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[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3613 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 3613

   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.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                            December 8, 2011

Mr. Johnson of Georgia (for himself, Mr. Farr, Mr. Kissell, Ms. Jackson 
   Lee of Texas, Mr. Conyers, Ms. Lee of California, Mr. Honda, Mr. 
  Grijalva, Mr. Michaud, Ms. Richardson, Ms. Fudge, Mr. Ryan of Ohio, 
  Mrs. Christensen, Mr. Carson of Indiana, Mr. Towns, Mr. Olver, Mr. 
 Frank of Massachusetts, Mr. Clay, Ms. Roybal-Allard, Mr. Boswell, Mr. 
  Filner, Ms. Slaughter, Ms. Schakowsky, Ms. Norton, Mr. Deutch, Mr. 
Hinchey, Ms. Moore, Mr. Jackson of Illinois, Ms. Woolsey, Mr. Davis of 
Illinois, Mr. Ellison, Mr. Lewis of Georgia, Mr. Kildee, and Mr. Jones) 
 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.

    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 
        element of the tiered cost-sharing structure (including a tier 
        used for very high cost or unique items) ineligible for lower-
        cost sharing through an exception under this paragraph.''.
                                 <all>
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