abuse whose access to coverage for frequently 
abused drugs under a prescription drug plan 
has been limited by a PDP sponsor under this 
paragraph, such PDP sponsor shall disclose 
data, including any necessary individually iden-
tifiable health information, in a form and man-
ner specified by the Secretary, about the deci-
sion to impose such limitations and the limita-
tions imposed by the sponsor under this part. 
‘‘(I) EDUCATION.—The Secretary shall 
provide education to enrollees in prescription 
drug plans of PDP sponsors and providers re-
garding the drug management program for at- 
risk beneficiaries described in this paragraph, 
including education— 
‘‘(i) provided by medicare administra-
tive contractors through the improper pay-
ment outreach and education program de-
scribed in section 1874A(h); and 
‘‘(ii) through current education efforts 
(such as State health insurance assistance 
programs described in subsection (a)(1)(A) 
of section 119 of the Medicare Improve-
ments for Patients and Providers Act of 
VerDate Sep 11 2014 
06:24 Feb 28, 2015
Jkt 049200
PO 00000
Frm 00034
Fmt 6652
Sfmt 6201
E:\BILLS\H1021.IH
H1021
SSpencer on DSK4SPTVN1PROD with BILLS
2008 (42 U.S.C. 1395b–3 note)) and ma-
terials directed toward such enrollees.’’. 
(2) INFORMATION
FOR
CONSUMERS.—Section 
1860D–4(a)(1)(B) of the Social Security Act (42 
U.S.C. 1395w–104(a)(1)(B)) is amended by adding 
at the end the following: 
‘‘(v) The drug management program 
for at-risk beneficiaries under subsection 
(c)(5).’’. 
(b) UTILIZATION MANAGEMENT PROGRAMS.—Sec-
tion 1860D–4(c) of the Social Security Act (42 U.S.C. 
1395w–104(c)), as amended by subsection (a) and section 
8, is further amended— 
(1) in paragraph (1), by inserting after sub-
paragraph (D) the following new subparagraph: 
‘‘(E) A utilization management tool to pre-
vent drug abuse (as described in paragraph 
(6)(A)).’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(6) UTILIZATION MANAGEMENT TOOL TO PRE-
VENT DRUG ABUSE.— 
‘‘(A) IN
GENERAL.—A tool described in 
this paragraph is any of the following: 
VerDate Sep 11 2014 
06:24 Feb 28, 2015
Jkt 049200
PO 00000
Frm 00035
Fmt 6652
Sfmt 6201
E:\BILLS\H1021.IH
H1021
SSpencer on DSK4SPTVN1PROD with BILLS
‘‘(i) A utilization tool designed to pre-
vent the abuse of frequently abused drugs 
by individuals and to prevent the diversion 
of such drugs at pharmacies. 
‘‘(ii) Retrospective utilization review 
to identify— 
‘‘(I) individuals that receive fre-
quently abused drugs at a frequency 
or in amounts that are not clinically 
appropriate; and 
‘‘(II) providers of services or sup-
pliers that may facilitate the abuse or 
diversion of frequently abused drugs 
by beneficiaries. 
‘‘(iii) Consultation with the Con-
tractor described in subparagraph (B) to 
verify if an individual enrolling in a pre-
scription drug plan offered by a PDP 
sponsor has been previously identified by 
another PDP sponsor as an individual de-
scribed in clause (ii)(I). 
‘‘(B) REPORTING.—A PDP sponsor offer-
ing a prescription drug plan in a State shall 
submit to the Secretary and the Medicare drug 
integrity contractor with which the Secretary 
VerDate Sep 11 2014 
06:24 Feb 28, 2015
Jkt 049200
PO 00000
Frm 00036
Fmt 6652
Sfmt 6201
E:\BILLS\H1021.IH
H1021
SSpencer on DSK4SPTVN1PROD with BILLS
has entered into a contract under section 1893 
with respect to such State a report, on a 
monthly basis, containing information on— 
‘‘(i) any provider of services or sup-
plier described in subparagraph (A)(ii)(II) 
that is identified by such plan sponsor dur-
ing the 30-day period before such report is 
submitted; and 
‘‘(ii) 
the 
name 
and 
prescription 
records of individuals described in para-
graph (5)(C).’’. 
(c) EXPANDING ACTIVITIES OF MEDICARE DRUG IN-
TEGRITY CONTRACTORS (MEDICS).—Section 1893 of the 
Social Security Act (42 U.S.C. 1395ddd) is amended by 
adding at the end the following new subsection: 
‘‘(j) EXPANDING ACTIVITIES OF MEDICARE DRUG 
INTEGRITY CONTRACTORS (MEDICS).— 
‘‘(1) ACCESS
TO
INFORMATION.—Under con-
tracts entered into under this section with Medicare 
drug integrity contractors, the Secretary shall au-
thorize such contractors to directly accept prescrip-
tion and necessary medical records from entities 
such as pharmacies, prescription drug plans, and 
physicians with respect to an individual in order for 
such contractors to provide information relevant to 
VerDate Sep 11 2014 
06:24 Feb 28, 2015
Jkt 049200
PO 00000
Frm 00037
Fmt 6652
Sfmt 6201
E:\BILLS\H1021.IH
H1021
SSpencer on DSK4SPTVN1PROD with BILLS
the determination of whether such individual is an 
at-risk beneficiary for prescription drug abuse, as 
defined in section 1860D–4(c)(5)(C). 
‘‘(2) REQUIREMENT
FOR
ACKNOWLEDGMENT 
OF REFERRALS.—If a PDP sponsor refers informa-
tion to a contractor described in paragraph (1) in 
order for such contractor to assist in the determina-
tion described in such paragraph, the contractor 
shall— 
‘‘(A) acknowledge to the PDP sponsor re-
ceipt of the referral; and 
‘‘(B) in the case that any PDP sponsor 
contacts the contractor requesting to know the 
determination by the contractor of whether or 
not an individual has been determined to be an 
individual described such paragraph, shall in-
form such PDP sponsor of such determination 
on a date that is not later than 15 days after 
the date on which the PDP sponsor contacts 
the contractor. 
‘‘(3) MAKING DATA AVAILABLE TO OTHER EN-
TITIES.— 
‘‘(A) IN GENERAL.—For purposes of car-
rying out this subsection, subject to subpara-
graph (B), the Secretary shall authorize MED-
VerDate Sep 11 2014 
06:24 Feb 28, 2015
Jkt 049200
PO 00000
Frm 00038
Fmt 6652
Sfmt 6201
E:\BILLS\H1021.IH
H1021
SSpencer on DSK4SPTVN1PROD with BILLS