I 
109TH CONGRESS 
2D SESSION 
H. R. 4660 
To provide for necessary beneficiary protections in order to ensure access 
to coverage under the Medicare part D prescription drug program. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 31, 2006 
Mr. ALLEN (for himself, Mr. BROWN of Ohio, Mr. BERRY, Mr. ROSS, Mr. 
MICHAUD, Mr. STRICKLAND, and Mr. WYNN) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committee on Ways and Means, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of 
such provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To provide for necessary beneficiary protections in order 
to ensure access to coverage under the Medicare part 
D prescription drug program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Requiring Emergency Pharmaceutical Access for Indi-
vidual Relief (REPAIR) Act of 2006’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows:
Sec. 1. Short title; table of contents 
Sec. 2. Transition requirements 
Sec. 3. Federal fallback for full-benefit dual eligible individuals for 2006 
Sec. 4. Identifying full-benefit dual eligible individuals in data records 
Sec. 5. Prohibition on conditioning Medicaid eligibility for individuals enrolled 
in certain creditable prescription drug coverage on enrollment 
in the Medicare part D drug program 
Sec. 6. Ensuring that full-benefit dual eligible individuals are not overcharged 
Sec. 7. Reimbursement of States for 2006 transition costs 
Sec. 8. Facilitation of identification and enrollment through pharmacies of full- 
benefit dual eligible individuals in the Medicare part D drug 
program 
Sec. 9. State health insurance program assistance regarding the new Medicare 
prescription drug benefit 
Sec. 10. Additional Medicare part D informational resources 
Sec. 11. GAO study and report on the imposition of co-payments under part 
D for full-benefit dual eligible individuals residing in a long- 
term care facility 
Sec. 12. State coverage of non-formulary prescription drugs for full-benefit dual 
eligible individuals during 2006 
Sec. 13. Protection for full-benefit dual eligible individuals from plan termi-
nation prior to receiving functioning access in a new part D 
plan 
SEC. 2. TRANSITION REQUIREMENTS. 
(a) REQUIREMENTS.— 
(1) IN GENERAL.—Section 1860D–4(b) of the 
Social Security Act (42 U.S.C. 1395w–104(b)) is 
amended by adding at the end the following new 
paragraphs: 
‘‘(4) TRANSITION
PERIOD
FOR
DRUG
COV-
ERAGE.— 
‘‘(A) IN GENERAL.—In the case of an indi-
vidual who has made an election to enroll (or to 
change such an election) in a prescription drug 
plan under this part (or an MA–PD plan under 
part C) and who as of the effective date of such 
election (or change) has a prescription for a
drug that a physician has determined necesary 
to stabilize such individual on a course of treat-
ment, if such prescription would expire within 
the 30-day period beginning on the day after 
such effective date, the PDP sponsor of the 
plan shall provide at least a 30-day supply of 
such drug at the dosage previously prescribed 
by a physician without imposing any prior au-
thorization requirements or other access restric-
tions for such individual. 
‘‘(B) APPLICATION TO LONG-TERM CARE 
SETTING.—In the case of an individual de-
scribed in subparagraph (A) who is residing in 
a long-term care setting as of the effective date 
described in such subparagraph, any reference 
to a 30-day period or 30-day supply shall be 
deemed a reference to a 90-day period or a 90- 
day supply, respectively. 
‘‘(5) CUSTOMER SERVICE.—The sponsor of a 
prescription drug plan under this part (or an MA– 
PD plan under part C) shall provide— 
‘‘(A) accessible and trained customer serv-
ice representatives available for full business 
hours from coast to coast to provide knowledge-
able assistance to individuals seeking help with
Medicare part D including, beneficiaries, case-
workers, SCHIP counselors, pharmacists, doc-
tors, and caregivers; 
‘‘(B) at least one dedicated phone line for 
pharmacists with sufficient staff to reduce wait 
times for pharmacists seeking Medicare part D 
assistance to no more than 20 minutes; and 
‘‘(C) sufficient staff to reduce wait times 
for all Medicare part D-related calls to plan 
phone lines to no more than 20 minutes.’’. 
(2) APPLICATION.—The requirements under 
paragraphs (4) and (5) of section 1860D–4(b) of the 
Social Security Act (42 U.S.C. 1395w–104(b)), as 
added by subsection (a), shall apply to the plan serv-
ing as the national point of sale contractor under 
part D of title XVIII of such Act. 
(b) ENFORCEMENT.—The Secretary may impose a 
civil monetary penalty in an amount not to exceed $15,000 
for conduct that a sponsor of a prescription drug plan or 
an organization offering an MA–PD plan knows or should 
know is a violation of the provisions of paragraph (4) or 
(5) of section 1860D–4(b) of the Social Security Act (42 
U.S.C. 1395w–104(b)), as added by subsection (a). The 
provisions of section 1128A of the Social Security Act (42 
U.S.C. a–7a), other than subsections (a) and (b) and the
second sentence of subsection (f), shall apply to a civil 
monetary penalty under the previous sentence in the same 
manner as such provisions apply to a penalty or pro-
ceeding under subsection (a) of such section 1128A(a). 
SEC. 3. FEDERAL FALLBACK FOR FULL-BENEFIT DUAL ELI-
GIBLE INDIVIDUALS FOR 2006. 
(a) IN GENERAL.— 
(1) IN GENERAL.—If a full-benefit dual eligible 
individual (as defined in section 1935(c)(6) of the 
Social Security Act (42 U.S.C. 1396u–5(c)(6))), or 
an individual who is presumed to be such an indi-
vidual pursuant to subsection (b), presents a pre-
scription for a covered part D drug (as defined in 
section 1860D–2(e) of such Act (42 U.S.C. 1395w– 
102(e))) at a pharmacy in 2006 and the pharmacy 
is unable to locate or verify the individual’s enroll-
ment through a reasonable effort, including the use 
of the pharmacy billing system or by calling an offi-
cial Medicare hotline, or to bill for the prescription 
through the plan serving as the national point of 
sale contractor, the pharmacy may provide a 30-day 
supply of the drug to the individual. 
(2) REFILL.—The pharmacy may provide an 
additional 30-day supply of a drug if the pharmacy 
continues to be unable to locate the individual’s en-
rollment through such reasonable efforts or to bill 
for the prescription through the plan serving as the 
national point of sale contractor when a prescription 
is presented on or after the date that a prescription 
refill is appropriate, but in no case after December 
31, 2006. 
(3) COST-SHARING.—The cost-sharing for a 
prescription filled pursuant to this subsection shall 
be cost-sharing provided for under section 1860D– 
14(a) of the Social Security Act (42 U.S.C. 1395w– 
114(a)). 
(b) PRESUMPTIVE ELIGIBILITY.—An individual shall 
be presumed to be a full-benefit dual eligible individual 
(as so defined) if the individual presents at the pharmacy 
with— 
(1) a government issued picture identification 
card; 
(2) reliable evidence of Medicaid enrollment, 
such as a Medicaid card, recent history of Medicaid 
billing in the pharmacy patient profile, or a copy of 
a current Medicaid award letter; and 
(3) reliable evidence of Medicare enrollment, 
such as a Medicare identification card, a Medicare 
enrollment approval letter, a Medicare Summary No-