I 
116TH CONGRESS 
1ST SESSION H. R. 3408 
To amend title XVIII of the Social Security Act to require prescription 
drug plan sponsors to include real-time benefit information as part of 
such sponsor’s electronic prescription program under the Medicare pro-
gram. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 21, 2019 
Mr. ARRINGTON (for himself and Mr. OLSON) 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 subse-
quently 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 require 
prescription drug plan sponsors to include real-time ben-
efit information as part of such sponsor’s electronic pre-
scription program under 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 ‘‘Shop Rx Act of 2019’’. 
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SEC. 2. REQUIRING PRESCRIPTION DRUG PLAN SPONSORS 
TO INCLUDE REAL-TIME BENEFIT INFORMA-
TION AS PART OF SUCH SPONSOR’S ELEC-
TRONIC PRESCRIPTION PROGRAM UNDER 
THE MEDICARE PROGRAM. 
Section 1860D–4(e)(2) of the Social Security Act (42 
U.S.C. 1395w–104(e)(2)) is amended— 
(1) in subparagraph (D), by striking ‘‘To the 
extent’’ and inserting ‘‘Except as provided in sub-
paragraph (F), to the extent’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(F) 
REAL-TIME
BENEFIT
INFORMA-
TION.— 
‘‘(i) IN
GENERAL.—Not later than 
January 1, 2021, the program shall pro-
vide for the real-time electronic trans-
mission to prescribing health care profes-
sionals, using technology capable of inte-
grating with such professionals’ electronic 
prescribing and electronic health record 
systems, of individual-specific formulary 
and benefit information under a prescrip-
tion drug plan with respect to an indi-
vidual enrolled in such plan. Such informa-
tion shall include, with respect to the pre-
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scribing of a covered part D drug to such 
individual, the following: 
‘‘(I) A description of any clini-
cally appropriate alternatives to such 
drug included in the formulary of 
such plan. 
‘‘(II) Information relating to ap-
plicable cost-sharing requirements for 
such drug and such alternatives, in-
cluding a description of any variance 
in such requirements based on the 
pharmacy dispensing such drug or 
such alternatives. 
‘‘(III) Information relating to 
any prior authorization or other utili-
zation management requirements ap-
plicable to such drug and such alter-
natives within the formulary of such 
plan. 
‘‘(ii) SPECIAL RULE FOR 2021.—The 
program shall be deemed to be in compli-
ance with clause (i) for 2021 if the pro-
gram complies with the provisions of sec-
tion 423.160(b)(7) of title 42, Code of 
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Federal Regulations (or a successor regula-
tion), for such year.’’. 
Æ 
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