II 

108TH CONGRESS 

2D SESSION S. 2343

To amend title XVIII of the Social Security Act to improve the medicare 

program, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 22, 2004

Mr. CONRAD (for himself and Mrs. LINCOLN) 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 improve 

the medicare program, and for other purposes.

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; AMENDMENTS TO THE SOCIAL 

4 SECURITY ACT; REFERENCES TO MMA AND 

5 SECRETARY; TABLE OF CONTENTS. 

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

7 ‘‘Medicare Modernization Improvement Act of 2004’’. 

8 (b) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex9 cept as otherwise specifically provided, whenever an 

10 amendment is expressed in terms of an amendment to or 
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1 repeal of a section or other provision, the reference shall 

2 be considered to be made to that section or other provision 

3 of the Social Security Act. 

4 (c) REFERENCES TO MMA AND SECRETARY.—In 

5 this Act: 

6 (1) MMA.—The term ‘‘MMA’’ means the Medi7 care Prescription Drug, Improvement, and Mod8 ernization Act of 2003 (117 Stat. 2066 et seq.). 

9 (2) SECRETARY.—The term ‘‘Secretary’’ means 

10 the Secretary of Health and Human Services. 

11 (d) TABLE OF CONTENTS.—The table of contents of 

12 this Act is as follows:

Sec. 1. Short title; amendments to the Social Security Act; references to MMA 

and Secretary; table of contents. 

TITLE I—PROVIDING MEDICARE BENEFICIARIES WITH LOWER, 

NEGOTIATED PRESCRIPTION DRUG PRICES 

Sec. 101. Negotiating fair prices for medicare prescription drugs. 

Sec. 102. Importation of prescription drugs. 

TITLE II—STABILIZING THE MEDICARE PRESCRIPTION DRUG 

BENEFIT 

Sec. 201. Requiring two prescription drug plans to avoid Federal fallback. 

Sec. 202. Improving the stability of the drug benefit. 

TITLE III—PROVIDING MEDICARE BENEFICIARIES WITH 

SOURCES OF ADDITIONAL PRESCRIPTION DRUG COVERAGE 

Sec. 301. Making available wraparound coverage through medigap. 

TITLE IV—IMPROVED ACCESS TO PHARMACY CARE FOR 

MEDICARE BENEFICIARIES 

Sec. 401. Improving access to pharmacy care. 

TITLE V—REPEAL OF HEALTH SAVINGS ACCOUNTS AND OTHER 

EMPLOYER RELATED PROVISIONS 

Sec. 501. Repeal of Health Savings Accounts. 

TITLE VI—IMPROVEMENT OF CHRONIC CARE MANAGEMENT 
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Sec. 601. Medicare complex clinical care management payment demonstration. 

TITLE VII—REQUIRING MORE APPROPRIATE PAYMENTS TO 

PRIVATE PLANS 

Sec. 701. Elimination of MA regional plan stabilization fund (slush fund). 

Sec. 702. Requiring private plan payments to reflect appropriate health risk adjustment. 

Sec. 703. Phase-in private plan payment to 100 percent of fee-for-service rate. 

TITLE VIII—REPEAL OF PREMIUM SUPPORT PROGRAM 

Sec. 801. Repeal of premium support program. 

TITLE IX—PROVIDING BETTER INFORMATION TO MEDICARE 

BENEFICIARIES 

Sec. 901. Providing accurate information to beneficiaries. 

Sec. 902. Providing medicare beneficiaries with better upfront drug coverage 

information. 

Sec. 903. Ensuring medicare beneficiaries are informed of formulary changes. 

TITLE X—FULL FUNDING AND EXPANSION FOR DEMONSTRATION PROJECT FOR COVERAGE OF CERTAIN PRESCRIPTION 

DRUGS AND BIOLOGICALS 

Sec. 1001. Full funding and expansion for demonstration project for coverage 

of certain prescription drugs and biologicals.

1 TITLE I—PROVIDING MEDICARE 

2 BENEFICIARIES WITH LOWER, 

3 NEGOTIATED PRESCRIPTION 

4 DRUG PRICES 

5 SEC. 101. NEGOTIATING FAIR PRICES FOR MEDICARE PRE6 SCRIPTION DRUGS. 

7 (a) IN GENERAL.—Section 1860D–11(i) (42 U.S.C. 

8 1395w–111(i)) is amended to read as follows: 

9 ‘‘(i) AUTHORITY TO NEGOTIATE PRICES WITH MAN10 UFACTURERS.—In order to ensure that beneficiaries en11 rolled under prescription drug plans and MA–PD plans 

12 pay the lowest possible price, the Secretary shall have au13 thority to negotiate contracts with manufacturers of cov-
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1 ered part D drugs as necessary to reduce prices and pro2 tect access to needed drugs, consistent with the require3 ments and in furtherance of the goals of providing quality 

4 care and containing costs under this part.’’. 

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

6 this section shall take effect as if included in the enact7 ment of section 101 of MMA (117 Stat. 2071). 

8 SEC. 102. IMPORTATION OF PRESCRIPTION DRUGS. 

9 (a) IN GENERAL.—Section 804 of the Federal Food, 

10 Drug, and Cosmetic Act (21 U.S.C. 535) is amended—

11 (1) by striking subsection (l); and 

12 (2) by redesignating subsection (m) as sub13 section (l). 

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

15 this section shall take effect as if included in the enact16 ment of section 1121 of MMA (117 Stat. 2464). 

17 TITLE II—STABILIZING THE 

18 MEDICARE PRESCRIPTION 

19 DRUG BENEFIT 

20 SEC. 201. REQUIRING TWO PRESCRIPTION DRUG PLANS TO 

21 AVOID FEDERAL FALLBACK. 

22 Section 1860D–3(a) (42 U.S.C. 1395w–103(a)) is 

23 amended—

24 (1) in paragraph (1)—
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1 (A) by striking ‘‘qualifying plans (as de2 fined in paragraph (3))’’ and inserting ‘‘pre3 scription drug plans’’; and 

4 (B) by striking ‘‘, at least one of which is 

5 a prescription drug plan’’; 

6 (2) in paragraph (2), by striking ‘‘qualifying 

7 plans’’ and inserting ‘‘prescription drug plans’’; and 

8 (3) by striking paragraph (3). 

9 SEC. 202. IMPROVING THE STABILITY OF THE DRUG BEN10 EFIT. 

11 (a) IN GENERAL.—Section 1860D–3 (42 U.S.C. 

12 1395w–103) is amended by adding at the end the fol13 lowing new subsection: 

14 ‘‘(c) FALLBACK PRESCRIPTION DRUG PLANS TO BE

15 AVAILABLE FOR 2 YEARS.—Notwithstanding subsection 

16 (b)(2), if the Secretary provides for the offering of a fall17 back prescription drug plan under subsection (a) in an 

18 area for a year, the following rules shall apply: 

19 ‘‘(1) The fallback prescription drug plan shall 

20 be available for not less than a 2-year period. 

21 ‘‘(2) The Secretary is not required to make the 

22 determination under subsection (a)(1) with respect 

23 to the second year in which the fallback prescription 

24 drug plan is offered in the area. 
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1 ‘‘(3) During the second year in which the fall2 back prescription drug plan is offered in an area, 

3 any part D eligible individual residing in the area 

4 (regardless of whether such individual was enrolled 

5 in the fallback prescription drug plan during the 

6 previous year) may elect to receive prescription drug 

7 coverage under the fallback prescription drug plan 

8 or through any other type of qualified prescription 

9 drug coverage available in the area, subject to the 

10 requirements of section 1860D–1.’’. 

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

12 this section shall take effect as if included in the enact13 ment of section 101 of MMA (117 Stat. 2071). 

14 TITLE III—PROVIDING MEDI15 CARE BENEFICIARIES WITH 

16 SOURCES OF ADDITIONAL 

17 PRESCRIPTION DRUG COV18 ERAGE 

19 SEC. 301. MAKING AVAILABLE WRAPAROUND COVERAGE 

20 THROUGH MEDIGAP. 

21 (a) IN GENERAL.—Section 1882(v)(1) (42 U.S.C. 

22 1395ss(v)(1)) is amended—

23 (1) in subparagraph (A), by inserting ‘‘, other 

24 than such a policy that provides wraparound pre25 scription drug coverage included within a range of
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1 such coverage approved under subparagraph 

2 (D)(ii),’’ after ‘‘paragraph (6)(A))’’; and 

3 (2) by adding at the end the following new sub4 paragraph: 

5 ‘‘(D) WRAPAROUND PRESCRIPTION DRUG

6 COVERAGE.—

7 ‘‘(i) IN GENERAL.—Notwithstanding 

8 any other provision of this subsection, a 

9 medigap Rx policy that provides wrap10 around prescription drug coverage included 

11 within a range of such coverage approved 

12 by the Secretary under clause (ii) may be 

13 offered to part D enrollees. 

14 ‘‘(ii) DEVELOPMENT OF STAND15 ARDS.—The Secretary shall approve a 

16 range of wraparound prescription drug 

17 coverage that may be offered under this 

18 subparagraph to part D enrollees.’’. 

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

20 this section shall take effect as if included in the enact21 ment of section 104 of MMA (117 Stat. 2161). 
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1 TITLE IV—IMPROVED ACCESS 

2 TO PHARMACY CARE FOR 

3 MEDICARE BENEFICIARIES 

4 SEC. 401. IMPROVING ACCESS TO PHARMACY CARE. 

5 (a) APPLICATION OF TRICARE PHARMACY ACCESS

6 STANDARDS.—Section 1860D–4(b)(1)(C)(ii) (42 U.S.C. 

7 1395w–104(b)(1)(C)(ii)) is amended—

8 (1) by striking: ‘‘APPLICATION OF TRICARE

9 STANDARDS.—The Secretary shall’’ and inserting 

10 the following: ‘‘APPLICATION OF TRICARE STAND11 ARDS.—

12 ‘‘(I) The Secretary shall’’; and 

13 (2) by adding at the end the following new sub14 clauses: 

15 ‘‘(II) In determining whether 

16 convenient access has been provided 

17 under subclause (I), the Secretary 

18 may only consider community retail 

19 pharmacies (as defined by the Sec20 retary) that are accessible to the gen21 eral public. The Secretary may not 

22 consider pharmacies located in long23 term care facilities, pharmacies lo24 cated in skilled nursing facilities, 

25 pharmacies operated by the Indian 
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1 Health Service, Indian tribes or tribal 

2 organizations, or urban Indian organi3 zations (as defined in section 4 of the 

4 Indian Health Care Improvement 

5 Act), mail order pharmacies, or phar6 macies located in community health 

7 centers receiving funds under section 

8 330 of the Public Health Service Act. 

9 ‘‘(III) The Secretary shall make 

10 a separate determination under sub11 clause (I) with respect to each State 

12 within the region served by the pre13 scription drug plan or MA–PD plan.’’. 

14 (b) LEVEL PLAYING FIELD.—Section 1860D–

15 4(b)(1)(D) (42 U.S.C. 1395w–104(b)(1)(D)) is amended 

16 to read as follows: 

17 ‘‘(D) LEVEL PLAYING FIELD.—Such a 

18 sponsor shall permit enrollees to receive the 

19 same amount, scope, and duration of drugs and 

20 biologicals (which may include a 90-day supply 

21 of drugs or biologicals) and medication therapy 

22 management services through any pharmacy 

23 (other than a mail order pharmacy) as the 

24 sponsor permits enrollees to receive through a 
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1 mail order pharmacy, with any differential in 

2 charge paid by such enrollees.’’. 

3 (c) PROVISION OF COVERAGE INFORMATION BY

4 PHARMACIES.—Section 1860D–4(a) is amended by add5 ing at the end the following new paragraph: 

6 ‘‘(5) DISSEMINATION OF INFORMATION BY

7 PHARMACISTS.—

8 ‘‘(A) PAYMENT TO PHARMACIES.—Subject 

9 to subparagraph (C)(ii), beginning on January 

10 1, 2006, and annually thereafter, the Secretary 

11 shall make an annual payment to each phar12 macy participating in a pharmacy network of a 

13 PDP sponsor for providing information to en14 rollees in prescription drug plans and MA–PD 

15 plans offered by that sponsor in an amount de16 termined by the Secretary based on an estimate 

17 of the number of enrollees in prescription drug 

18 plans and MA–PD plans served by the phar19 macy and taking into account the costs of the 

20 pharmacy in distributing such information and 

21 the availability of funding under subparagraph 

22 (C). 

23 ‘‘(B) PROVISION OF INFORMATION TO

24 PHARMACIES.—Each PDP sponsor offering a 

25 prescription drug plan or an MA–PD plan shall 
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1 furnish each pharmacy that participates in its 

2 network with the information to be provided 

3 under subparagraph (A). 

4 ‘‘(C) FUNDING.—

5 ‘‘(i) IN GENERAL.—Subject to clause 

6 (ii), the Secretary shall make payments 

7 under subparagraph (A) from the Medicare 

8 Prescription Drug Account. 

9 ‘‘(ii) LIMITATION.—The Secretary 

10 may not make any payments under sub11 paragraph (A) after the date on which a 

12 total of $500,000,000 have been expended 

13 from such Account as a result of the appli14 cation of this paragraph.’’. 

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

16 this section shall take effect as if included in the enact17 ment of section 101 of MMA (117 Stat. 2071). 

18 TITLE V—REPEAL OF HEALTH 

19 SAVINGS ACCOUNTS AND 

20 OTHER EMPLOYER RELATED 

21 PROVISIONS 

22 SEC. 501. REPEAL OF HEALTH SAVINGS ACCOUNTS. 

23 Section 1201 of MMA (117 Stat. 2469) is repealed 

24 and any provisions of law amended by such section are 

25 restored as if such section had not been enacted. 
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1 TITLE VI—IMPROVEMENT OF 

2 CHRONIC CARE MANAGEMENT 

3 SEC. 601. MEDICARE COMPLEX CLINICAL CARE MANAGE4 MENT PAYMENT DEMONSTRATION. 

5 (a) ESTABLISHMENT.—

6 (1) IN GENERAL.—The Secretary shall establish 

7 a demonstration program to make the medicare pro8 gram more responsive to needs of eligible bene9 ficiaries by promoting continuity of care, helping 

10 stabilize medical conditions, preventing or mini11 mizing acute exacerbations of chronic conditions, 

12 and reducing adverse health outcomes, such as ad13 verse drug interactions related to polypharmacy. 

14 (2) SITES.—The Secretary shall designate 10 

15 sites at which to conduct the demonstration program 

16 under this section, of which at least 4 shall be in a 

17 rural area. One of the sites shall be located in the 

18 State of Arkansas and 1 of the sites shall be in the 

19 State of North Dakota. 

20 (3) DURATION.—The Secretary shall conduct 

21 the demonstration program under this section for a 

22 3-year period. 

23 (4) IMPLEMENTATION.—The Secretary shall 

24 not implement the demonstration program before 

25 October 1, 2004.
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1 (b) PARTICIPANTS.—Any eligible beneficiary who re2 sides in an area designated by the Secretary as a dem3 onstration site under subsection (a)(2) may participate in 

4 the demonstration program under this section if such ben5 eficiary identifies a care coordinator who agrees to manage 

6 the complex clinical care of the eligible beneficiary under 

7 the demonstration program. 

8 (c) CARE COORDINATOR RESPONSIBILITIES.—The 

9 Secretary shall enter into an agreement with each care co10 ordinator who agrees to manage the complex clinical care 

11 of an eligible beneficiary under subsection (b) under which 

12 the care coordinator shall—

13 (1) serve as the primary contact of the eligible 

14 beneficiary in accessing items and services for which 

15 payment may be made under the medicare program; 

16 (2) maintain medical information related to 

17 care provided by other health care providers who 

18 provide health care items and services to the eligible 

19 beneficiary, including clinical reports, medication 

20 and treatments prescribed by other care coordina21 tors, hospital and hospital outpatient services, skilled 

22 nursing home care, home health care, and medical 

23 equipment services; 
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1 (3) monitor and advocate for the continuity of 

2 care of the eligible beneficiary and the use of evi3 dence-based guidelines; 

4 (4) promote self-care and family caregiver in5 volvement where appropriate; 

6 (5) have appropriate staffing arrangements to 

7 conduct patient self-management and other care co8 ordination activities as specified by the Secretary; 

9 (6) refer the eligible beneficiary to community 

10 services organizations and coordinate the services of 

11 such organizations with the care provided by health 

12 care providers; and 

13 (7) meet such other complex care management 

14 requirements as the Secretary may specify. 

15 (d) COMPLEX CLINICAL CARE MANAGEMENT FEE.—

16 (1) PAYMENT.—Under an agreement entered 

17 into under subsection (c), the Secretary shall pay to 

18 each care coordinator, on behalf of each eligible ben19 eficiary under the care of that care coordinator, the 

20 complex clinical care management fee developed by 

21 the Secretary under paragraph (2). 

22 (2) DEVELOPMENT OF FEE.—The Secretary 

23 shall develop a complex care management fee under 

24 this paragraph that is paid on a monthly basis and 

25 which shall be payment in full for all the functions 
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1 performed by the care coordinator under the dem2 onstration program, including any functions per3 formed by other qualified practitioners acting on be4 half of the care coordinator, appropriate staff under 

5 the supervision of the care coordinator, and any 

6 other person under a contract with the care coordi7 nator, including any person who conducts patient 

8 self-management and caregiver education under sub9 section (c)(4). 

10 (e) FUNDING.—The Secretary shall provide for the 

11 transfer from the Federal Supplementary Insurance Trust 

12 Fund established under section 1841 of the Social Secu13 rity Act (42 U.S.C. 1395t) of $1,000,000,000 for the costs 

14 of carrying out the demonstration program under this sec15 tion. 

16 (f) WAIVER AUTHORITY.—The Secretary may waive 

17 such requirements of titles XI and XVIII of the Social 

18 Security Act (42 U.S.C. 1301 et seq.; 1395 et seq.) as 

19 may be necessary for the purpose of carrying out the dem20 onstration program under this section. 

21 (g) REPORT.—Not later than 6 months after the 

22 completion of the demonstration program under this sec23 tion, the Secretary shall submit to Congress a report on 

24 such program, together with recommendations for such 
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1 legislation and administrative action as the Secretary de2 termines to be appropriate. 

3 (h) DEFINITIONS.—In this section: 

4 (1) CARE COORDINATOR.—The term ‘‘care co5 ordinator’’ means a physician (as defined in sub6 section (r)(1)) or an entity that meets such condi7 tions as the Secretary may specify (which may in8 clude physicians, physician group practices, or other 

9 health care professionals or entities the Secretary 

10 may find appropriate) working in collaboration with 

11 a physician that—

12 (A) has entered into a care coordination 

13 agreement with the Secretary; and 

14 (B) meets such other criteria as the Sec15 retary may establish (which may include experi16 ence in the provision of care coordination). 

17 (2) CHRONIC CONDITION.—The term ‘‘chronic 

18 condition’’ means an illness, functional limitation, or 

19 cognitive impairment that is expected to last at least 

20 one year, limits the activities of an individual, and 

21 requires ongoing care. 

22 (3) ELIGIBLE INDIVIDUAL.—For purposes of 

23 this subsection, the term ‘‘eligible individual’’ means 

24 an individual who has—
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1 (A) multiple chronic conditions, including 

2 dementia; 

3 (B) a high rate of use of covered part D 

4 drugs (as defined in section 1860D–2(e)(1)); 

5 and 

6 (C) a high rate of use of services for which 

7 payment is made under this title. 

8 (4) MEDICARE PROGRAM.—The term ‘‘medicare 

9 program’’ means the health care program under title 

10 XVIII of the Social Security Act (42 U.S.C. 1395 et 

11 seq.). 

12 (i) CONFORMING REPEAL.—

13 (1) REPEAL.—Section 649 of MMA (42 U.S.C. 

14 1395b–1 note) is repealed. 

15 (2) EFFECTIVE DATE.—The amendment made 

16 by this subsection shall take effect as if such section 

17 649 was not included in the enactment of MMA 

18 (117 Stat. 2066 et seq.). 

19 TITLE VII—REQUIRING MORE 

20 APPROPRIATE PAYMENTS TO 

21 PRIVATE PLANS 

22 SEC. 701. ELIMINATION OF MA REGIONAL PLAN STABILIZA23 TION FUND (SLUSH FUND). 

24 (a) IN GENERAL.—Subsection (e) of section 1858 (42 

25 U.S.C. 1395w–27a) is repealed. 
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1 (b) EFFECTIVE DATE.—The amendment made by 

2 this section shall take effect as if such subsection had not 

3 been included in the enactment of section 221(c) of MMA 

4 (117 Stat. 2181). 

5 SEC. 702. REQUIRING PRIVATE PLAN PAYMENTS TO RE6 FLECT APPROPRIATE HEALTH RISK ADJUST7 MENT. 

8 Effective January 1, 2005, in applying risk adjust9 ment factors to payments to organizations under section 

10 1853 of the Social Security Act (42 U.S.C. 1395w–23) 

11 in a budget neutral manner— 

12 (1) the Secretary shall ensure that such factors, 

13 in the aggregate, take into account the actuarial 

14 characteristics of the entire medicare population, 

15 and not merely the population of individuals enrolled 

16 under a plan under part C of title XVIII of such 

17 Act; and 

18 (2) the Secretary shall not make any adjust19 ments in the aggregate amount of payments under 

20 this part solely for the purpose of ensuring that such 

21 aggregate payments are not affected in whole or in 

22 part by the application of such risk adjustment fac23 tors.
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1 SEC. 703. PHASE-IN PRIVATE PLAN PAYMENT TO 100 PER2 CENT OF FEE-FOR-SERVICE RATE. 

3 Notwithstanding any other provision of law, the Sec4 retary shall provide, in a phased-in manner over a 5-year 

5 period beginning with 2005, for adjustment of payment 

6 rates to organizations under section 1853 of the Social 

7 Security Act (42 U.S.C. 1395w–23) so that, at the end 

8 of such phase-in period, such payment rates reflect only 

9 the payment rate described in subsection (c)(1)(D) of such 

10 section (relating to 100 percent fee-for-service payment). 

11 TITLE VIII—REPEAL OF 

12 PREMIUM SUPPORT PROGRAM 

13 SEC. 801. REPEAL OF PREMIUM SUPPORT PROGRAM. 

14 Subtitle E of title II of MMA (117 Stat. 2214) is 

15 repealed and any provisions of law amended by such sec16 tion are restored as if such subtitle had not been enacted. 

17 TITLE IX—PROVIDING BETTER 

18 INFORMATION TO MEDICARE 

19 BENEFICIARIES 

20 SEC. 901. PROVIDING ACCURATE INFORMATION TO BENE21 FICIARIES. 

22 (a) IN GENERAL.—Section 1860D–1(c)(1) (42 

23 U.S.C. 1395w–101(c)(1)) is amended by striking ‘‘Such 

24 activities shall ensure that such information is first made 

25 available’’ and inserting ‘‘Such activities shall ensure that 

26 such information is not misleading, false, or deceptive and 
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1 appropriately targets part D eligible individuals (and pro2 spective eligible individuals). Funding expended for these 

3 activities shall give priority to activities that directly target 

4 part D eligible individuals (and prospective eligible individ5 uals), including face-to-face educational sessions with such 

6 individuals. This information shall be made available’’. 

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

8 this section shall take effect as if included in the enact9 ment of section 101 of MMA (117 Stat. 2071). 

10 SEC. 902. PROVIDING MEDICARE BENEFICIARIES WITH 

11 BETTER UPFRONT DRUG COVERAGE INFOR12 MATION. 

13 (a) IN GENERAL.—Section 1860D–1(c) (42 U.S.C. 

14 1395w–101(c)) is amended by adding at the end the fol15 lowing new paragraph: 

16 ‘‘(5) DISCLOSURE BY PLAN SPONSORS OF

17 DRUG-SPECIFIC COVERAGE INFORMATION PRIOR TO

18 ENROLLMENT.— 

19 ‘‘(A) IN GENERAL.—Upon the request of 

20 any part D eligible individual, a PDP sponsor 

21 offering a prescription drug plan or an MA or22 ganization offering an MA–PD plan shall dis23 close to the individual the information described 

24 in subparagraph (B) during the period in which 

25 the individual is eligible to elect coverage under 
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1 the plan so that such individual may take such 

2 information into account in determining wheth3 er to enroll under the plan. 

4 ‘‘(B) INFORMATION DESCRIBED.—The in5 formation described in this subparagraph is as 

6 follows: 

7 ‘‘(i) Access to specific covered part D 

8 drugs, including access through pharmacy 

9 networks. 

10 ‘‘(ii) How any formulary (including 

11 any tiered formulary structure) used by 

12 the sponsor functions, including a descrip13 tion of how a part D eligible individual 

14 may obtain information on the formulary 

15 consistent with section 1860D–4(a)(3). 

16 ‘‘(iii) Beneficiary cost-sharing require17 ments and how a part D eligible individual 

18 may obtain information on such require19 ments, including tiered or other copayment 

20 level applicable to each drug (or class of 

21 drugs), consistent with section 1860D–

22 4(a)(3). 

23 ‘‘(iv) The medication therapy manage24 ment program required under section 

25 1860D–4(c). The provisions of section 
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1 1927(b)(3)(D) shall apply to information 

2 disclosed to the Secretary under this para3 graph.’’. 

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

5 this section shall take effect as if included in the enact6 ment of section 101 of MMA (117 Stat. 2071). 

7 SEC. 903. ENSURING MEDICARE BENEFICIARIES ARE IN8 FORMED OF FORMULARY CHANGES. 

9 (a) IN GENERAL.—Section 1860D–4(a)(3)(B) (42 

10 U.S.C. 1395w–104(a)(3)(B)) is amended to read as fol11 lows: 

12 ‘‘(B) NOTIFICATION OF CHANGES IN FOR13 MULARY THROUGH THE INTERNET, MAIL, AND

14 TELEPHONE.—A PDP sponsor offering a pre15 scription drug plan shall make available infor16 mation on specific changes in the formulary 

17 under the plan (including changes to tiered or 

18 preferred status of covered part D drugs) on a 

19 timely basis—

20 ‘‘(i) through an Internet website; 

21 ‘‘(ii) by mailing a notice of the spe22 cific changes to each enrollee who may be 

23 affected by such changes; and 
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1 ‘‘(iii) through the toll-free telephone 

2 number established under subparagraph 

3 (A).’’. 

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

5 this section shall take effect as if included in the enact6 ment of section 101 of MMA (117 Stat. 2071). 

7 TITLE X—FULL FUNDING AND 

8 EXPANSION FOR DEM9 ONSTRATION PROJECT FOR 

10 COVERAGE OF CERTAIN PRE11 SCRIPTION DRUGS AND 

12 BIOLOGICALS 

13 SEC. 1001. FULL FUNDING AND EXPANSION FOR DEM14 ONSTRATION PROJECT FOR COVERAGE OF 

15 CERTAIN PRESCRIPTION DRUGS AND 

16 BIOLOGICALS. 

17 (a) IN GENERAL.—Section 641 of MMA (42 U.S.C. 

18 1395l note) is amended—

19 (1) by striking subsection (b) and inserting the 

20 following new subsection: 

21 ‘‘(b) NATIONWIDE COVERAGE.—The project estab22 lished under this section shall be conducted throughout 

23 the entire United States.’’; and 

24 (2) in subsection (d)—
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1 (A) in the matter preceding paragraph (1), 

2 by striking ‘‘may not’’ and inserting ‘‘shall’’; 

3 (B) by striking paragraph (1) and insert4 ing the following new paragraph: 

5 ‘‘(1) coverage for each medicare beneficiary for 

6 whom a drug or biological described in subsection 

7 (a) is prescribed; and’’; and 

8 (C) in paragraph (2), by striking ‘‘more 

9 than $500,000,000 in funding’’ and inserting 

10 ‘‘for not more than $2,100,000,000 in fund11 ing’’. 

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

13 this section shall take effect as if included in the enact14 ment of section 641 of MMA (177 Stat. 2321).

Æ