II 

109TH CONGRESS 

2D SESSION S. 3703 

To provide for a temporary process for individuals entering the Medicare 

coverage gap to switch to a plan that provides coverage in the gap. 

IN THE SENATE OF THE UNITED STATES 

JULY 20, 2006 

Ms. SNOWE (for herself and Mr. WYDEN) introduced the following bill; which 

was read twice and referred to the Committee on Finance 

A BILL 

To provide for a temporary process for individuals entering 

the Medicare coverage gap to switch to a plan that 

provides coverage in the gap. 

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 ‘‘Medicare Prescription 

5 Drug Lifeline Act of 2006’’. 


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•S 3703 IS

1 SEC. 2. TEMPORARY PROCESS FOR INDIVIDUALS ENTER2 ING THE MEDICARE COVERAGE GAP TO 

3 SWITCH TO A PLAN THAT PROVIDES COV4 ERAGE IN THE GAP. 

5 (a) PROCESS.—Notwithstanding any other provision 

6 of law, by not later than 30 days after the date of enact7 ment of this Act, the Secretary of Health and Human 

8 Services (in this section referred to as the ‘‘Secretary’’) 

9 shall establish a process under which an applicable indi10 vidual may terminate enrollment in the prescription drug 

11 plan or the MA–PD plan in which they are enrolled and 

12 enroll in any prescription drug plan or MA–PD plan— 

13 (1) that provides some coverage of covered part 

14 D drugs (as defined in subsection (e) of section 

15 1860D–2 of the Social Security Act (42 U.S.C. 

16 1395w–102)) after the individual has reached the 

17 initial coverage limit under the plan but has not 

18 reached the annual out-of-pocket threshold under 

19 subsection (b)(4)(B) of such section; and 

20 (2) subject to subsection (b), that serves the 

21 area in which the individual resides. 

22 (b) SPECIAL RULE PERMITTING APPLICABLE INDI23 VIDUALS TO ENROLL IN A PRESCRIPTION DRUG PLAN

24 OUTSIDE OF THE REGION IN WHICH THE INDIVIDUAL

25 RESIDES.—In the case of an applicable individual that re26 sides in a PDP region under section 1860D–11(a)(2) of 


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1 the Social Security Act (42 U.S.C. 1395w–111(a)(2)) in 

2 which there is no prescription drug plan available that pro3 vides some coverage of brand name covered part D drugs 

4 (as so defined) after the individual has reached the initial 

5 coverage limit under the plan but before the individual has 

6 reached such annual out-of-pocket threshold, the Sec7 retary shall ensure that the process established under sub8 section (a) permits the individual to enroll in a prescrip9 tion drug plan that provides such coverage but is in an10 other PDP region. The Secretary shall determine the PDP 

11 region in which the individual may enroll in such a pre12 scription drug plan. 

13 (c) NOTIFICATION OF APPLICABLE INDIVIDUALS.— 

14 Under the process established under subsection (a), the 

15 Secretary shall notify, or require sponsors of prescription 

16 drug plans and organizations offering MA–PD plans to 

17 notify, applicable individuals of the option to change plans 

18 under such process. Such notice shall be provided to an 

19 applicable individual within 30 days of meeting the defini20 tion of such an individual. 

21 (d) PROCESS IN EFFECT FOR REMAINING PORTION

22 OF 2006.—The process established under subsection (a) 

23 shall remain in effect through December 31, 2006. 

24 (e) DEFINITIONS.—In this section: 


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1 (1) APPLICABLE INDIVIDUAL.—The term ‘‘ap2 plicable individual’’ means a part D eligible indi3 vidual (as defined in section 1860D–1(a)(3)(A) of 

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

5 101(a)(3)(A)) who, with respect to a year— 

6 (A) is enrolled in a prescription drug plan 

7 or an MA–PD plan that does not provide any 

8 coverage of covered part D drugs (as so de9 fined) after the individual has reached the ini10 tial coverage limit under the plan but has not 

11 reached such annual out-of-pocket threshold; 

12 and 

13 (B) has reached such initial coverage limit 

14 or is within $750 of reaching such limit. 

15 (2) PRESCRIPTION DRUG PLAN; MA–PD PLAN.— 

16 The terms ‘‘prescription drug plan’’ and ‘‘MA–PD 

17 plan’’ have the meanings given those terms in sec18 tion 1860D–41(a)(14) of the Social Security Act (42 

19 U.S.C. 1395w–151(a)(14)) and section 1860D– 

20 1(a)(3)(C) of such Act (42 U.S.C. 1395w– 

21 101(a)(3)(C)), respectively. 

22 SEC. 3. GAO STUDY AND REPORT ON THE ELIMINATION OF 

23 THE MEDICARE PART D COVERAGE GAP. 

24 (a) STUDY.—The Comptroller General of the United 

25 States shall conduct a study on— 


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1 (1) the costs to the Medicare program of elimi2 nating the initial coverage limit under paragraph (3) 

3 of section 1860D–2(b) of the Social Security Act (42 

4 U.S.C. 1395w–102(b)) (and providing that standard 

5 prescription drug coverage included the coverage de6 scribed in paragraph (2) of such section until the in7 dividual reached the annual out-of-pocket threshold 

8 under subsection (b)(4)(B) of such section); and 

9 (2) the adjustment to the coinsurance under 

10 paragraph (2) of such section that would be nec11 essary to eliminate the initial coverage limit (and 

12 provide that standard prescription drug coverage in13 cluded such adjusted coinsurance amount until the 

14 individual reached such annual out-of-pocket thresh15 old) without increasing the costs to the Medicare 

16 program. 

17 (b) REPORT.—Not later than May 1, 2007, the 

18 Comptroller General of the United States shall submit a 

19 report to Congress on the study conducted under sub20 section (a) together with such recommendations as the 

21 Comptroller General determines to be appropriate. 

Æ 


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