295 
‘‘(ii) REASONABLE ACCESS.—In mak-
ing the selections under this subpara-
graph— 
‘‘(I) a PDP sponsor shall ensure 
that the beneficiary continues to have 
reasonable access to drugs described 
in subparagraph (G), taking into ac-
count geographic location, beneficiary 
preference, impact on cost-sharing, 
and reasonable travel time; or 
‘‘(II) a PDP sponsor shall ensure 
such access to prescribers and phar-
macies in the case of individuals with 
multiple residences and in the case of 
natural disasters and similar emer-
gency situations. 
‘‘(iii) BENEFICIARY PREFERENCES.— 
‘‘(I) IN GENERAL.—If an at-risk 
beneficiary 
for 
prescription 
drug 
abuse submits preferences for which 
in-network prescribers and pharmacies 
the beneficiary would prefer the PDP 
sponsor select in response to a notice 
under subparagraph (B), the PDP 
sponsor shall— 
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296 
‘‘(aa) 
review 
such 
pref-
erences; 
‘‘(bb) select or change the 
selection of prescribers and phar-
macies for the beneficiary based 
on such preferences; and 
‘‘(cc) inform the beneficiary 
of such selection or change of se-
lection. 
‘‘(II) EXCEPTION.—In the case 
that the PDP sponsor determines that 
a change to the selection of prescriber 
or pharmacy under item (bb) by the 
PDP sponsor is contributing or would 
contribute to prescription drug abuse 
or drug diversion by the beneficiary, 
the PDP sponsor may change the se-
lection of prescriber or pharmacy for 
the beneficiary without regard to the 
preferences of the beneficiary de-
scribed in subclause (I). 
‘‘(iv) CONFIRMATION.—Before select-
ing a prescriber (or prescribers) or phar-
macy (or pharmacies) under this subpara-
graph, a PDP sponsor must request and 
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297 
receive confirmation from such a prescriber 
or pharmacy acknowledging and accepting 
that the beneficiary involved is in the drug 
management program for at-risk bene-
ficiaries. 
‘‘(E) TERMINATIONS AND APPEALS.—The 
identification of an individual as an at-risk ben-
eficiary for prescription drug abuse under this 
paragraph, a coverage determination made 
under a drug management program for at-risk 
beneficiaries, and the selection of prescriber or 
pharmacy under subparagraph (D) with respect 
to such individual shall be subject to reconsider-
ation and appeal under subsection (h) and the 
option of an automatic escalation to external re-
view to the extent provided by the Secretary. 
‘‘(F) TERMINATION OF IDENTIFICATION.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall develop standards for the termination 
of identification of an individual as an at- 
risk beneficiary for prescription drug abuse 
under this paragraph. Under such stand-
ards such identification shall terminate as 
of the earlier of— 
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298 
‘‘(I) the date the individual dem-
onstrates that the individual is no 
longer likely, in the absence of the re-
strictions under this paragraph, to be 
an at-risk beneficiary for prescription 
drug abuse described in subparagraph 
(C)(i); or 
‘‘(II) the end of such maximum 
period of identification as the Sec-
retary may specify. 
‘‘(ii) 
RULE
OF
CONSTRUCTION.— 
Nothing in clause (i) shall be construed as 
preventing a plan from identifying an indi-
vidual as an at-risk beneficiary for pre-
scription drug abuse under subparagraph 
(C)(i) after such termination on the basis 
of additional information on drug use oc-
curring after the date of notice of such ter-
mination. 
‘‘(G) FREQUENTLY
ABUSED
DRUG.—For 
purposes of this subsection, the term ‘frequently 
abused drug’ means a drug that is a controlled 
substance that the Secretary determines to be 
frequently abused or diverted. 
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299 
‘‘(H) DATA DISCLOSURE.—In the case of 
an at-risk beneficiary for prescription drug 
abuse whose access to coverage for frequently 
abused drugs under a prescription drug plan 
has been limited by a PDP sponsor under this 
paragraph, such PDP sponsor shall disclose 
data, including any necessary individually iden-
tifiable health information, in a form and man-
ner specified by the Secretary, about the deci-
sion to impose such limitations and the limita-
tions imposed by the sponsor under this part. 
‘‘(I) EDUCATION.—The Secretary shall 
provide education to enrollees in prescription 
drug plans of PDP sponsors and providers re-
garding the drug management program for at- 
risk beneficiaries described in this paragraph, 
including education— 
‘‘(i) provided by medicare administra-
tive contractors through the improper pay-
ment outreach and education program de-
scribed in section 1874A(h); and 
‘‘(ii) through current education efforts 
(such as State health insurance assistance 
programs described in subsection (a)(1)(A) 
of section 119 of the Medicare Improve-
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300 
ments for Patients and Providers Act of 
2008 (42 U.S.C. 1395b–3 note)) and ma-
terials directed toward such enrollees. 
‘‘(J) 
APPLICATION
UNDER
MA–PD 
PLANS.—Pursuant to section 1860D—21(c)(1), 
the provisions of this paragraph apply under 
part D to MA organizations offering MA–PD 
plans to MA eligible individuals in the same 
manner as such provisions apply under this 
part to a PDP sponsor offering a prescription 
drug plan to a part D eligible individual.’’. 
(2) INFORMATION
FOR
CONSUMERS.—Section 
1860D–4(a)(1)(B) of the Social Security Act (42 
U.S.C. 1395w–104(a)(1)(B)) is amended by adding 
at the end the following: 
‘‘(v) The drug management program 
for at-risk beneficiaries under subsection 
(c)(5).’’. 
(b) UTILIZATION MANAGEMENT PROGRAMS.—Sec-
tion 1860D–4(c) of the Social Security Act (42 U.S.C. 
1395w–104(c)), as amended by subsection (a)(1), is fur-
ther amended— 
(1) in paragraph (1), by inserting after sub-
paragraph (D) the following new subparagraph: 
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