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 explana-
tory 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 Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to require 
the sponsor of a prescription drug plan or an organiza-
tion 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 ex-
planatory prescription drug information and cards dis-
tributed by prescription drug plan sponsors. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Fair and Speedy 
Treatment (FAST) of Medicare Prescription Drug Claims 
Act of 2007’’. 
SEC. 2. PROMPT PAYMENT BY MEDICARE PRESCRIPTION 
DRUG PLANS AND MA–PD PLANS UNDER 
PART D. 
(a) APPLICATION TO PRESCRIPTION DRUG PLANS.— 
Section 1860D–12(b) of the Social Security Act (42 
U.S.C. 1395w–112 (b)) is amended by adding at the end 
the following new paragraph: 
‘‘(4) PROMPT PAYMENT OF CLEAN CLAIMS.— 
‘‘(A) PROMPT
PAYMENT.—Each contract 
entered into with a PDP sponsor under this 
subsection with respect to a prescription drug 
plan offered by such sponsor shall provide that 
payment shall be issued, mailed, or otherwise 
transmitted with respect to all clean claims sub-
mitted under this part within the applicable 
number of calendar days after the date on 
which the claim is received. 
‘‘(B) DEFINITIONS.—In this paragraph: 
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‘‘(I) CLEAN CLAIM.—The term ‘clean 
claim’ means a claim, with respect to a 
covered part D drug, that has no apparent 
defect or impropriety (including any lack 
of any required substantiating documenta-
tion) or particular circumstance requiring 
special treatment that prevents timely pay-
ment from being made on the claim under 
this part. 
‘‘(ii) APPLICABLE
NUMBER
OF
CAL-
ENDAR DAYS.—The term ‘applicable num-
ber of calendar days’ means— 
‘‘(I) with respect to claims sub-
mitted 
electronically, 
calendar 
days; and 
‘‘(II) with respect to claims sub-
mitted otherwise, 30 calendar days. 
‘‘(c) INTEREST PAYMENT.—If payment is 
not issued, mailed, or otherwise transmitted 
within the applicable number of calendar days 
(as defined in subparagraph (B)) after a clean 
claim is received, interest shall be paid at a rate 
used for purposes of section 3902(a) of title 31, 
United States Code (relating to interest pen-
alties for failure to make prompt payments), for 
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the period beginning on the day after the re-
quired payment date and ending on the date on 
which payment is made. 
‘‘(D) PROCEDURES INVOLVING CLAIMS.— 
‘‘(I) CLAIMS DEEMED TO BE CLEAN 
CLAIMS.— 
‘‘(I) IN GENERAL.—A claim for a 
covered part D drug shall be deemed 
to be a clean claim for purposes of 
this paragraph if the PDP sponsor in-
volved does not provide a notification 
of deficiency to the claimant by the 
10th day that begins after the date on 
which the claim is submitted. 
‘‘(II) NOTIFICATION
OF
DEFI-
CIENCY.—For purposes of subclause 
(II), the term ‘notification of defi-
ciency’ means a notification that 
specifies all defects or improprieties in 
the claim involved and that lists all 
additional information or documents 
necessary for the proper processing 
and payment of the claim. 
‘‘(ii) PAYMENT OF CLEAN PORTIONS 
OF CLAIMS.—A PDP sponsor shall, as ap-
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propriate, pay any portion of a claim for a 
covered part D drug that would be a clean 
claim but for a defect or impropriety in a 
separate portion of the claim in accordance 
with subparagraph (A). 
‘‘(iii) OBLIGATION TO PAY.—A claim 
for a covered part D drug submitted to a 
PDP sponsor that is not paid or contested 
by the provider within the applicable num-
ber of calendar days (as defined in sub-
paragraph (B)) shall be deemed to be a 
clean claim and shall be paid by the PDP 
sponsor in accordance with subparagraph 
(A). 
‘‘(iv) DATE OF PAYMENT OF CLAIM.— 
Payment of a clean claim under subpara-
graph (A) is considered to have been made 
on the date on which full payment is re-
ceived by the provider. 
‘‘(E) 
ELECTRONIC
TRANSFER
OF 
FUNDS.—A PDP sponsor shall pay all clean 
claims submitted electronically by an electronic 
funds transfer mechanism.’’. 
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(b) APPLICATION
TO
MA–PD PLANS.—Section 
1857(f) of such Act (42 U.S.C. 1395w–27) is amended 
by adding at the end the following new paragraph: 
‘‘(3) INCORPORATION
OF
CERTAIN
PRESCRIP-
TION DRUG PLAN CONTRACT REQUIREMENTS.—The 
provisions of section 1860D–12(b)(4) shall apply to 
contracts with a Medicare Advantage organization in 
the same manner as they apply to contracts with a 
PDP sponsor offering a prescription drug plan 
under part D.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to contracts entered into or re-
newed on or after the date of the enactment of this Act. 
SEC. 3. RESTRICTION ON CO-BRANDING. 
(a) APPLICATION TO PRESCRIPTION DRUG INFORMA-
TION DISSEMINATED.—Subsection (a) of section 1860D– 
4 of the Social Security Act (42 U.S.C. 1395w–104) is 
amended by adding at the end the following new para-
graph: 
‘‘(5) RESTRICTION ON DISPLAYING PHARMACY 
BRAND OR TRADEMARK INFORMATION.— 
‘‘(A) IN GENERAL.—It is unlawful for a 
PDP sponsor of a prescription drug plan to dis-
play on any explanatory information described 
in subparagraph (B), with respect to benefits 
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provided under this part, the brand or trade-
mark of any pharmacy. 
‘‘(B) EXPLANATORY
INFORMATION
DE-
SCRIBED.—For purposes of subparagraph (A), 
explanatory information is each of the fol-
lowing: 
‘‘(i) Information on evidence of cov-
erage under this part. 
‘‘(ii) Information that summarizes 
benefits provided under this part. 
‘‘(iii) Enrollment and disenrollment 
forms. 
‘‘(iv) Enrollment and disenrollment 
letters. 
‘‘(v) Pharmacy directories. 
‘‘(vi) Formulary information. 
‘‘(vii) Grievance letters provided pur-
suant to subsection (f), coverage deter-
mination letters provided pursuant to sub-
section (g), and appeals letters provided 
pursuant to subsection (h). 
‘‘(viii) Exceptions process letters. 
‘‘(ix) Information contained in sales 
descriptions or sales presentations.’’. 
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(b) APPLICATION TO ENROLLEE CARDS.—Subsection 
(b)(2)(A) of such section is amended by adding at the end 
the following new sentence: ‘‘It is unlawful for a PDP 
sponsor of a prescription drug plan to display on such a 
card the name, brand, or trademark of any pharmacy.’’ 
(c) EFFECTIVE DATE.— 
(1) EXPLANATORY
INFORMATION.—With re-
spect to explanatory information dispensed on or 
after the date of the enactment of this Act, the 
amendment made by subsection (a) shall apply to 
such information on and after the date that is 90 
days after such date of enactment. 
(2) ENROLLEE CARDS.—With respect to cards 
dispensed before, on, or after the date of the enact-
ment of this Act, the amendment made by sub-
section (b) shall apply to such cards on and after the 
date that is 90 days after such date of enactment. 
Any card dispensed before such date that is 90 days 
after the date of enactment that violates the second 
sentence of section 1860D–4(b)(2)(A) of the Social 
Security Act, as added by subsection (b), shall be re-
issued by such 90-day date. 
Æ 
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