I 

112TH CONGRESS 

1ST SESSION H. R. 2296 

To establish an America Rx program to establish fairer pricing for prescription drugs for individuals without access to prescription drugs at discounted prices. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 22, 2011 

Mr. MICHAUD (for himself, Mr. HINCHEY, Ms. PINGREE of Maine, and Mr. 

JACKSON of Illinois) introduced the following bill; which was referred to 

the Committee on Energy and Commerce 

A BILL 

To establish an America Rx program to establish fairer pricing for prescription drugs for individuals without access 

to prescription drugs at discounted prices. 

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; PURPOSE. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘America Rx Act of 2011’’. 

6 (b) PURPOSE.—The purpose of this Act is to estab7 lish an America Rx program that utilizes manufacturer 

8 rebates and pharmacy discounts to reduce prescription 


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1 drug prices to those residents who are without access to 

2 discounted prices for outpatient prescription drugs. 

3 SEC. 2. AMERICA RX PROGRAM. 

4 (a) ESTABLISHMENT.— 

5 (1) IN GENERAL.—Not later than 1 year after 

6 the date of the enactment of this Act, the Secretary 

7 of Health and Human Services shall establish a pro8 gram (in this section referred to as the ‘‘America Rx 

9 program’’) consistent with the provisions of this sec10 tion to provide qualified residents with access to dis11 counted prices for outpatient prescription drugs 

12 through rebate agreements that the Secretary has 

13 negotiated with prescription drug manufacturers. 

14 (2) OUTREACH.—The Secretary shall provide 

15 for— 

16 (A) outreach efforts to build public aware17 ness of the program and maximize enrollment 

18 of qualified residents; and 

19 (B) simplified eligibility procedures and 

20 uniform eligibility standards for qualified resi21 dents. 

22 (3) SUSPENSION; TERMINATION.—If the Sec23 retary determines that American Health Benefit Ex24 changes are operational under subtitle D of title I of 

25 the Patient Protection and Affordable Care Act 


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1 (Public Law 111–148) and the America Rx program 

2 is no longer needed to ensure that qualified residents 

3 have access to outpatient prescription drugs at af4 fordable prices, the Secretary may suspend or termi5 nate the program. 

6 (b) REBATE AGREEMENTS WITH MANUFACTUR7 ERS.— 

8 (1) IN GENERAL.—Under the America Rx pro9 gram the Secretary shall negotiate with manufactur10 ers of outpatient prescription drugs rebate agree11 ments with respect to drugs offered under the pro12 gram to qualified residents. 

13 (2) MINIMUM AMOUNT OF REBATES.—In nego14 tiating the amount of such a rebate under paragraph 

15 (1), the Secretary shall take into consideration the 

16 amount of the rebate calculated under the Medicaid 

17 program, the average manufacturer price of pre18 scription drugs, and other information on prescrip19 tion drug prices and price discounts. The Secretary 

20 shall negotiate the amount of such rebates in a man21 ner so that the rebates on average are comparable 

22 to the average percentage rebate obtained in out23 patient prescription drugs provided under section 

24 1927(c) of the Social Security Act (42 U.S.C. 

25 1396r–8(c)). 


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1 (3) DISCOUNTED PRICES.—The Secretary shall 

2 specify the method for computing and applying such 

3 discounts, including a method for computing and ap4 plying discounts on a uniform, average percentage 

5 basis. 

6 (4) PAYMENT.—Rebates under such agreements 

7 shall be payable to the Secretary according to a 

8 schedule (not less often than quarterly) negotiated 

9 with manufacturers and shall be paid, directly or 

10 through States, to participating pharmacies that 

11 provide discounts to qualified residents. 

12 (5) INCENTIVE.—In order to induce manufac13 turers of outpatient prescription drugs to enter into 

14 such rebate agreements to carry out the purpose de15 scribed in section 1(b), the Secretary shall provide, 

16 in the case of a manufacturer that has not entered 

17 into such an agreement, for a denial of a deduction 

18 under chapter 1 of the Internal Revenue Code of 

19 1986 for the amount of expenses of the manufac20 turer for advertising and marketing of drugs of the 

21 manufacturer, other than expenses for free samples 

22 of drugs subject to section 503(b)(1) of the Federal 

23 Food, Drug, and Cosmetic Act intended to be dis24 tributed to patients. 


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1 (6) APPLICATION OF REBATES.—Amounts re2 ceived by the Secretary as rebates under this sub3 section shall be placed into an appropriate account 

4 in the Treasury and shall be available in advance of 

5 appropriations to the Secretary for the payment of 

6 discounts and other costs of participating phar7 macies in carrying out the America Rx program and 

8 for the payment of administrative costs in carrying 

9 out the program. Under the America Rx program, 

10 participating pharmacies shall be ensured reasonable 

11 and timely payment of discounts they provide to 

12 qualified residents under the program. 

13 (c) ROLE OF STATES IN ADMINISTERING PRO14 GRAM.— 

15 (1) IN GENERAL.—Under the America Rx pro16 gram the Secretary may enter into appropriate ar17 rangements with States under which States provide 

18 for the administration of the program in return for 

19 payment of the reasonable administrative expenses 

20 associated with such administration. 

21 (2) ADMINISTRATIVE FUNCTIONS.—Such ad22 ministration functions may include— 

23 (A) determinations of eligibility of qualified 

24 residents; 


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1 (B) arrangements with participating phar2 macies; and 

3 (C) such other functions as the Secretary 

4 determines appropriate. 

5 (3) CONTRACTUAL AUTHORITY.—In carrying 

6 out responsibilities under this section, the Secretary 

7 and States may enter into agreements with phar8 macy benefit managers and other third parties. 

9 (d) PROGRAM ELIGIBILITY.— 

10 (1) QUALIFIED RESIDENT DEFINED.—For pur11 poses of this section, the term ‘‘qualified resident’’ 

12 means an individual who— 

13 (A) is a citizen or national of the United 

14 States or is lawfully present in the United 

15 States (as determined in accordance with sec16 tion 1411 of the Patient Protection and Afford17 able Care Act); and 

18 (B) as determined under regulations of the 

19 Secretary, is not covered under any public or 

20 private program that provides substantial bene21 fits (which may be discounted prices) towards 

22 the purchase of outpatient prescription drugs. 

23 (2) SCREENING.— 

24 (A) FOR OTHER GOVERNMENTAL PRO25 GRAMS.—Individuals who apply for benefits 


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1 under the America Rx program shall be 

2 screened for eligibility under the Medicaid pro3 gram and other applicable Governmental health 

4 care programs and, if found eligible, shall be 

5 enrolled in such program or programs. 

6 (B) SCREENING BY HEALTH INSURANCE

7 EXCHANGES.—In the case of individuals enroll8 ing in a qualified health plan through a Health 

9 Insurance Exchange under title I of the Patient 

10 Protection and Affordable Care Act, the Ex11 change shall provide (at the time of enrollment) 

12 for a screening of the individual to determine if 

13 the individual is a qualified resident for pur14 poses of the America Rx program. 

15 (3) RELATION TO OTHER COVERAGE.—In order 

16 not to discourage employers and health insurance 

17 issuers from providing comprehensive prescription 

18 drug coverage through a group health plan or health 

19 insurance coverage, no such employer or issuer may 

20 participate in a Health Insurance Exchange if the 

21 Secretary determines that the prescription drug ben22 efits under the plan or coverage have been reduced 

23 as a result of the America Rx program. 

24 (4) PROTECTION OF THE LOW INCOME.—Noth25 ing in this section shall be construed as reducing the 


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1 prescription drug benefits available to low-income in2 dividuals, as well as senior citizens and the disabled, 

3 under the Medicare or Medicaid programs as a re4 sult of the implementation of the America Rx pro5 gram. 

6 (e) ARRANGEMENTS WITH PARTICIPATING PHAR7 MACIES.— 

8 (1) IN GENERAL.—Under the America Rx pro9 gram arrangements are made with pharmacies for 

10 the provision of prescription drugs at discounted 

11 prices to qualified residents in a reasonably acces12 sible manner. Such arrangements shall provide 

13 that— 

14 (A) each participating pharmacy shall— 

15 (i) provide discounts on prices for out16 patient prescription drugs for qualified 

17 residents in return for prompt reimburse18 ment of the amount of such discounts and 

19 a reasonable dispensing fee; 

20 (ii) not charge qualified residents 

21 more (before such discounts) for outpatient 

22 prescription drugs than the amount that 

23 individuals who are not qualified residents 

24 are charged for such drugs; and 


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1 (iii) report to the Secretary (or the 

2 Secretary’s designee) information regard3 ing the discounts provided and fees in4 curred; and 

5 (B) the program shall— 

6 (i) ensure the reasonable and timely 

7 payment to a participating retail pharmacy 

8 on a prompt basis (no less promptly than 

9 as provided under the Medicare program) 

10 for discounted prices provided to qualified 

11 residents under the program and for rea12 sonable dispensing fees; and 

13 (ii) not impose any additional fees on 

14 such pharmacies in connection with partici15 pation in the program. 

16 (2) DISCOUNTED PRICES.—The amount of the 

17 discount provided to enrolled qualifying residents 

18 shall reflect the amount of rebates obtained, reduced 

19 by expenses relating to administrative costs of the 

20 Federal and State governments and of participating 

21 pharmacies. 

22 (f) DEFINITIONS.—For purposes of this section: 

23 (1) The term ‘‘Health Insurance Exchange’’ 

24 means such an Exchange as established and operVerDate Mar 15 2010 22:39 Jun 27, 2011 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2296.IH H2296

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1 ated under part 3 of subtitle D of title I of the Pa2 tient Protection and Affordable Care Act. 

3 (2) The term ‘‘manufacturer’’ has the meaning 

4 given such term in section 1927(k)(5) of the Social 

5 Security Act (42 U.S.C. 1396r–8(k)(5)). 

6 (3) The term ‘‘Medicaid program’’ means a 

7 State program under title XIX of the Social Security 

8 Act, including such a program operating under a 

9 Statewide waiver under section 1115 of such Act. 

10 (4) The term ‘‘outpatient prescription drug’’ 

11 has the meaning given the term ‘‘covered outpatient 

12 drug’’ in section 1927(k)(2) of the Social Security 

13 Act (42 U.S.C. 1396r–8(k)(2)). 

14 (5) The term ‘‘Secretary’’ means the Secretary 

15 of Health and Human Services. 

16 (6) The term ‘‘State’’ has the meaning given 

17 such term for purposes of title XIX of the Social Se18 curity Act. 

Æ 


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