I 

115TH CONGRESS 

2D SESSION H. R. 4841 

To amend title XVIII of the Social Security Act to provide for electronic 

prior authorization under Medicare part D for covered part D drugs, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 18, 2018 

Mr. SCHWEIKERT (for himself, Mr. BEN RAY LUJA ́N of New Mexico, Mr. 

JOHNSON of Ohio, and Mr. THOMPSON of California) 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 provide 

for electronic prior authorization under Medicare part 

D for covered part D drugs, and for other purposes. 

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 ‘‘Standardizing Elec5 tronic Prior Authorization for Safe Prescribing Act of 

6 2018’’. 


daltland on DSKBBV9HB2PROD with BILLS
2 

•HR 4841 IH

1 SEC. 2. ELECTRONIC PRIOR AUTHORIZATION FOR COV2 ERED PART D DRUGS. 

3 (a) INCLUSION IN ELECTRONIC PRESCRIPTION PRO4 GRAM.—Section 1860D–4(e)(2) of the Social Security Act 

5 (42 U.S.C. 1395w–104(e)(2)) is amended by adding at the 

6 end the following new subparagraph: 

7 ‘‘(E) ELECTRONIC PRIOR AUTHORIZA8 TION.— 

9 ‘‘(i) IN GENERAL.—Effective on and 

10 after January 1, 2020, the program shall 

11 provide for the secure electronic trans12 mittal of— 

13 ‘‘(I) a prior authorization request 

14 from the prescribing health care pro15 fessional for coverage of a covered 

16 part D drug for a part D eligible indi17 vidual enrolled in a part D plan (as 

18 defined in section 1860D–23(a)(5)) to 

19 the PDP sponsor or Medicare Advan20 tage organization offering such plan; 

21 and 

22 ‘‘(II) a response, in accordance 

23 with this subparagraph, from such 

24 PDP sponsor or Medicare Advantage 

25 organization, respectively, to such pro26 fessional. 


daltland on DSKBBV9HB2PROD with BILLS
3 

•HR 4841 IH

1 ‘‘(ii) ELECTRONIC TRANSMISSION.— 

2 ‘‘(I) EXCLUSIONS.—For purposes 

3 of this subparagraph, a facsimile, pro4 prietary payer portal, or electronic 

5 form shall not be treated as an elec6 tronic transmission described in clause 

7 (i). 

8 ‘‘(II) STANDARDS.—In order to 

9 be treated, for purposes of this sub10 paragraph, as an electronic trans11 mission described in clause (i), such 

12 transmission shall comply with tech13 nical standards adopted by the Sec14 retary in consultation with the Na15 tional Council for Prescription Drug 

16 Programs, other standard setting or17 ganizations determined appropriate by 

18 the Secretary, and stakeholders in19 cluding PDP sponsors, Medicare Ad20 vantage organizations, health care 

21 professionals, and health information 

22 technology software vendors.’’. 

23 (b) SENSE OF CONGRESS REGARDING ELECTRONIC

24 PRIOR AUTHORIZATION.—It is the sense of the Congress 

25 that— 


daltland on DSKBBV9HB2PROD with BILLS
4 

•HR 4841 IH

1 (1) there should be increased use of electronic 

2 prior authorizations for coverage of covered part D 

3 drugs for part D eligible individuals enrolled in pre4 scription drug plans under part D of title XVIII of 

5 the Social Security Act and MA–PD plans under 

6 part C of such title to reduce access delays by re7 solving coverage issues before prescriptions for such 

8 drugs are transmitted; and 

9 (2) greater priority should be placed on increas10 ing the adoption of use of such electronic prior au11 thorizations among prescribers of such drugs, phar12 macies, PDP sponsors, and Medicare Advantage or13 ganizations. 

Æ 


daltland on DSKBBV9HB2PROD with BILLS