described but for the fact that their income ex-
ceeds 100 percent, but does not exceed 135 per-
cent, of the official poverty line (referred to in 
such section) for a family of the size involved; 
‘‘(II) for making medical assistance avail-
able, subject to section 1905(p)(4), for a reduc-
tion in medicare cost-sharing described in sec-
tion 1860D–5(e)(2) for individuals (other than 
qualified medicare beneficiaries and individuals 
described in subclause (I)) who are enrolled 
under part D of title XVIII and are described 
in section 1905(p)(1)(B) or would be described 
under such section but for the fact that their 
income exceeds 135 percent, but does not ex-
ceed 185 percent, of the official poverty line 
(referred to in such section) for a family of the 
size involved; and 
‘‘(III) for individuals (other than qualified 
medicare beneficiaries and individuals described 
in subclause (I) or (II)) who are enrolled under 
part D of title XVIII and would be described in 
section 1905(p)(1)(B) but for the fact that 
their income exceeds 200 percent, but does not 
exceed 300 percent, of the official poverty line 
(referred to in such section) for a family of the
size involved, for making medical assistance 
available for medicare cost-sharing described in 
section 1905(p)(3)(A)(iii);’’. 
(c) FEDERAL FINANCING OF ADDITIONAL LOW IN-
COME
ASSISTANCE.—The third sentence of section 
1905(b) (42 U.S.C. 1396d(b)) is amended by inserting be-
fore the period at the end the following: ‘‘and with respect 
to amounts expended that are attributable to the amend-
ments made by subsection (a) or (b) of section 104 of the 
Medicare Prescription Drug Affordability Act of 2005’’. 
(d) TREATMENT OF TERRITORIES.— 
(1) IN GENERAL.—Section 1905(p) (42 U.S.C. 
1396d(p)) is amended— 
(A) by redesignating paragraphs (5) and 
(6) as paragraphs (6) and (7), respectively; and 
(B) by inserting after paragraph (4) the 
following new paragraph: 
‘‘(5)(A) In the case of a State, other than the 50 
States and the District of Columbia— 
‘‘(i) the provisions of paragraph (3) insofar as 
they relate to section 1860D–5 and the provisions of 
section 1902(a)(10)(E)(v) shall not apply to resi-
dents of such State; and 
‘‘(ii) if the State establishes a plan described in 
subparagraph (B) (for providing medical assistance
with respect to the provision of prescription drugs to 
medicare beneficiaries), the amount otherwise deter-
mined under section 1108(f) (as increased under 
section 1108(g)) for the State shall be increased by 
the amount specified in subparagraph (C). 
‘‘(B) The plan described in this subparagraph is a 
plan that— 
‘‘(i) provides medical assistance with respect to 
the provision of covered outpatient drugs (as defined 
in section 1860D–5(b)) to low-income medicare 
beneficiaries; and 
‘‘(ii) assures that additional amounts received 
by the State that are attributable to the operation 
of this paragraph are used only for such assistance. 
‘‘(C)(i) The amount specified in this subparagraph 
for a State for a year is equal to the product of— 
‘‘(I) the aggregate amount specified in clause 
(ii); and 
‘‘(II) the amount specified in section 1108(g)(1) 
for that State, divided by the sum of the amounts 
specified in such section for all such States. 
‘‘(ii) The aggregate amount specified in this clause 
for— 
‘‘(I) 2006, is equal to $25,000,000; or
‘‘(II) a subsequent year, is equal to the aggre-
gate amount specified in this clause for the previous 
year increased by annual percentage increase speci-
fied in section 1860D–5(c)(8)(B) for the year in-
volved. 
‘‘(D) The Secretary shall submit to Congress a report 
on the application of this paragraph and may include in 
the report such recommendations as the Secretary deems 
appropriate.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1108(f) (42 U.S.C. 1308(f)) is amended by inserting 
‘‘and section 1905(p)(5)(A)(ii)’’ after ‘‘Subject to 
subsection (g)’’. 
(e) 
APPLICATION
OF
COST-SHARING.—Section 
1902(n)(2) (42 U.S.C. 1396a(n)(2)) is amended by add-
ing at the end the following: ‘‘The previous sentence shall 
not apply to medicare cost-sharing relating to benefits 
under part D of title XVIII.’’. 
(f) EFFECTIVE DATE.—The amendments made by 
this section apply to medical assistance for premiums and 
cost-sharing incurred on or after January 1, 2006, with 
regard to whether regulations to implement such amend-
ments are promulgated by such date.
SEC. 105. EXPANSION OF MEMBERSHIP AND DUTIES OF 
MEDICARE PAYMENT ADVISORY COMMISSION 
(MEDPAC). 
(a) EXPANSION OF MEMBERSHIP.— 
(1) IN GENERAL.—Section 1805(c) (42 U.S.C. 
1395b–6(c)) is amended— 
(A) in paragraph (1), by striking ‘‘17’’ and 
inserting ‘‘19’’; and 
(B) in paragraph (2)(B), by inserting ‘‘ex-
perts in the area of pharmacology and prescrip-
tion drug benefit programs,’’ after ‘‘other 
health professionals,’’. 
(2) INITIAL
TERMS
OF
ADDITIONAL
MEM-
BERS.— 
(A) IN GENERAL.—For purposes of stag-
gering the initial terms of members of the 
Medicare Payment Advisory Commission under 
section 1805(c)(3) of the Social Security Act 
(42 U.S.C. 1395b–6(c)(3)), the initial terms of 
the 2 additional members of the Commission 
provided for by the amendment under para-
graph (1)(A) are as follows: 
(i) One member shall be appointed for 
1 year. 
(ii) One member shall be appointed 
for 2 years.
(B) COMMENCEMENT
OF
TERMS.—Such 
terms shall begin on January 1, 2006. 
(b) EXPANSION OF DUTIES.—Section 1805(b)(2) (42 
U.S.C. 1395b–6(b)(2)) is amended by adding at the end 
the following new subparagraph: 
‘‘(D) PRESCRIPTION DRUG BENEFIT PRO-
GRAM.—Specifically, the Commission shall re-
view, with respect to the prescription drug ben-
efit program under part D, the following: 
‘‘(i) The methodologies used for the 
management of costs and utilization of 
prescription drugs. 
‘‘(ii) The prices negotiated and paid, 
including trends in such prices and appli-
cable discounts and comparisons with 
prices under section 1860D–6(a)(2)(E). 
‘‘(iii) The relationship of pharmacy 
acquisition costs to the prices so negotiated 
and paid. 
‘‘(iv) The methodologies used to en-
sure access to covered outpatient prescrip-
tion drugs and to ensure quality in the ap-
propriate dispensing and utilization of such 
drugs.
‘‘(v) The impact of the program on 
promoting the development of break-
through drugs.’’. 
TITLE II—AFFORDABLE 
PHARMACEUTICALS 
Subtitle A—Importation of 
Prescription Drugs 
SEC. 201. SHORT TITLE. 
This subtitle may be cited as the ‘‘Pharmaceutical 
Market Access Act of 2005’’. 
SEC. 202. FINDINGS. 
The Congress finds as follows: 
(1) Americans unjustly pay up to 1000 percent 
more to fill their prescriptions than consumers in 
other countries. 
(2) The United States is the world’s largest 
market for pharmaceuticals yet consumers still pay 
the world’s highest prices. 
(3) An unaffordable drug is neither safe nor ef-
fective. Allowing and structuring the importation of 
prescription drugs ensures access to affordable 
drugs, thus providing a level of safety to American 
consumers they do not currently enjoy.
(4) According to the Congressional Budget Of-
fice, American seniors alone will spend $1.8 trillion 
dollars on pharmaceuticals over the next ten years. 
(5) Allowing open pharmaceutical markets 
could save American consumers at least $635 billion 
of their own money each year. 
SEC. 203. PURPOSES. 
The purposes of this subtitle are as follows: 
(1) RELIEF FROM HIGH DRUG COSTS.—To give 
all Americans immediate relief from the outrageously 
high cost of pharmaceuticals. 
(2) CORRECT ECONOMICS OF DRUG MARKET.— 
To reverse the perverse economics of the American 
pharmaceutical markets. 
(3) LIMITING
IMPORTATION
OF
DRUGS
TO 
THOSE ONLY APPROVED BY THE FDA.—To allow the 
importation of drugs only if the drugs and the facili-
ties where they are manufactured are approved by 
the Food and Drug Administration, and to exclude 
pharmaceutical narcotics. 
(4) USE
OF
COUNTERFEIT-RESISTANT
PACK-
AGING.—To require that imported prescription drugs 
be packaged and shipped using counterfeit-resistant 
technologies approved by the Bureau of Engraving
and Printing (technologies similar to those used to 
secure United States currency). 
SEC. 204. IMPORTATION OF PRESCRIPTION DRUGS. 
(a) RESTORATION OF FORMER TEXT.—The Federal 
Food, Drug, and Cosmetic Act is is amended— 
(1) in section 804 (21 U.S.C. 384), by amend-
ing the section to read as if section 1121(a) of the 
Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108–173) 
had not been enacted; 
(2) in section 301 (21 U.S.C. 331), by amend-
ing the section to read as if section 1121(b)(1) of 
such Act had not been enacted; and 
(3) in section 303 (21 U.S.C. 333), by amend-
ing the section to read as if section 1121(b)(2) of 
such Act had not been enacted. 
(b) IMPORTATION OF PRESCRIPTION DRUGS.—Sec-
tion 804 of the Federal Food, Drug, and Cosmetic Act, 
as amended by subsection (a), is amended— 
(1) in subsection (a)— 
(A) by striking ‘‘The Secretary’’ and in-
serting ‘‘Not later than 180 days after the date 
of the enactment of the Pharmaceutical Market 
Access Act of 2005, the Secretary’’; and
(B) by striking ‘‘pharmacists and whole-
salers’’ and inserting ‘‘pharmacists, wholesalers, 
and qualifying individuals’’; 
(2) in subsection (b)— 
(A) by amending paragraph (1) to read as 
follows: 
‘‘(1) require that each covered product imported 
pursuant to such subsection complies with sections 
501, 502, and 505, and other applicable require-
ments of this Act; and’’; 
(B) in paragraph (2), by striking ‘‘, includ-
ing subsection (d); and’’ and inserting a period; 
and 
(C) by striking paragraph (3); 
(3) in subsection (c), by inserting ‘‘by phar-
macists and wholesalers (but not qualifying individ-
uals)’’ after ‘‘importation of covered products’’; 
(4) in subsection (d)— 
(A) by striking paragraphs (3) and (10); 
(B) in paragraph (5), by striking ‘‘, includ-
ing the professional license number of the im-
porter, if any’’; 
(C) in paragraph (6)—