I

104TH CONGRESS

2D SESSION H. R. 3757

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

of pharmaceutical care services under part B of the Medicare program.

IN THE HOUSE OF REPRESENTATIVES

JULY 8, 1996

Mr. PALLONE (for himself, Mr. BREWSTER, Mr. FOX of Pennsylvania, Mr.

FROST, Mr. ENGEL, Mr. TORRICELLI, Mr. LIPINSKI, Mr. FRAZER, Mr.

THOMPSON, Ms. BROWN of Florida, Mr. ACKERMAN, Mr. CRAMER, Mr.

DELLUMS, and Mrs. LOWEY) introduced the following bill; which was referred to the Committee on 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 coverage of pharmaceutical care services under part

B of 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 ‘‘Safe Medications for

5 the Elderly Act’’.
2

•HR 3757 IH

1 SEC. 2. MEDICARE COVERAGE OF PHARMACEUTICAL CARE

2 SERVICES.

3 (a) COVERAGE.—Section 1861(s)(2) of the Social Se4 curity Act (42 U.S.C. 1395x(s)(2)) is amended—

5 (1) by striking ‘‘and’’ at the end of subpara6 graph (N); and

7 (2) by inserting after subparagraph (O) the fol8 lowing new subparagraph:

9 ‘‘(P) covered pharmaceutical care services (as

10 defined in subsection (oo));’’.

11 (b) SERVICES DESCRIBED.—Section 1861 of such

12 Act (42 U.S.C. 1395x) is amended by adding at the end

13 the following new subsection:

14 ‘‘Covered Pharmaceutical Care Services

15 ‘‘(oo)(1) The term ‘covered pharmaceutical care serv16 ices’ means pharmaceutical care services described in

17 paragraph (2) which are furnished by a pharmacist who

18 is legally authorized to furnish such services under State

19 law (or the State regulatory mechanism provided by State

20 law) of the State in which the services are furnished.

21 ‘‘(2) The pharmaceutical care services described in

22 this paragraph are as follows:

23 ‘‘(A) Services covered under subsection (s)(10)

24 (relating to certain vaccines and their administra25 tion).
3

•HR 3757 IH

1 ‘‘(B) Consultation with a physician which re2 sults in the physician taking any of the following ac3 tions with respect to an outpatient prescription drug

4 furnished to an individual enrolled under part B

5 (without regard to whether or not payment is made

6 for the drug under such part):

7 ‘‘(i) A change in the individual’s drug regi8 men to avoid an adverse interaction with an9 other drug or medical condition.

10 ‘‘(ii) A change in the dosage or form of an

11 outpatient prescription drug taken by the indi12 vidual.

13 ‘‘(iii) The elimination of a drug from the

14 individual’s drug regimen.

15 ‘‘(iv) The initiation of a drug therapy for

16 a medical condition.

17 ‘‘(C) Consultation with an individual enrolled

18 under part B which results in improved compliance

19 by the individual with an outpatient prescription

20 drug regimen with respect to any drug identified by

21 the Secretary pursuant to paragraph (3), if the

22 pharmacist maintains documentation (in accordance

23 with such requirements as the Secretary may im24 pose) that the improvement in compliance is consid-
4

•HR 3757 IH

1 ered necessary by the prescriber of the drug or

2 under peer-reviewed medical literature.

3 ‘‘(3)(A) With respect to the consultations described

4 in paragraph (2)(C), the Secretary shall, not later than

5 one year after the date of the enactment of this subsection,

6 identify and publish a list of outpatient prescription drugs

7 (without regard to whether payment is made for such drug

8 under part B) which are used in the treatment of the fol9 lowing conditions prevalent in the elderly:

10 ‘‘(i) Asthma and chronic obstructive pulmonary

11 disease.

12 ‘‘(ii) Congestive heart failure.

13 ‘‘(iii) Depression.

14 ‘‘(iv) Hyperlipidemia.

15 ‘‘(v) Non-insulin-dependent diabetes.

16 ‘‘(vi) Prevention of stroke (including

17 antihypertensive and anticoagulant therapy).

18 ‘‘(vii) Simultaneous use of 4 or more drugs.

19 ‘‘(B) Beginning 5 years after the date of the enact20 ment of this subsection, the Secretary may periodically up21 date such list of drugs to reflect changes in medical and

22 pharmaceutical practice, the development of new drugs,

23 and other factors the Secretary considers appropriate.’’.

24 (c) PAYMENT.—
5

•HR 3757 IH

1 (1) IN GENERAL.—Section 1833(a)(1) of such

2 Act (42 U.S.C. 1395l(a)(1)) is amended—

3 (A) by striking ‘‘and (P)’’ and inserting

4 ‘‘(P)’’; and

5 (B) by striking the semicolon at the end

6 and inserting the following: ‘‘, and (Q) with re7 spect to covered pharmaceutical care services

8 (as defined in section 1861(oo)), the amounts

9 paid shall be the amounts described in section

10 1834(k)(1);’’.

11 (2) ESTABLISHMENT OF FEE SCHEDULE.—Sec12 tion 1834 of such Act (42 U.S.C. 1395m) is amend13 ed by adding at the end the following new sub14 section:

15 ‘‘(k) FEE SCHEDULES FOR PHARMACEUTICAL CARE

16 SERVICES.—

17 ‘‘(1) DEVELOPMENT.—The Secretary shall de18 velop—

19 ‘‘(A) a relative value scale to serve as the

20 basis for the payment of covered pharma21 ceutical care services (as defined in section

22 1861(oo)) under this part; and

23 ‘‘(B) using such scale and appropriate con24 version factors, fee schedules (on a regional,

25 statewide, locality, or carrier service area basis)
6

•HR 3757 IH

1 for payment for covered pharmaceutical care

2 services under this part, to be implemented for

3 such services furnished during years beginning

4 after the expiration of the 3-year period which

5 begins on the date of the enactment of this sub6 section.

7 ‘‘(2) CONSIDERATIONS.—In developing the rel8 ative value scale and fee schedules under paragraph

9 (1), the Secretary shall take into account—

10 ‘‘(A) differences in the time required to

11 perform types of covered pharmaceutical care

12 services;

13 ‘‘(B) differences in the level of risk associ14 ated with the use of particular outpatient pre15 scription drugs or groups of drugs; and

16 ‘‘(C) differences in the health status of in17 dividuals to whom covered pharmaceutical care

18 services are provided.

19 ‘‘(3) PAYMENTS PRIOR TO IMPLEMENTATION

20 OF FEE SCHEDULE.—In the case of covered pharma21 ceutical care services described in subparagraph (B)

22 or (C) of section 1861(oo)(2) which are furnished

23 prior to the implementation of the fee schedule

24 under paragraph (1)(B), the amount of payment

25 made under this part shall be equal to 80 percent
7

•HR 3757 IH

1 of the amount which would be paid for the service

2 under the fee schedule applicable under section 1848

3 if the service were furnished by a physician.’’.

4 (3) REPORT TO CONGRESS.—Not later than 3

5 years after the date of the enactment of this Act, the

6 Secretary of Health and Human Services shall sub7 mit a report to Congress on the relative value scale

8 and fee schedules developed pursuant to section

9 1834(k)(1) of the Social Security Act (as added by

10 paragraph (2)) for covered pharmaceutical services

11 under part B of the Medicare program.

12 (d) EFFECTIVE DATE.—The amendments made by

13 this section shall apply to services furnished on or after

14 January 1, 1997.

Æ