(g)(2) of the Social Security Act (42 U.S.C. 1395w–103(g)(2)) is amended—

(1) in the first sentence—

(A) by striking “for tiered cost-sharing for drugs included within a formulary and” and inserting “for any tiered cost-sharing structure within a formulary (including a structure that”; and

(B) by inserting “, or provides for different co-payment or coinsurance amounts for drugs in different tiers included within the formulary)” before “, a part D eligible individual”;

(2) in the second sentence, by inserting “in any plan formulary” before “could be covered”; and

(3) by inserting the following before the last sentence: “In no case may the Secretary allow a PDP sponsor to make any formulary tier of the tiered cost-sharing structure (including a formulary tier used for very high cost or unique items) ineligible for lower-cost sharing through an exception under this paragraph.”.