I 

110TH CONGRESS 

1ST SESSION H. R. 1474 

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

of a prescription drug plan or an organization offering an MA–PD 

plan to promptly pay claims submitted under part D and to prohibit 

the inclusion of certain identifying information of pharmacies on explanatory prescription drug information and cards distributed by prescription 

drug plan sponsors. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 12, 2007 

Mr. BERRY (for himself, Ms. HERSETH, Mr. JONES of North Carolina, Mr. 

WICKER, Mr. ALLEN, Mr. ADERHOLT, Mr. ROSS, Mr. GRAVES, Mrs. 

EMERSON, Mr. COURTNEY, and Mr. MORAN of Kansas) 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 

the sponsor of a prescription drug plan or an organization offering an MA–PD plan to promptly pay claims 

submitted under part D and to prohibit the inclusion 

of certain identifying information of pharmacies on explanatory prescription drug information and cards distributed by prescription drug plan sponsors. 


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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 ‘‘Fair and Speedy 

5 Treatment (FAST) of Medicare Prescription Drug Claims 

6 Act of 2007’’. 

7 SEC. 2. PROMPT PAYMENT BY MEDICARE PRESCRIPTION 

8 DRUG PLANS AND MA–PD PLANS UNDER 

9 PART D. 

10 (a) APPLICATION TO PRESCRIPTION DRUG PLANS.— 

11 Section 1860D–12(b) of the Social Security Act (42 

12 U.S.C. 1395w–112 (b)) is amended by adding at the end 

13 the following new paragraph: 

14 ‘‘(4) PROMPT PAYMENT OF CLEAN CLAIMS.— 

15 ‘‘(A) PROMPT PAYMENT.—Each contract 

16 entered into with a PDP sponsor under this 

17 subsection with respect to a prescription drug 

18 plan offered by such sponsor shall provide that 

19 payment shall be issued, mailed, or otherwise 

20 transmitted with respect to all clean claims sub21 mitted under this part within the applicable 

22 number of calendar days after the date on 

23 which the claim is received. 

24 ‘‘(B) DEFINITIONS.—In this paragraph: 


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1 ‘‘(I) CLEAN CLAIM.—The term ‘clean 

2 claim’ means a claim, with respect to a 

3 covered part D drug, that has no apparent 

4 defect or impropriety (including any lack 

5 of any required substantiating documenta6 tion) or particular circumstance requiring 

7 special treatment that prevents timely pay8 ment from being made on the claim under 

9 this part. 

10 ‘‘(ii) APPLICABLE NUMBER OF CAL11 ENDAR DAYS.—The term ‘applicable num12 ber of calendar days’ means— 

13 ‘‘(I) with respect to claims sub14 mitted electronically, 14 calendar 

15 days; and 

16 ‘‘(II) with respect to claims sub17 mitted otherwise, 30 calendar days. 

18 ‘‘(c) INTEREST PAYMENT.—If payment is 

19 not issued, mailed, or otherwise transmitted 

20 within the applicable number of calendar days 

21 (as defined in subparagraph (B)) after a clean 

22 claim is received, interest shall be paid at a rate 

23 used for purposes of section 3902(a) of title 31, 

24 United States Code (relating to interest pen25 alties for failure to make prompt payments), for 


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1 the period beginning on the day after the re2 quired payment date and ending on the date on 

3 which payment is made. 

4 ‘‘(D) PROCEDURES INVOLVING CLAIMS.— 

5 ‘‘(I) CLAIMS DEEMED TO BE CLEAN

6 CLAIMS.— 

7 ‘‘(I) IN GENERAL.—A claim for a 

8 covered part D drug shall be deemed 

9 to be a clean claim for purposes of 

10 this paragraph if the PDP sponsor in11 volved does not provide a notification 

12 of deficiency to the claimant by the 

13 10th day that begins after the date on 

14 which the claim is submitted. 

15 ‘‘(II) NOTIFICATION OF DEFI16 CIENCY.—For purposes of subclause 

17 (II), the term ‘notification of defi18 ciency’ means a notification that 

19 specifies all defects or improprieties in 

20 the claim involved and that lists all 

21 additional information or documents 

22 necessary for the proper processing 

23 and payment of the claim. 

24 ‘‘(ii) PAYMENT OF CLEAN PORTIONS

25 OF CLAIMS.—A PDP sponsor shall, as apVerDate Aug 31 2005 22:09 Mar 15, 2007 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1474.IH H1474

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1 propriate, pay any portion of a claim for a 

2 covered part D drug that would be a clean 

3 claim but for a defect or impropriety in a 

4 separate portion of the claim in accordance 

5 with subparagraph (A). 

6 ‘‘(iii) OBLIGATION TO PAY.—A claim 

7 for a covered part D drug submitted to a 

8 PDP sponsor that is not paid or contested 

9 by the provider within the applicable num10 ber of calendar days (as defined in sub11 paragraph (B)) shall be deemed to be a 

12 clean claim and shall be paid by the PDP 

13 sponsor in accordance with subparagraph 

14 (A). 

15 ‘‘(iv) DATE OF PAYMENT OF CLAIM.— 

16 Payment of a clean claim under subpara17 graph (A) is considered to have been made 

18 on the date on which full payment is re19 ceived by the provider. 

20 ‘‘(E) ELECTRONIC TRANSFER OF

21 FUNDS.—A PDP sponsor shall pay all clean 

22 claims submitted electronically by an electronic 

23 funds transfer mechanism.’’. 


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1 (b) APPLICATION TO MA–PD PLANS.—Section 

2 1857(f) of such Act (42 U.S.C. 1395w–27) is amended 

3 by adding at the end the following new paragraph: 

4 ‘‘(3) INCORPORATION OF CERTAIN PRESCRIP5 TION DRUG PLAN CONTRACT REQUIREMENTS.—The 

6 provisions of section 1860D–12(b)(4) shall apply to 

7 contracts with a Medicare Advantage organization in 

8 the same manner as they apply to contracts with a 

9 PDP sponsor offering a prescription drug plan 

10 under part D.’’. 

11 (c) EFFECTIVE DATE.—The amendments made by 

12 this section shall apply to contracts entered into or re13 newed on or after the date of the enactment of this Act. 

14 SEC. 3. RESTRICTION ON CO-BRANDING. 

15 (a) APPLICATION TO PRESCRIPTION DRUG INFORMA16 TION DISSEMINATED.—Subsection (a) of section 1860D– 

17 4 of the Social Security Act (42 U.S.C. 1395w–104) is 

18 amended by adding at the end the following new para19 graph: 

20 ‘‘(5) RESTRICTION ON DISPLAYING PHARMACY

21 BRAND OR TRADEMARK INFORMATION.— 

22 ‘‘(A) IN GENERAL.—It is unlawful for a 

23 PDP sponsor of a prescription drug plan to dis24 play on any explanatory information described 

25 in subparagraph (B), with respect to benefits 


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1 provided under this part, the brand or trade2 mark of any pharmacy. 

3 ‘‘(B) EXPLANATORY INFORMATION DE4 SCRIBED.—For purposes of subparagraph (A), 

5 explanatory information is each of the fol6 lowing: 

7 ‘‘(i) Information on evidence of cov8 erage under this part. 

9 ‘‘(ii) Information that summarizes 

10 benefits provided under this part. 

11 ‘‘(iii) Enrollment and disenrollment 

12 forms. 

13 ‘‘(iv) Enrollment and disenrollment 

14 letters. 

15 ‘‘(v) Pharmacy directories. 

16 ‘‘(vi) Formulary information. 

17 ‘‘(vii) Grievance letters provided pur18 suant to subsection (f), coverage deter19 mination letters provided pursuant to sub20 section (g), and appeals letters provided 

21 pursuant to subsection (h). 

22 ‘‘(viii) Exceptions process letters. 

23 ‘‘(ix) Information contained in sales 

24 descriptions or sales presentations.’’. 


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1 (b) APPLICATION TO ENROLLEE CARDS.—Subsection 

2 (b)(2)(A) of such section is amended by adding at the end 

3 the following new sentence: ‘‘It is unlawful for a PDP 

4 sponsor of a prescription drug plan to display on such a 

5 card the name, brand, or trademark of any pharmacy.’’ 

6 (c) EFFECTIVE DATE.— 

7 (1) EXPLANATORY INFORMATION.—With re8 spect to explanatory information dispensed on or 

9 after the date of the enactment of this Act, the 

10 amendment made by subsection (a) shall apply to 

11 such information on and after the date that is 90 

12 days after such date of enactment. 

13 (2) ENROLLEE CARDS.—With respect to cards 

14 dispensed before, on, or after the date of the enact15 ment of this Act, the amendment made by sub16 section (b) shall apply to such cards on and after the 

17 date that is 90 days after such date of enactment. 

18 Any card dispensed before such date that is 90 days 

19 after the date of enactment that violates the second 

20 sentence of section 1860D–4(b)(2)(A) of the Social 

21 Security Act, as added by subsection (b), shall be re22 issued by such 90-day date. 

Æ 


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