I 

116TH CONGRESS 

1ST SESSION H. R. 3408 

To amend title XVIII of the Social Security Act to require prescription 

drug plan sponsors to include real-time benefit information as part of 

such sponsor’s electronic prescription program under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 21, 2019 

Mr. ARRINGTON (for himself and Mr. OLSON) 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 require 

prescription drug plan sponsors to include real-time benefit information as part of such sponsor’s electronic prescription program under the Medicare program. 

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 ‘‘Shop Rx Act of 2019’’. 


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1 SEC. 2. REQUIRING PRESCRIPTION DRUG PLAN SPONSORS 

2 TO INCLUDE REAL-TIME BENEFIT INFORMA3 TION AS PART OF SUCH SPONSOR’S ELEC4 TRONIC PRESCRIPTION PROGRAM UNDER 

5 THE MEDICARE PROGRAM. 

6 Section 1860D–4(e)(2) of the Social Security Act (42 

7 U.S.C. 1395w–104(e)(2)) is amended— 

8 (1) in subparagraph (D), by striking ‘‘To the 

9 extent’’ and inserting ‘‘Except as provided in sub10 paragraph (F), to the extent’’; and 

11 (2) by adding at the end the following new sub12 paragraph: 

13 ‘‘(F) REAL-TIME BENEFIT INFORMA14 TION.— 

15 ‘‘(i) IN GENERAL.—Not later than 

16 January 1, 2021, the program shall pro17 vide for the real-time electronic trans18 mission to prescribing health care profes19 sionals, using technology capable of inte20 grating with such professionals’ electronic 

21 prescribing and electronic health record 

22 systems, of individual-specific formulary 

23 and benefit information under a prescrip24 tion drug plan with respect to an indi25 vidual enrolled in such plan. Such informa26 tion shall include, with respect to the preVerDate Sep 11 2014 00:21 Jun 27, 2019 Jkt 034408 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3408.IH H3408

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1 scribing of a covered part D drug to such 

2 individual, the following: 

3 ‘‘(I) A description of any clini4 cally appropriate alternatives to such 

5 drug included in the formulary of 

6 such plan. 

7 ‘‘(II) Information relating to ap8 plicable cost-sharing requirements for 

9 such drug and such alternatives, in10 cluding a description of any variance 

11 in such requirements based on the 

12 pharmacy dispensing such drug or 

13 such alternatives. 

14 ‘‘(III) Information relating to 

15 any prior authorization or other utili16 zation management requirements ap17 plicable to such drug and such alter18 natives within the formulary of such 

19 plan. 

20 ‘‘(ii) SPECIAL RULE FOR 2021.—The 

21 program shall be deemed to be in compli22 ance with clause (i) for 2021 if the pro23 gram complies with the provisions of sec24 tion 423.160(b)(7) of title 42, Code of 


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1 Federal Regulations (or a successor regula2 tion), for such year.’’. 

Æ 


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