I 

108TH CONGRESS 

2D SESSION H. R. 4681 

To require the Secretary of Health and Human Services to establish and 

maintain an Internet website that is designed to allow consumers to 

compare the usual and customary prices for covered outpatient drugs 

sold by retail pharmacies that participate in the Medicaid Program 

for each postal Zip Code, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 24, 2004 

Mr. CARDIN (for himself, Mr. PALLONE, and Mr. MCNULTY) introduced the 

following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To require the Secretary of Health and Human Services 

to establish and maintain an Internet website that is 

designed to allow consumers to compare the usual and 

customary prices for covered outpatient drugs sold by 

retail pharmacies that participate in the Medicaid Program for each postal Zip Code, 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. 

4 This Act may be cited as the ‘‘Prescription Drug 

5 Price Comparison for Savings Act of 2004’’. 
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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) Access to prescription drugs is important to 

4 all Americans. 

5 (2) Many individuals cannot afford to purchase 

6 the drugs prescribed by their doctors. Others skip 

7 doses or split pills contrary to their doctor’s orders 

8 because they cannot afford to refill their prescrip9 tions. 

10 (3) Individuals who use their limited financial 

11 resources to obtain needed drugs may do so by fore12 going other expenditures important to their health 

13 and well-being. 

14 (4) Among the objectives of the medicaid pro15 gram set forth in section 1901 of the Social Security 

16 Act (42 U.S.C. 1396) is the objective to enable each 

17 State to furnish services to help low-income families 

18 and aged, blind, or disabled individuals ‘‘attain or 

19 retain capability for independence or self-care’’. 

20 (5) Some States, such as Maryland, have estab21 lished interactive Internet websites that use the 

22 usual and customary price information reported by 

23 pharmacies participating in the State’s medicaid 

24 program to allow all residents of the State to com25 parison shop for prescription drugs. 
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1 (6) Requiring all States to collect from phar2 macies that participate in the medicaid program the 

3 usual and customary price for prescription drugs 

4 sold by the pharmacies and to report that informa5 tion to the Secretary of Health and Human Services 

6 in order that a national, interactive Internet website 

7 may be established and maintained for individuals to 

8 use to comparison shop for prescription drugs is 

9 consistent with the objectives of the medicaid pro10 gram. 

11 SEC. 3. STATE PLAN REQUIREMENT TO COLLECT AND RE12 PORT USUAL AND CUSTOMARY PRICES FOR 

13 COVERED OUTPATIENT DRUGS SOLD UNDER 

14 THE MEDICAID PROGRAM. 

15 Section 1902(a) of the Social Security Act (42 U.S.C. 

16 1396a(a)) is amended— 

17 (1) in paragraph (66), by striking ‘‘and’’ at the 

18 end; 

19 (2) in paragraph (67), by striking the period 

20 and inserting ‘‘; and’’; and 

21 (3) by inserting after paragraph (67), the fol22 lowing: 

23 ‘‘(68) provide that the State shall— 

24 ‘‘(A) require each retail pharmacy which 

25 receives payments under the plan to report to 
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1 the State concurrent with the filling of a pre2 scription for a covered outpatient drug (as de3 fined in section 1927(k)(2)) for an individual 

4 receiving medical assistance under this title— 

5 ‘‘(i) the usual and customary price (as 

6 defined in section 1927(k)(10)) for the 

7 strength, quantity, and dosage form of the 

8 covered outpatient drug, as of the date the 

9 prescription is filled; and 

10 ‘‘(ii) the postal Zip Code in which the 

11 retail pharmacy is located; and 

12 ‘‘(B) submit the information reported 

13 under subparagraph (A) to the Secretary on 

14 such frequent basis as the Secretary shall re15 quire so as to allow for monthly updates of the 

16 information posted on the Internet website re17 quired to be established under section 5 of the 

18 Prescription Drug Price Comparison for Sav19 ings Act of 2004.’’. 

20 SEC. 4. USUAL AND CUSTOMARY PRICES FOR COVERED 

21 OUTPATIENT DRUGS. 

22 (a) DEFINITION.—Section 1927(k) of the Social Se23 curity Act (42 U.S.C. 1396r–8(k)) is amended by adding 

24 at the end the following: 
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1 ‘‘(10) USUAL AND CUSTOMARY PRICE.—The 

2 term ‘usual and customary price’ means the price a 

3 retail pharmacy would charge an individual who does 

4 not have health insurance coverage for purchasing a 

5 specific strength, quantity, and dosage form of a 

6 covered outpatient drug.’’. 

7 (b) INCLUSION OF INFORMATION IN ANNUAL RE8 PORT TO CONGRESS.—Section 1927(i)(2)(E) of the Social 

9 Security Act (42 U.S.C. 1396r–8(i)(2)(E)) is amended— 

10 (1) by redesignating subparagraphs (E) and 

11 (F) as subparagraphs (F) and (G), respectively; and 

12 (2) by inserting after subparagraph (D), the 

13 following: 

14 ‘‘(E) the range of usual and customary 

15 prices for specific strengths, quantities, and 

16 dosage forms of covered outpatient drugs, 

17 disaggregated by postal Zip Code;’’. 

18 SEC. 5. REQUIREMENT TO ESTABLISH AND MAINTAIN PRE19 SCRIPTION DRUG PRICE COMPARISON 

20 WEBSITE. 

21 (a) AUTHORITY.—Not later than 6 months after the 

22 date of enactment of this Act, the Secretary shall establish 

23 and arrange for the maintenance of an Internet website 

24 that is designed to allow an individual to compare the 

25 usual and customary prices for a range of strengths and 
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1 quantities of covered outpatient drugs sold by retail phar2 macies that receive payments under the medicaid program 

3 for each postal Zip Code that corresponds to an area of 

4 a State. 

5 (b) REQUIREMENTS.—The Internet website required 

6 to be established and maintained under this section shall 

7 consist of— 

8 (1) the information submitted to the Secretary 

9 in accordance with section 1902(a)(68)(B) of the 

10 Social Security Act (42 U.S.C. 1396a(a)(68)(B)) (as 

11 added by section 3(a)(3)); and 

12 (2) such other information as the Secretary de13 termines is appropriate. 

14 (c) DEFINITIONS.—In this section: 

15 (1) COVERED OUTPATIENT DRUG.—The term 

16 ‘‘covered outpatient drug’’ has the meaning given 

17 that term in section 1927(k)(2) of the Social Secu18 rity Act (42 U.S.C. 1396r–8(k)(2)). 

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

20 the Secretary of Health and Human Services. 

21 (3) STATE.—The term ‘‘State’’ has the mean22 ing given that term for purposes of title XIX of the 

23 Social Security Act (42 U.S.C. 1396 et seq.). 

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