I

106TH CONGRESS

2D SESSION H. R. 5467

To provide for substantial reductions in the price of prescription drugs for

Medicare beneficiaries and for women diagnosed with breast cancer.

IN THE HOUSE OF REPRESENTATIVES

OCTOBER 12, 2000

Mrs. MCCARTHY of New York introduced the following bill; which was referred to the Committee on 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 provide for substantial reductions in the price of prescription drugs for Medicare beneficiaries and for women

diagnosed with breast cancer.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Breast Cancer Pre5 scription Drug Fairness Act’’.

6 SEC. 2. FINDINGS AND PURPOSES.

7 (a) FINDINGS.—The Congress finds the following:
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1 (1) All women are at risk for breast cancer and

2 that risk increases with age.

3 (2) Breast cancer is the most common cancer

4 among women.

5 (3) Annually, there are 180,200 new cases of

6 breast cancer in the United States, and 2,000 on

7 Long Island, New York, alone.

8 (4) Manufacturers of prescription drugs engage

9 in price discrimination practices that compel many

10 older Americans and women to pay substantially

11 more for prescription drugs than the drug manufac12 turers’ most favored customers, such as health in13 surers, health maintenance organizations, and the

14 Federal Government.

15 (5) On average, older Americans and women

16 who buy their own prescription drugs pay twice as

17 much for prescription drugs as the drug manufac18 turers’ most favored customers. In some cases, older

19 Americans and women pay over 15 times more for

20 prescription drugs than the most favored customers.

21 (6) The discriminatory pricing by major drug

22 manufacturers sustains their annual profits of

23 $20,000,000,000, but causes financial hardship and

24 impairs the health and well-being of millions of older

25 Americans and women. More than one in eight older
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1 Americans and women are forced to choose between

2 buying their food and buying their medicines.

3 (7) Most federally funded health care programs,

4 including Medicaid, the Veterans Health Administra5 tion, the Public Health Service, and the Indian

6 Health Service, obtain prescription drugs for their

7 beneficiaries at low prices. Medicare beneficiaries are

8 denied this benefit and cannot obtain their prescrip9 tion drugs at the favorable prices available to other

10 federally funded health care programs.

11 (8) Implementation of the policy set forth in

12 this Act is estimated to reduce prescription drug

13 prices for Medicare beneficiaries by more than 40

14 percent.

15 (9) In addition to substantially lowering the

16 costs of prescription drugs for older Americans and

17 women, implementation of the policy set forth in this

18 Act will significantly improve the health and well19 being of older Americans and women and lower the

20 costs to the Federal taxpayer of the Medicare pro21 gram.

22 (10) Older Americans and women who are ter23 minally ill and receiving hospice care services rep24 resent some of the most vulnerable individuals in our

25 nation. Making prescription drugs available to Medi-
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1 care beneficiaries under the care of Medicare-cer2 tified hospices will assist in extending the benefits of

3 lower prescription drug prices to those most vulner4 able and in need.

5 (b) PURPOSE.—The purpose of this Act is to protect

6 women diagnosed with breast cancer and Medicare bene7 ficiaries from discriminatory pricing by drug manufactur8 ers and to make prescription drugs available to Medicare

9 beneficiaries at substantially reduced prices.

10 SEC. 3. PARTICIPATING MANUFACTURERS.

11 (a) IN GENERAL.—Each participating manufacturer

12 of a covered outpatient drug shall make available for pur13 chase by each pharmacy such covered outpatient drug in

14 the amount described in subsection (b) at the price de15 scribed in subsection (c).

16 (b) DESCRIPTION OF AMOUNT OF DRUGS.—The

17 amount of a covered outpatient drug that a participating

18 manufacturer shall make available for purchase by a phar19 macy is an amount equal to the aggregate amount of the

20 covered outpatient drug sold or distributed by the phar21 macy to Medicare beneficiaries.

22 (c) DESCRIPTION OF PRICE.—The price at which a

23 participating manufacturer shall make a covered out24 patient drug available for purchase by a pharmacy is the

25 price equal to the lower of the following:
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1 (1) The lowest price paid for the covered out2 patient drug by any agency or department of the

3 United States.

4 (2) The manufacturer’s best price for the cov5 ered outpatient drug, as defined in section

6 1927(c)(1)(C) of the Social Security Act (42 U.S.C.

7 1396r–8(c)(1)(C)).

8 SEC. 4. SPECIAL PROVISION WITH RESPECT TO HOSPICE

9 PROGRAMS.

10 For purposes of determining the amount of a covered

11 outpatient drug that a participating manufacturer shall

12 make available for purchase by a pharmacy under section

13 3, there shall be included in the calculation of such

14 amount the amount of the covered outpatient drug sold

15 or distributed by a pharmacy to a hospice program. In

16 calculating such amount, only amounts of the covered out17 patient drug furnished to a Medicare beneficiary enrolled

18 in the hospice program shall be included.

19 SEC. 5. ADMINISTRATION.

20 The Secretary shall issue such regulations as may be

21 necessary to implement this Act.

22 SEC. 6. REPORTS TO CONGRESS REGARDING EFFECTIVE23 NESS OF ACT.

24 (a) IN GENERAL.—Not later than 2 years after the

25 date of the enactment of this Act, and annually thereafter,
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1 the Secretary shall report to the Congress regarding the

2 effectiveness of this Act in—

3 (1) protecting Medicare beneficiaries from dis4 criminatory pricing by drug manufacturers, and

5 (2) making prescription drugs available to

6 Medicare beneficiaries at substantially reduced

7 prices.

8 (b) CONSULTATION.—In preparing such reports, the

9 Secretary shall consult with public health experts, affected

10 industries, organizations representing consumers and

11 older Americans and women, and other interested persons.

12 (c) RECOMMENDATIONS.—The Secretary shall in13 clude in such reports any recommendations they consider

14 appropriate for changes in this Act to further reduce the

15 cost of covered outpatient drugs to Medicare beneficiaries.

16 SEC. 7. DEFINITIONS.

17 In this Act:

18 (1) PARTICIPATING MANUFACTURER.—The

19 term ‘‘participating manufacturer’’ means any man20 ufacturer of drugs or biologicals that, on or after the

21 date of the enactment of this Act, enters into a con22 tract or agreement with the United States for the

23 sale or distribution of covered outpatient drugs to

24 the United States.
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1 (2) COVERED OUTPATIENT DRUG.—The term

2 ‘‘covered outpatient drug’’ has the meaning given

3 that term in section 1927(k)(2) of the Social Secu4 rity Act (42 U.S.C. 1396r–8(k)(2)).

5 (3) MEDICARE BENEFICIARY.—The term

6 ‘‘Medicare beneficiary’’ means an individual entitled

7 to benefits under part A of title XVIII of the Social

8 Security Act or enrolled under part B of such title,

9 or both, and includes individuals who are not so en10 titled or enrolled but who have been diagnosed with

11 breast cancer.

12 (4) HOSPICE PROGRAM.—The term ‘‘hospice

13 program’’ has the meaning given that term under

14 section 1861(dd)(2) of the Social Security Act (42

15 U.S.C. 1395x(dd)(2)).

16 (5) SECRETARY.—The term ‘‘Secretary’’ means

17 the Secretary of Health and Human Services.

18 SEC. 8. EFFECTIVE DATE.

19 The Secretary shall implement this Act as expedi20 tiously as practicable and in a manner consistent with the

21 obligations of the United States.
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1 SEC. 9. STUDY ON LIFE EXPECTANCY OF WOMEN DIAG2 NOSED WITH BREAST CANCER WHO LACK

3 PRESCRIPTION DRUG COVERAGE.

4 (a) STUDY.—The Secretary of Health and Human

5 Services, acting through the Director of the Center for

6 Disease Control and Prevention, shall conduct a study on

7 women diagnosed with breast cancer and analyze the ef8 fect, if any, that the lack of prescription drug coverage

9 has on the life expectancy of such women.

10 (b) REPORT.—By not later than one year after the

11 date of the enactment of this Act, the Secretary shall sub12 mit to Congress a report on the study conducted under

13 subsection (a).

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