I
104TH CONGRESS
2D SESSION
H. R. 3757
To amend title XVIII of the Social Security Act to provide for coverage
of pharmaceutical care services under part B of the Medicare program.
IN THE HOUSE OF REPRESENTATIVES
JULY 8, 1996
Mr. PALLONE (for himself, Mr. BREWSTER, Mr. FOX of Pennsylvania, Mr.
FROST, Mr. ENGEL, Mr. TORRICELLI, Mr. LIPINSKI, Mr. FRAZER, Mr.
THOMPSON, Ms. BROWN of Florida, Mr. ACKERMAN, Mr. CRAMER, Mr.
DELLUMS, and Mrs. LOWEY) introduced the following bill; which was re-
ferred to the Committee on 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 title XVIII of the Social Security Act to provide
for coverage of pharmaceutical care services under part
B of the Medicare 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.
This Act may be cited as the ‘‘Safe Medications for
the Elderly Act’’.
SEC. 2. MEDICARE COVERAGE OF PHARMACEUTICAL CARE
SERVICES.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (N); and
(2) by inserting after subparagraph (O) the fol-
lowing new subparagraph:
‘‘(P) covered pharmaceutical care services (as
defined in subsection (oo));’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) is amended by adding at the end
the following new subsection:
‘‘Covered Pharmaceutical Care Services
‘‘(oo)(1) The term ‘covered pharmaceutical care serv-
ices’ means pharmaceutical care services described in
paragraph (2) which are furnished by a pharmacist who
is legally authorized to furnish such services under State
law (or the State regulatory mechanism provided by State
law) of the State in which the services are furnished.
‘‘(2) The pharmaceutical care services described in
this paragraph are as follows:
‘‘(A) Services covered under subsection (s)(10)
(relating to certain vaccines and their administra-
tion).
‘‘(B) Consultation with a physician which re-
sults in the physician taking any of the following ac-
tions with respect to an outpatient prescription drug
furnished to an individual enrolled under part B
(without regard to whether or not payment is made
for the drug under such part):
‘‘(i) A change in the individual’s drug regi-
men to avoid an adverse interaction with an-
other drug or medical condition.
‘‘(ii) A change in the dosage or form of an
outpatient prescription drug taken by the indi-
vidual.
‘‘(iii) The elimination of a drug from the
individual’s drug regimen.
‘‘(iv) The initiation of a drug therapy for
a medical condition.
‘‘(C) Consultation with an individual enrolled
under part B which results in improved compliance
by the individual with an outpatient prescription
drug regimen with respect to any drug identified by
the Secretary pursuant to paragraph (3), if the
pharmacist maintains documentation (in accordance
with such requirements as the Secretary may im-
pose) that the improvement in compliance is consid-
ered necessary by the prescriber of the drug or
under peer-reviewed medical literature.
‘‘(3)(A) With respect to the consultations described
in paragraph (2)(C), the Secretary shall, not later than
one year after the date of the enactment of this subsection,
identify and publish a list of outpatient prescription drugs
(without regard to whether payment is made for such drug
under part B) which are used in the treatment of the fol-
lowing conditions prevalent in the elderly:
‘‘(i) Asthma and chronic obstructive pulmonary
disease.
‘‘(ii) Congestive heart failure.
‘‘(iii) Depression.
‘‘(iv) Hyperlipidemia.
‘‘(v) Non-insulin-dependent diabetes.
‘‘(vi) 
Prevention 
of 
stroke 
(including
antihypertensive and anticoagulant therapy).
‘‘(vii) Simultaneous use of 4 or more drugs.
‘‘(B) Beginning 5 years after the date of the enact-
ment of this subsection, the Secretary may periodically up-
date such list of drugs to reflect changes in medical and
pharmaceutical practice, the development of new drugs,
and other factors the Secretary considers appropriate.’’.
(c) PAYMENT.—
(1) IN GENERAL.—Section 1833(a)(1) of such
Act (42 U.S.C. 1395l(a)(1)) is amended—
(A) by striking ‘‘and (P)’’ and inserting
‘‘(P)’’; and
(B) by striking the semicolon at the end
and inserting the following: ‘‘, and (Q) with re-
spect to covered pharmaceutical care services
(as defined in section 1861(oo)), the amounts
paid shall be the amounts described in section
1834(k)(1);’’.
(2) ESTABLISHMENT OF FEE SCHEDULE.—Sec-
tion 1834 of such Act (42 U.S.C. 1395m) is amend-
ed by adding at the end the following new sub-
section:
‘‘(k) FEE SCHEDULES FOR PHARMACEUTICAL CARE
SERVICES.—
‘‘(1) DEVELOPMENT.—The Secretary shall de-
velop—
‘‘(A) a relative value scale to serve as the
basis for the payment of covered pharma-
ceutical care services (as defined in section
1861(oo)) under this part; and
‘‘(B) using such scale and appropriate con-
version factors, fee schedules (on a regional,
statewide, locality, or carrier service area basis)
for payment for covered pharmaceutical care
services under this part, to be implemented for
such services furnished during years beginning
after the expiration of the 3-year period which
begins on the date of the enactment of this sub-
section.
‘‘(2) CONSIDERATIONS.—In developing the rel-
ative value scale and fee schedules under paragraph
(1), the Secretary shall take into account—
‘‘(A) differences in the time required to
perform types of covered pharmaceutical care
services;
‘‘(B) differences in the level of risk associ-
ated with the use of particular outpatient pre-
scription drugs or groups of drugs; and
‘‘(C) differences in the health status of in-
dividuals to whom covered pharmaceutical care
services are provided.
‘‘(3) PAYMENTS
PRIOR
TO
IMPLEMENTATION
OF FEE SCHEDULE.—In the case of covered pharma-
ceutical care services described in subparagraph (B)
or (C) of section 1861(oo)(2) which are furnished
prior to the implementation of the fee schedule
under paragraph (1)(B), the amount of payment
made under this part shall be equal to 80 percent
of the amount which would be paid for the service
under the fee schedule applicable under section 1848
if the service were furnished by a physician.’’.
(3) REPORT TO CONGRESS.—Not later than 3
years after the date of the enactment of this Act, the
Secretary of Health and Human Services shall sub-
mit a report to Congress on the relative value scale
and fee schedules developed pursuant to section
1834(k)(1) of the Social Security Act (as added by
paragraph (2)) for covered pharmaceutical services
under part B of the Medicare program.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 1997.
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