II 

116TH CONGRESS 

1ST SESSION S. 1999 

To amend title XVIII of the Social Security Act to provide transitional 

coverage and retroactive Medicare part D coverage for certain low-income 

beneficiaries. 

IN THE SENATE OF THE UNITED STATES 

JUNE 27, 2019 

Mr. CASEY (for himself and Mr. DAINES) introduced the following bill; which 

was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

transitional coverage and retroactive Medicare part D 

coverage for certain low-income beneficiaries. 

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 ‘‘Improving Low Income 

5 Access to Prescription Drugs Act of 2019’’. 


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1 SEC. 2. TRANSITIONAL COVERAGE AND RETROACTIVE 

2 MEDICARE PART D COVERAGE FOR CERTAIN 

3 LOW-INCOME BENEFICIARIES. 

4 Section 1860D–14 of the Social Security Act (42 

5 U.S.C. 1395w–114) is amended— 

6 (1) by redesignating subsection (e) as sub7 section (f); and 

8 (2) by adding after subsection (d) the following 

9 new subsection: 

10 ‘‘(e) LIMITED INCOME NEWLY ELIGIBLE TRANSI11 TION PROGRAM.— 

12 ‘‘(1) IN GENERAL.—Beginning not later than 

13 January 1, 2021, the Secretary shall carry out a 

14 program to provide transitional coverage for covered 

15 part D drugs for LI NET eligible individuals in ac16 cordance with this subsection. 

17 ‘‘(2) LI NET ELIGIBLE INDIVIDUAL DEFINED.— 

18 For purposes of this subsection, the term ‘LI NET 

19 eligible individual’ means a part D eligible individual 

20 who— 

21 ‘‘(A) meets the requirements of clauses (ii) 

22 and (iii) of subsection (a)(3)(A); and 

23 ‘‘(B) has not yet enrolled in a prescription 

24 drug plan or an MA–PD plan, or, who has so 

25 enrolled, but with respect to whom coverage 

26 under such plan has not yet taken effect. 


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1 ‘‘(3) TRANSITIONAL COVERAGE.—For purposes 

2 of this subsection, the term ‘transitional coverage’ 

3 means with respect to an LI NET eligible indi4 vidual— 

5 ‘‘(A) immediate access to covered part D 

6 drugs at the point of sale during the period 

7 that begins on the first day of the month such 

8 individual is determined to meet the require9 ments of clauses (ii) and (iii) of subsection 

10 (a)(3)(A) and ends on the date that coverage 

11 under a prescription drug plan or MA–PD plan 

12 takes effect with respect to such individual; and 

13 ‘‘(B) in the case of an LI NET eligible in14 dividual who is a full-benefit dual eligible indi15 vidual (as defined in section 1935(c)(6)) or a 

16 recipient of supplemental security income bene17 fits under title XVI, retroactive coverage (in the 

18 form of reimbursement of the amounts that 

19 would have been paid under this part had such 

20 individual been enrolled in a prescription drug 

21 plan or MA–PD plan) of covered part D drugs 

22 purchased by such individual during the period 

23 that begins on the date that is the later of— 


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1 ‘‘(i) the date that such individual was 

2 first eligible for a low-income subsidy 

3 under this part; or 

4 ‘‘(ii) the date that is 36 months prior 

5 to the date such individual enrolls in a pre6 scription drug plan or MA–PD plan, 

7 and ends on the date that coverage under such 

8 plan takes effect. 

9 ‘‘(4) PROGRAM ADMINISTRATION.— 

10 ‘‘(A) SINGLE POINT OF CONTACT.—The 

11 Secretary shall, to the extent feasible, admin12 ister the program under this subsection through 

13 a contract with a single program administrator. 

14 ‘‘(B) BENEFIT DESIGN.—The Secretary 

15 shall ensure that the transitional coverage pro16 vided to LI NET eligible individuals under this 

17 subsection— 

18 ‘‘(i) provides access to all covered part 

19 D drugs under an open formulary; 

20 ‘‘(ii) permits all pharmacies deter21 mined by the Secretary to be in good 

22 standing to process claims under the pro23 gram; 

24 ‘‘(iii) is consistent with such require25 ments as the Secretary considers necessary 


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1 to improve patient safety and ensure ap2 propriate dispensing of medication; and 

3 ‘‘(iv) meets such other requirements 

4 as the Secretary may establish. 

5 ‘‘(5) RELATIONSHIP TO OTHER PROVISIONS OF

6 THIS TITLE; WAIVER AUTHORITY.— 

7 ‘‘(A) IN GENERAL.—The following provi8 sions shall not apply with respect to the pro9 gram under this subsection: 

10 ‘‘(i) Paragraphs (1) and (3)(B) of sec11 tion 1860D–4(a) (relating to dissemination 

12 of general information; availability of infor13 mation on changes in formulary through 

14 the internet). 

15 ‘‘(ii) Subparagraphs (A) and (B) of 

16 section 1860D–4(b)(3) (relating to require17 ments on development and application of 

18 formularies; formulary development). 

19 ‘‘(iii) Paragraphs (1)(C) and (2) of 

20 section 1860D–4(c) (relating to medication 

21 therapy management program). 

22 ‘‘(B) WAIVER AUTHORITY.—The Secretary 

23 may waive such other requirements of title XI 

24 and this title as may be necessary to carry out 


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1 the purposes of the program established under 

2 this subsection.’’. 

Æ 


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