I 
109TH CONGRESS 
2D SESSION 
H. R. 5433 
To amend title XVIII of the Social Security Act to provide for a Medicare 
Prescription Drug Ombudsman. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 19, 2006 
Ms. HOOLEY (for herself, Mr. DEFAZIO, and Mr. BLUMENAUER) 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 subsequently determined by the Speaker, in each case for 
consideration 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 provide 
for a Medicare Prescription Drug Ombudsman. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. MEDICARE PRESCRIPTION DRUG OMBUDSMAN. 
Section 1808 of the Social Security Act (42 U.S.C. 
1395b–9) is amended by adding at the end the following 
new subsection: 
‘‘(d) MEDICARE
PRESCRIPTION
DRUG
OMBUDS-
MAN.— 
VerDate Aug 31 2005 
22:21 May 22, 2006
Jkt 049200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5433.IH
H5433
cchase on PROD1PC60 with BILLS
‘‘(1) IN GENERAL.—There is hereby established 
within the Department of Health and Human Serv-
ices an Office of the Medicare Prescription Drug 
Ombudsman (in this subsection referred to as the 
‘Office’) to be headed by a Medicare Prescription 
Drug Ombudsman appointed by the Secretary. The 
Secretary shall appoint as such Ombudsman an indi-
vidual who has expertise and experience in the fields 
of health care and education of (and assistance to) 
individuals entitled to benefits under this title with 
respect to prescription drug coverage under part D. 
‘‘(2) 
DUTIES.—The 
Medicare 
Prescription 
Drug Ombudsman through the Office shall— 
‘‘(A) receive complaints, grievances, and 
requests for information submitted by individ-
uals entitled to benefits under part D, partici-
pating pharmacists, physicians, and hospitals; 
‘‘(B) provide assistance with respect to 
complaints, grievances, and requests referred to 
in subparagraph (A), including— 
‘‘(i) assistance in collecting relevant 
information for such individuals and seek-
ing appeal of a decision or determination 
made by a PDP sponsor or MA organiza-
tion; 
VerDate Aug 31 2005 
22:21 May 22, 2006
Jkt 049200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5433.IH
H5433
cchase on PROD1PC60 with BILLS
‘‘(ii) assistance to such individuals 
with any issues arising from disenrollment 
from a PDP under part C or an MA–PD 
plan under part D; and 
‘‘(iii) registering complaints about the 
benefits under prescription drug plans and 
MA–PD plans and helping resolve disputes 
between the Centers for Medicare and 
Medicaid, sponsors of prescription drug 
plans, and organizations offering MA–PD 
plans and individuals entitled to benefits 
under part D, participating pharmacists, 
physicians, and hospitals; 
‘‘(C) provide assistance to beneficiaries in 
relation to State medicaid programs under title 
XIX and drug manufacturers in accessing 
medically necessary drugs that are excluded 
from coverage under part D; and 
‘‘(D) submit annual reports to Congress 
and the Secretary that describe the activities of 
the Office and that include such recommenda-
tions for improvement in the administration of 
part D as the Medicare Prescription Drug Om-
budsman determines appropriate. 
VerDate Aug 31 2005 
22:21 May 22, 2006
Jkt 049200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5433.IH
H5433
cchase on PROD1PC60 with BILLS
The annual report under subparagraph (D) in 2007 
and 2009 shall include information on the number 
of cases described in subparagraph (C) that are han-
dled and the success rates in finding alternative 
sources of prescription drug coverage.’’. 
Æ 
VerDate Aug 31 2005 
22:21 May 22, 2006
Jkt 049200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6301
E:\BILLS\H5433.IH
H5433
cchase on PROD1PC60 with BILLS