I 

109TH CONGRESS 

2D SESSION H. R. 5116 

To amend title XVIII of the Social Security Act to extend the 2006 initial 

enrollment period for the Medicare prescription drug benefit by six 

months, to suspend the late enrollment penalty for such benefit during 

2006, to permit Medicare beneficiaries to change enrollment in a prescription drug plan once a year, and to prevent changes in formularies 

other than at the time of open enrollment periods and only with advance 

notice. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 6, 2006 

Mrs. TAUSCHER (for herself, Mr. SMITH of Washington, Mr. DAVIS of Alabama, Mr. KIND, Mrs. MCCARTHY, Mr. INSLEE, Ms. HERSETH, Mr. 

CROWLEY, Mr. MEEKS of New York, Mr. EMANUEL, Ms. MILLENDERMCDONALD, Mr. HIGGINS, Ms. HARMAN, Mr. PRICE of North Carolina, 

Mr. BAIRD, Ms. SCHWARTZ of Pennsylvania, Mr. MCINTYRE, Mr. 

ENGEL, Mr. ISRAEL, Mr. CHANDLER, Mr. BOSWELL, Ms. LORETTA

SANCHEZ of California, Mr. LARSON of Connecticut, Mr. DAVIS of Florida, Mr. MOORE of Kansas, and Ms. HOOLEY) 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 extend 

the 2006 initial enrollment period for the Medicare prescription drug benefit by six months, to suspend the 

late enrollment penalty for such benefit during 2006, 

to permit Medicare beneficiaries to change enrollment 

in a prescription drug plan once a year, and to prevent 


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changes in formularies other than at the time of open 

enrollment periods and only with advance notice. 

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 ‘‘Choice for America’s 

5 Seniors Act of 2006’’. 

6 SEC. 2. SIX-MONTH EXTENSION OF 2006 INITIAL ENROLL7 MENT PERIOD FOR MEDICARE PRESCRIP8 TION DRUG PLANS AND MA PLANS. 

9 (a) IN GENERAL.—Section 1851(e)(3)(B)(iii) of the 

10 Social Security Act (42 U.S.C. 1395w–21(e)(3)(B)(iii)) is 

11 amended by striking ‘‘May 15, 2006’’ and inserting ‘‘No12 vember 14, 2006’’. 

13 (b) EFFECTIVE DATE.—The amendments made by 

14 this section shall take effect as if included in the enact15 ment of the Medicare Prescription Drug, Improvement, 

16 and Modernization Act of 2003 (Public Law 108–173). 

17 SEC. 3. SUSPENSION OF MEDICARE PRESCRIPTION DRUG 

18 LATE ENROLLMENT PENALTY DURING 2006. 

19 (a) IN GENERAL.—Section 1860D–13(b)(3)(B) of 

20 the Social Security Act (42 U.S.C. 1395w–113(b)(3)(B)) 

21 is amended by inserting ‘‘(after December 2006)’’ after 

22 ‘‘any month’’. 

23 (b) EFFECTIVE DATE.—The amendments made by 

24 this section shall take effect as if included in the enactVerDate Aug 31 2005 17:47 Apr 13, 2006 Jkt 049196 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5116.IH H5116

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1 ment of the Medicare Prescription Drug, Improvement, 

2 and Modernization Act of 2003 (Public Law 108–173). 

3 SEC. 4. CHANGES OF ENROLLMENT IN PRESCRIPTION 

4 DRUG PLANS AND MA PLANS ALLOWED 

5 TWICE DURING YEAR. 

6 (a) ADDITIONAL ELECTION PERMITTED ONCE EACH

7 YEAR OUTSIDE OF ANNUAL COORDINATED ELECTION

8 PERIOD.—Section 1851(e)(4) of the Social Security Act 

9 (42 U.S.C. 1395w–21(e)(4)) is amended by inserting 

10 ‘‘once every year, and in addition,’’ after ‘‘make a new 

11 election under this section’’. 

12 (b) EFFECTIVE DATE.—The amendment made by 

13 subsection (a) shall take effect as of the date of the enact14 ment of this Act. 

15 SEC. 5. LIMITATION ON REMOVAL OR CHANGE OF COV16 ERED PART D DRUGS FROM THE PRESCRIP17 TION DRUG PLAN FORMULARY; NOTICE OF 

18 CHANGES IN COVERAGE. 

19 (a) LIMITATION ON REMOVAL OR CHANGE OF COV20 ERED PART D DRUGS FROM THE PRESCRIPTION DRUG

21 PLAN FORMULARY.—Section 1860D–4(b)(3)(E) of the 

22 Social Security Act (42 U.S.C. 1395w–104(b)(3)(E)) is 

23 amended to read as follows: 


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1 ‘‘(E) REMOVING A DRUG FROM FOR2 MULARY OR IMPOSING A RESTRICTION OR LIMI3 TATION ON COVERAGE.— 

4 ‘‘(i) LIMITATION ON REMOVAL, LIMI5 TATION, OR RESTRICTION.— 

6 ‘‘(I) IN GENERAL.—Subject to 

7 subclause (II) and clause (ii), begin8 ning with 2006, the PDP sponsor of 

9 a prescription drug plan may not re10 move a covered part D drug from the 

11 plan formulary or impose a restriction 

12 or limitation on the coverage of such 

13 a drug (such as through the applica14 tion of a preferred status, usage re15 striction, step therapy, prior author16 ization, or quantity limitation) other 

17 than at the beginning of each plan 

18 year except as the Secretary may per19 mit to take into account new thera20 peutic uses and newly covered part D 

21 drugs. 

22 ‘‘(II) SPECIAL RULE FOR NEWLY

23 ENROLLED INDIVIDUALS.—Subject to 

24 clause (ii), in the case of an individual 

25 who enrolls in a prescription drug 


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1 plan on or after the date of enactment 

2 of this subparagraph, the PDP spon3 sor of such plan may not remove a 

4 covered part D drug from the plan 

5 formulary or impose a restriction or 

6 limitation on the coverage of such a 

7 drug (such as through the application 

8 of a preferred status, usage restric9 tion, step therapy, prior authorization, 

10 or quantity limitation) during the pe11 riod beginning on the date of such en12 rollment and ending on December 31 

13 of the immediately succeeding plan 

14 year except as the Secretary may per15 mit to take into account new thera16 peutic uses and newly covered part D 

17 drugs. 

18 ‘‘(ii) EXCEPTIONS TO LIMITATION ON

19 REMOVAL.—Clause (i) shall not apply with 

20 respect to a covered part D drug that— 

21 ‘‘(I) is a brand name drug for 

22 which there is a generic drug ap23 proved under section 505(j) of the 

24 Food and Drug Cosmetic Act (21 

25 U.S.C. 355(j)) that is placed on the 


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1 market during the period in which 

2 there are limitations on removal or 

3 change in the formulary under sub4 clause (I) or (II) of clause (i) if such 

5 generic drug is included in the for6 mulary without any restriction or limi7 tation placed on the coverage of such 

8 generic drug other than a restriction 

9 or limitation that would be placed on 

10 the coverage of the brand name drug 

11 during such period without the appli12 cation of this clause; 

13 ‘‘(II) is a brand name drug that 

14 goes off-patent during such period; 

15 ‘‘(III) is a drug for which the 

16 Commissioner of Food and Drugs 

17 issues a clinical warning that imposes 

18 a restriction or limitation on the drug 

19 during such period; 

20 ‘‘(IV) is a drug that the appro21 priate pharmacy and therapeutic com22 mittee determines, based on evidence 

23 from peer-reviewed medical research, 

24 to be unsafe or ineffective during such 

25 period; or 


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1 ‘‘(V) is any other drug that satis2 fies any other requirement determined 

3 appropriate by the Secretary. 

4 ‘‘(iii) NOTICE OF REMOVAL UNDER

5 APPLICATION OF EXCEPTION TO LIMITA6 TION.—Not later than 90 days before a 

7 PDP sponsor of a prescription drug plan 

8 removes a covered part D drug from the 

9 plan formulary (or restricts or limits such 

10 coverage) under clause (ii), the sponsor 

11 shall provide appropriate notice (such as 

12 under subsection (a)(3)) of such removal 

13 (or restriction or limitation) to the Sec14 retary, affected enrollees, physicians, phar15 macies, and pharmacists.’’. 

16 (a) ADVANCE NOTICE REQUIRED FOR CHANGE IN

17 FORMULARY AND OTHER RESTRICTIONS OR LIMITATIONS

18 ON COVERAGE.— 

19 (1) IN GENERAL.—Section 1860D–4(a) of the 

20 Social Security Act (42 U.S.C. 1395w–104(a)) is 

21 amended by adding at the end the following new 

22 paragraph: 

23 ‘‘(5) ANNUAL NOTICE OF CHANGES IN FOR24 MULARY AND OTHER RESTRICTIONS OR LIMITATIONS

25 ON COVERAGE.—Each PDP sponsor offering a preVerDate Aug 31 2005 17:47 Apr 13, 2006 Jkt 049196 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5116.IH H5116

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1 scription drug plan shall furnish to each enrollee 90 

2 days before the time of each annual coordinated 

3 election period (referred to in section 1860D– 

4 1(b)(1)(B)(iii)) for a plan year a notice of any 

5 changes in the formulary or other restrictions or 

6 limitations on coverage of a covered part D drug 

7 under the plan that will take effect for the plan 

8 year.’’. 

9 (2) EFFECTIVE DATE.—The amendment made 

10 by paragraph (1) shall apply to annual coordinated 

11 election periods beginning after the date of the en12 actment of this Act, except that if this Act is en13 acted after September 15, 2006, and before January 

14 1, 2007, the notice required under such section shall 

15 apply with respect to the annual coordinated election 

16 period that begins on November 15, 2006, as of 

17 such date (as soon as possible after such date of en18 actment) as the Secretary of Health and Human 

19 Services shall specify. 

Æ 


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