I 
109TH CONGRESS 
2D SESSION 
H. R. 5263 
To amend part D of title XVIII of the Social Security Act to extend the 
2006 and 2007 initial enrollment periods for the Medicare prescription 
drug benefit and suspend the late enrollment penalty through December 
31, 2007, to permit Medicare beneficiaries to change enrollment in a 
prescription drug plan during the first 12 months of enrollment, and 
to prevent changes in formularies other than at the time of open enroll-
ment periods and only with advance notice. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 2, 2006 
Mrs. CHRISTENSEN (for herself, Mr. WATT, Ms. LEE, Mr. OWENS, Ms. 
MILLENDER-MCDONALD, Mr. TOWNS, Mr. CONYERS, Ms. NORTON, Ms. 
CARSON, Mr. CLEAVER, Mr. FATTAH, Mr. PAYNE, Ms. KILPATRICK of 
Michigan, Ms. CORRINE BROWN of Florida, Ms. MOORE of Wisconsin, 
Mr. MEEKS of New York, Mr. CLAY, Mr. WYNN, Mr. AL GREEN of 
Texas, Ms. JACKSON-LEE of Texas, Mr. RUSH, Mr. JACKSON of Illinois, 
Mr. THOMPSON of Mississippi, Mr. SCOTT of Virginia, Mr. BISHOP of 
Georgia, Mr. LEWIS of Georgia, Ms. EDDIE BERNICE JOHNSON of Texas, 
Mr. HASTINGS of Florida, Mr. DAVIS of Alabama, Mr. RANGEL, Mrs. 
JONES of Ohio, Mr. BUTTERFIELD, Mr. JEFFERSON, Mr. CLYBURN, Ms. 
WATSON, Mr. CUMMINGS, Ms. WATERS, Mr. DAVIS of Illinois, Mr. SCOTT 
of Georgia, Ms. MCKINNEY, Mr. MEEK of Florida, and Mr. FORD) intro-
duced 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 subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of the 
committee concerned 
A BILL 
To amend part D of title XVIII of the Social Security 
Act to extend the 2006 and 2007 initial enrollment peri-
ods for the Medicare prescription drug benefit and sus-
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pend the late enrollment penalty through December 31, 
2007, to permit Medicare beneficiaries to change enroll-
ment in a prescription drug plan during the first 12 
months of enrollment, and to prevent changes in 
formularies other than at the time of open enrollment 
periods and only with advance notice. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. EXTENSION OF MEDICARE PRESCRIPTION 
DRUG INITIAL ENROLLMENT PERIODS FOR 
2006 AND 2007; SUSPENSION OF LATE EN-
ROLLMENT PENALTY THROUGH DECEMBER 
31, 2007. 
(a) EXTENSION OF MEDICARE PRESCRIPTION DRUG 
INITIAL ENROLLMENT PERIODS FOR 2006 AND 2007.— 
Section 1860D–1(b)(1) of the Social Security Act (42 
U.S.C. 1395w–101(b)(1)) is amended— 
(1) in subparagraph (B)(iii), by inserting ‘‘sub-
paragraph (D) and’’ after ‘‘Subject to’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) EXTENSION OF INITIAL ENROLLMENT PE-
RIODS.—For purposes of subparagraph (B)(iii), in 
applying section 1851(e)(1), with respect to the an-
nual, coordinated election period— 
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‘‘(i) for 2006, such period shall begin on 
November 15, 2005, and end on November 14, 
2006; and 
‘‘(ii) for 2007, such period shall begin on 
November 15, 2006, and end on November 14, 
2007.’’. 
(b) SUSPENSION OF LATE ENROLLMENT PENALTY 
THROUGH
DECEMBER
31, 2007.—Section 1860D– 
13(b)(3)(B) of such Act (42 U.S.C. 1395w–113(b)(3)(B)) 
is amended by inserting ‘‘(after December 2007)’’ after 
‘‘any month’’. 
SEC. 2. OPEN ENROLLMENT AND DISENROLLMENT IN PRE-
SCRIPTION DRUG PLANS ALLOWED DURING 
FIRST 12 MONTHS OF ENROLLMENT. 
Section 1860D–1(b)(1) of the Social Security Act (42 
U.S.C. 1395w–101(b)(1)) is amended by adding at the 
end the following new subparagraph: 
‘‘(D) 
OPEN
ENROLLMENT
AND 
DISENROLLMENT
PERIOD
FOR
FIRST
MONTHS OF ENROLLMENT.—In establishing the 
process under subparagraph (A), in the case of 
a part D eligible individual who initially enrolls 
under section 1860D–1(a) in a prescription 
drug plan on or after the date of enactment of 
this paragraph, the Secretary shall permit such 
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individual to change such enrollment into an-
other prescription drug plan once at any time 
during the first 12 months of such initial en-
rollment (other than during an annual, coordi-
nated election period referred to in section 
1860D–1(b)(1)(B)(iii)).’’. 
SEC. 3. LIMITATIONS ON CHANGING PRESCRIPTION DRUG 
PLAN FORMULARIES; NOTICE OF CHANGE IN 
FORMULARY. 
(a) LIMITATION ON REMOVAL OR CHANGE OF COV-
ERED PART D DRUGS FROM THE PRESCRIPTION DRUG 
PLAN FORMULARY.—Section 1860D–4(b)(3)(E) of the 
Social Security Act (42 U.S.C. 1395w–104(b)(3)(E)) is 
amended to read as follows: 
‘‘(E) REMOVING
A
DRUG
FROM
FOR-
MULARY OR IMPOSING A RESTRICTION OR LIMI-
TATION ON COVERAGE.— 
‘‘(i) LIMITATION ON REMOVAL, LIMI-
TATION, OR RESTRICTION.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II) and clause (ii), begin-
ning with 2006, the PDP sponsor of 
a prescription drug plan may not re-
move a covered part D drug from the 
plan formulary or impose a restriction 
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or limitation on the coverage of such 
a drug (such as through the applica-
tion of a preferred status, usage re-
striction, step therapy, prior author-
ization, or quantity limitation) other 
than at the beginning of each plan 
year except as the Secretary may per-
mit to take into account new thera-
peutic uses and newly covered part D 
drugs. 
‘‘(II) SPECIAL RULE FOR NEWLY 
ENROLLED INDIVIDUALS.—Subject to 
clause (ii), in the case of an individual 
who enrolls in a prescription drug 
plan on or after the date of enactment 
of this subparagraph, the PDP spon-
sor of such plan may not remove a 
covered part D drug from the plan 
formulary or impose a restriction or 
limitation on the coverage of such a 
drug (such as through the application 
of a preferred status, usage restric-
tion, step therapy, prior authorization, 
or quantity limitation) during the pe-
riod beginning on the date of such en-
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rollment and ending on December 31 
of the immediately succeeding plan 
year except as the Secretary may per-
mit to take into account new thera-
peutic uses and newly covered part D 
drugs. 
‘‘(ii) EXCEPTIONS TO LIMITATION ON 
REMOVAL.—Clause (i) shall not apply with 
respect to a covered part D drug that— 
‘‘(I) is a brand name drug for 
which there is a generic drug ap-
proved under section 505(j) of the 
Food and Drug Cosmetic Act (21 
U.S.C. 355(j)) that is placed on the 
market during the period in which 
there are limitations on removal or 
change in the formulary under sub-
clause (I) or (II) of clause (i); 
‘‘(II) is a brand name drug that 
goes off-patent during such period; 
‘‘(III) is a drug for which the 
Commissioner of Food and Drugs 
issues a clinical warning that imposes 
a restriction or limitation on the drug 
during such period; or 
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‘‘(IV) has been determined to be 
ineffective during such period. 
‘‘(iii) NOTICE
OF
REMOVAL
UNDER 
APPLICATION
OF
EXCEPTION
TO
LIMITA-
TION.—The PDP sponsor of a prescription 
drug plan shall provide appropriate notice 
(such as under subsection (a)(3)) of any 
removal or change under clause (ii) to the 
Secretary, affected enrollees, physicians, 
pharmacies, and pharmacists.’’. 
(b) NOTICE OF CHANGE IN FORMULARY AND OTHER 
RESTRICTIONS OR LIMITATIONS ON COVERAGE.— 
(1) IN GENERAL.—Section 1860D–4(a) of such 
Act (42 U.S.C. 1395w–104(a)) is amended by add-
ing at the end the following new paragraph: 
‘‘(5) ANNUAL
NOTICE
OF
CHANGES
IN
FOR-
MULARY AND OTHER RESTRICTIONS OR LIMITATIONS 
ON COVERAGE.—Each PDP sponsor offering a pre-
scription drug plan shall furnish to each enrollee at 
the time of each annual coordinated election period 
(referred to in section 1860D–1(b)(1)(B)(iii)) for a 
plan year a notice of any changes in the formulary 
or other restrictions or limitations on coverage of a 
covered part D drug under the plan that will take 
effect for the plan year.’’. 
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(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to annual coordinated 
election periods beginning after the date of the en-
actment of this Act. 
Æ 
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