II 

110TH CONGRESS 

1ST SESSION S. 137 

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

beneficiary protections. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 4, 2007 

Mr. CARDIN 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 

additional beneficiary protections. 

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; TABLE OF CONTENTS. 

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

5 ‘‘Preserving Medicare for All Act of 2007’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Negotiation of prices for medicare prescription drugs. 

Sec. 3. Guaranteed prescription drug benefits. 

Sec. 4. Full reimbursement for qualified retiree prescription drug plans. 

Sec. 5. Repeal of comparative cost adjustment (cca) program. 

Sec. 6. Repeal of MA Regional Plan Stabilization Fund. 

Sec. 7. Repeal of cost containment provisions. 


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Sec. 8. Removal of exclusion of benzodiazepines from required coverage under 

the Medicare prescription drug program. 

1 SEC. 2. NEGOTIATION OF PRICES FOR MEDICARE PRE2 SCRIPTION DRUGS. 

3 Section 1860D–11 of the Social Security Act (42 

4 U.S.C. 1395w–111) is amended by striking subsection (i) 

5 (relating to noninterference) and inserting the following: 

6 ‘‘(i) NEGOTIATION; NO NATIONAL FORMULARY OR

7 PRICE STRUCTURE.— 

8 ‘‘(1) NEGOTIATION OF PRICES WITH MANUFAC9 TURERS.—In order to ensure that beneficiaries en10 rolled under prescription drug plans and MA–PD 

11 plans pay the lowest possible price, the Secretary 

12 shall have and exercise authority similar to that of 

13 other Federal entities that purchase prescription 

14 drugs in bulk to negotiate contracts with manufac15 turers of covered part D drugs, consistent with the 

16 requirements and in furtherance of the goals of pro17 viding quality care and containing costs under this 

18 part. 

19 ‘‘(2) NO NATIONAL FORMULARY OR PRICE

20 STRUCTURE.—In order to promote competition 

21 under this part and in carrying out this part, the 

22 Secretary may not require a particular formulary or 

23 institute a price structure for the reimbursement of 

24 covered part D drugs.’’. 


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1 SEC. 3. GUARANTEED PRESCRIPTION DRUG BENEFITS. 

2 (a) IN GENERAL.—Section 1860D–3 of the Social 

3 Security Act (42 U.S.C. 1395w–103) is amended to read 

4 as follows: 

5 ‘‘ACCESS TO A CHOICE OF QUALIFIED PRESCRIPTION

6 DRUG COVERAGE

7 ‘‘SEC. 1860D–3. (a) ASSURING ACCESS TO A CHOICE

8 OF COVERAGE.— 

9 ‘‘(1) CHOICE OF AT LEAST THREE PLANS IN

10 EACH AREA.—Beginning on January 1, 2008, the 

11 Secretary shall ensure that each part D eligible indi12 vidual has available, consistent with paragraph (2), 

13 a choice of enrollment in— 

14 ‘‘(A) a nationwide prescription drug plan 

15 offered by the Secretary in accordance with 

16 subsection (b); and 

17 ‘‘(B) at least 2 qualifying plans (as defined 

18 in paragraph (3)) in the area in which the indi19 vidual resides, at least one of which is a pre20 scription drug plan. 

21 ‘‘(2) REQUIREMENT FOR DIFFERENT PLAN

22 SPONSORS.—The requirement in paragraph (1)(B) is 

23 not satisfied with respect to an area if only one enti24 ty offers all the qualifying plans in the area. 


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1 ‘‘(3) QUALIFYING PLAN DEFINED.—For pur2 poses of this section, the term ‘qualifying plan’ 

3 means— 

4 ‘‘(A) a prescription drug plan; 

5 ‘‘(B) an MA–PD plan described in section 

6 1851(a)(2)(A)(i) that provides— 

7 ‘‘(i) basic prescription drug coverage; 

8 or 

9 ‘‘(ii) qualified prescription drug cov10 erage that provides supplemental prescrip11 tion drug coverage so long as there is no 

12 MA monthly supplemental beneficiary pre13 mium applied under the plan, due to the 

14 application of a credit against such pre15 mium of a rebate under section 

16 1854(b)(1)(C); or 

17 ‘‘(C) a nationwide prescription drug plan 

18 offered by the Secretary in accordance with 

19 subsection (b). 

20 ‘‘(b) HHS AS PDP SPONSOR FOR A NATIONWIDE

21 PRESCRIPTION DRUG PLAN.— 

22 ‘‘(1) IN GENERAL.—The Secretary, acting 

23 through the Administrator of the Centers for Medi24 care & Medicaid Services, shall take such steps as 

25 may be necessary to qualify and serve as a PDP 


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1 sponsor and to offer a prescription drug plan that 

2 offers basic prescription drug coverage throughout 

3 the United States. Such a plan shall be in addition 

4 to, and not in lieu of, other prescription drug plans 

5 offered under this part. 

6 ‘‘(2) PREMIUM; SOLVENCY; AUTHORITIES.—In 

7 carrying out paragraph (1), the Secretary— 

8 ‘‘(A) shall establish a premium in the 

9 amount of $35 for months in 2008 and, for 

10 months in subsequent years, in the amount 

11 specified in this paragraph for months in the 

12 previous year increased by the annual percent13 age increase described in section 1860D– 

14 2(b)(6) (relating to growth in medicare pre15 scription drug costs per beneficiary) for the 

16 year involved; 

17 ‘‘(B) is deemed to have met any applicable 

18 solvency and capital adequacy standards; and 

19 ‘‘(C) shall exercise such authorities (includ20 ing the use of regional or other pharmaceutical 

21 benefit managers) as the Secretary determines 

22 necessary to offer the prescription drug plan in 

23 the same or a comparable manner as is the case 

24 for prescription drug plans offered by private 

25 PDP sponsors. 


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1 ‘‘(c) FLEXIBILITY IN RISK ASSUMED.—In order to 

2 ensure access pursuant to subsection (a) in an area the 

3 Secretary may approve limited risk plans under section 

4 1860D–11(f) for the area.’’. 

5 (b) CONFORMING AMENDMENT.—Section 1860D– 

6 11(g) of the Social Security Act (42 U.S.C. 1395w– 

7 111(g)) is amended by adding at the end the following 

8 new paragraph: 

9 ‘‘(8) APPLICATION.—This subsection shall not 

10 apply on or after January 1, 2008.’’. 

11 SEC. 4. FULL REIMBURSEMENT FOR QUALIFIED RETIREE 

12 PRESCRIPTION DRUG PLANS. 

13 (a) ELIMINATION OF TRUE OUT-OF-POCKET LIMITA14 TION.—Section 1860D–2(b)(4)(C)(ii) of the Social Secu15 rity Act (42 U.S.C. 1395w–102(b)(4)(C)(ii) is amended— 

16 (1) by inserting ‘‘under a qualified retiree pre17 scription drug plan (as defined in section 1860D– 

18 22(a)(2)),’’ after ‘‘under section 1860D–14,’’; and 

19 (2) by inserting ‘‘, under such a qualified re20 tiree prescription drug plan,’’ after ‘‘(other than 

21 under such section’’. 

22 (b) EQUALIZATION OF SUBSIDIES.—Notwithstanding 

23 any other provision of law, the Secretary of Health and 

24 Human Services shall provide for such increase in the spe25 cial subsidy payment amounts under section 1860D– 


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1 22(a)(3) of the Social Security Act (42 U.S.C. 1395w– 

2 132(a)(3)) as may be appropriate to provide for payments 

3 in the aggregate equivalent to the payments that would 

4 have been made under section 1860D–15 of such Act (42 

5 U.S.C. 1395w–115) if the individuals were not enrolled 

6 in a qualified retiree prescription drug plan. In making 

7 such computation, the Secretary shall not take into ac8 count the application of the amendments made by section 

9 1202 of the Medicare Prescription Drug, Improvement, 

10 and Modernization Act of 2003 (Public Law 108–173; 117 

11 Stat. 2480). 

12 (c) EFFECTIVE DATE.—This section, and the amend13 ments made by this section, shall take effect on January 

14 1, 2008. 

15 SEC. 5. REPEAL OF COMPARATIVE COST ADJUSTMENT 

16 (CCA) PROGRAM. 

17 Subtitle E of title II of the Medicare Prescription 

18 Drug, Improvement, and Modernization Act of 2003 (Pub19 lic Law 108–173; 117 Stat. 2214), and the amendments 

20 made by such subtitle, are repealed. 

21 SEC. 6. REPEAL OF MA REGIONAL PLAN STABILIZATION 

22 FUND. 

23 (a) IN GENERAL.—Subsection (e) of section 1858 of 

24 the Social Security Act (42 U.S.C. 1395w–27a) is re25 pealed. 


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1 (b) CONFORMING AMENDMENT.—Section 1858(f)(1) 

2 of the Social Security Act (42 U.S.C. 1395w–27a(f)(1)) 

3 is amended by striking ‘‘subject to subsection (e),’’. 

4 SEC. 7. REPEAL OF COST CONTAINMENT PROVISIONS. 

5 Subtitle A of title VIII of the Medicare Prescription 

6 Drug, Improvement, and Modernization Act of 2003 (Pub7 lic Law 108–173; 117 Stat. 2357) is repealed and any 

8 provisions of law amended by such subtitle are restored 

9 as if such subtitle had not been enacted. 

10 SEC. 8. REMOVAL OF EXCLUSION OF BENZODIAZEPINES 

11 FROM REQUIRED COVERAGE UNDER THE 

12 MEDICARE PRESCRIPTION DRUG PROGRAM. 

13 (a) REMOVAL OF EXCLUSION.— 

14 (1) IN GENERAL.—Section 1860D–2(e)(2) of 

15 the Social Security Act (42 U.S.C. 1395w– 

16 102(e)(2)) is amended— 

17 (A) by striking ‘‘subparagraph (E)’’ and 

18 inserting ‘‘subparagraphs (E) and (J)’’; and 

19 (B) by inserting ‘‘and benzodiazepines’’ 

20 after ‘‘smoking cessation agents’’. 

21 (2) EFFECTIVE DATE.—The amendments made 

22 by paragraph (1) shall apply to prescriptions dis23 pensed on or after January 1, 2008. 

24 (b) REVIEW OF BENZODIAZEPINE PRESCRIPTION

25 POLICIES TO ASSURE APPROPRIATENESS AND TO AVOID


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1 ABUSE.—The Secretary of Health and Human Services 

2 shall review the policies of Medicare prescription drug 

3 plans (and MA–PD plans) under parts C and D of title 

4 XVIII of the Social Security Act regarding the filling of 

5 prescriptions for benzodiazepine to ensure that these poli6 cies are consistent with accepted clinical guidelines, are 

7 appropriate to individual health histories, and are de8 signed to minimize long term use, guard against over-pre9 scribing, and prevent patient abuse. 

10 (c) DEVELOPMENT BY MEDICARE QUALITY IM11 PROVEMENT ORGANIZATIONS OF EDUCATIONAL GUIDE12 LINES FOR PHYSICIANS REGARDING PRESCRIBING OF

13 BENZODIAZEPINES.—The Secretary of Health and 

14 Human Services shall provide, in contracts entered into 

15 with Medicare quality improvement organizations under 

16 part B of title XI of the Social Security Act, for the devel17 opment by such organizations of appropriate educational 

18 guidelines for physicians regarding the prescribing of 

19 benzodiazepines. 

Æ 


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