II 

109TH CONGRESS 

1ST SESSION S. 778 

To amend titles XVIII and XIX of the Social Security Act to require a 

pharmacy that receives payments or has contracts under the medicare 

and medicaid programs to ensure that all valid prescriptions are filled 

without unnecessary delay or interference. 

IN THE SENATE OF THE UNITED STATES 

APRIL 13, 2005 

Mrs. BOXER (for herself and Mr. LAUTENBERG) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend titles XVIII and XIX of the Social Security Act 

to require a pharmacy that receives payments or has 

contracts under the medicare and medicaid programs 

to ensure that all valid prescriptions are filled without 

unnecessary delay or interference. 

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 ‘‘Pharmacy Consumer 

5 Protection Act of 2005’’. 
2 

•S 778 IS

1 SEC. 2. MEDICARE PHARMACY REQUIREMENTS. 

2 (a) IN GENERAL.—Title XVIII of the Social Security 

3 Act (42 U.S.C. 1395 et seq.) is amended by adding at 

4 the end the following new section: 

5 ‘‘PHARMACY REQUIREMENTS

6 ‘‘SEC. 1898. (a) REQUIREMENTS.—No payment (as 

7 defined in subsection (b)(1)) may be made to a pharmacy 

8 unless the pharmacy complies with the following require9 ments: 

10 ‘‘(1) VALID PRESCRIPTIONS FILLED.—The 

11 pharmacy ensures that each valid prescription is 

12 filled without unnecessary delay or other inter13 ference, consistent with the normal timeframe for 

14 filling prescriptions. 

15 ‘‘(2) PRESCRIBED ITEM NOT IN STOCK.—The 

16 pharmacy ensures that, if the prescribed item is not 

17 in the pharmacy’s stock, the pharmacy will order 

18 such item without unnecessary delay or, if the pa19 tient prefers, the pharmacy will transfer the pre20 scription to a local pharmacy of the patient’s choice 

21 or return the prescription to the patient, at the pa22 tient’s request. 

23 ‘‘(b) DEFINITIONS.—For purposes of this section: 

24 ‘‘(1) PAYMENT.—For purposes of this section 

25 the term ‘payment’ means either of the following: 

26 ‘‘(A) Direct payment to a pharmacy. 
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•S 778 IS

1 ‘‘(B) Payment to a pharmacy through a 

2 contract with a PDP sponsor offering a pre3 scription drug plan, an MA organization offer4 ing an MA–PD plan, or a fallback prescription 

5 drug plan. 

6 ‘‘(2) PRESCRIBED ITEM.—The term ‘prescribed 

7 item’ means a drug or device approved by the Food 

8 and Drug Administration under section 505 of the 

9 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 

10 355), or a biological product licensed under section 

11 351 of the Public Health Services Act (42 U.S.C. 

12 238 et seq.). 

13 ‘‘(3) VALID PRESCRIPTION.—The term ‘valid 

14 prescription’ means a prescription issued by a li15 censed health care provider for a prescribed item (as 

16 defined in paragraph (2)). 

17 ‘‘(c) RULE OF CONSTRUCTION.—Nothing in this sec18 tion shall prohibit a pharmacy from refusing to dispense 

19 a prescribed item, in accordance with standard pharmacy 

20 practice, if there is a valid medical concern that such pre21 scribed item will cause problems due to therapeutic dupli22 cations, drug-disease contraindications, drug interactions 

23 (including serious interactions with prescription or over24 the-counter medications), incorrect dosage or duration of 

25 drug treatment, drug-allergy interactions, or drug abuse 
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1 or misuse. Any refusal to dispense a prescribed item must 

2 be based on generally accepted practice among health care 

3 providers.’’. 

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

5 4(b)(1)(A) of the Social Security Act (42 U.S.C. 1395w– 

6 104(b)(1)(A)) is amended by adding ‘‘, such terms and 

7 conditions shall require that the pharmacy complies with 

8 the requirements of section 1898’’ before the period at the 

9 end. 

10 SEC. 3. MEDICAID PHARMACY REQUIREMENTS. 

11 Section 1902(a)(23) of the Social Security Act (42 

12 U.S.C. 1396a(a)(23)) is amended— 

13 (1) by striking ‘‘and (B)’’ and inserting ‘‘(B)’’; 

14 and 

15 (2) by inserting the following before the semi16 colon at the end: ‘‘, and (C) any pharmacy that pro17 vides services to any individual eligible for medical 

18 assistance shall comply with the requirements of sec19 tion 1898’’. 

20 SEC. 4. EFFECTIVE DATE. 

21 The amendments made by this act shall apply to pre22 scriptions issued or filled on or after January 1, 2006. 

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