I 
109TH CONGRESS 
2D SESSION 
H. R. 5116 
To amend title XVIII of the Social Security Act to extend the 2006 initial 
enrollment period for the Medicare prescription drug benefit by six 
months, to suspend the late enrollment penalty for such benefit during 
2006, to permit Medicare beneficiaries to change enrollment in a pre-
scription drug plan once a year, and to prevent changes in formularies 
other than at the time of open enrollment periods and only with advance 
notice. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 6, 2006 
Mrs. TAUSCHER (for herself, Mr. SMITH of Washington, Mr. DAVIS of Ala-
bama, Mr. KIND, Mrs. MCCARTHY, Mr. INSLEE, Ms. HERSETH, Mr. 
CROWLEY, Mr. MEEKS of New York, Mr. EMANUEL, Ms. MILLENDER- 
MCDONALD, Mr. HIGGINS, Ms. HARMAN, Mr. PRICE of North Carolina, 
Mr. BAIRD, Ms. SCHWARTZ of Pennsylvania, Mr. MCINTYRE, Mr. 
ENGEL, Mr. ISRAEL, Mr. CHANDLER, Mr. BOSWELL, Ms. LORETTA 
SANCHEZ of California, Mr. LARSON of Connecticut, Mr. DAVIS of Flor-
ida, Mr. MOORE of Kansas, and Ms. HOOLEY) 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 sub-
sequently 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 extend 
the 2006 initial enrollment period for the Medicare pre-
scription drug benefit by six months, to suspend the 
late enrollment penalty for such benefit during 2006, 
to permit Medicare beneficiaries to change enrollment 
in a prescription drug plan once a year, and to prevent 
VerDate Aug 31 2005 
17:47 Apr 13, 2006
Jkt 049196
PO 00000
Frm 00001
Fmt 6652
Sfmt 6652
E:\BILLS\H5116.IH
H5116
dsatterwhite on PROD1PC76 with BILLS
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. SHORT TITLE. 
This Act may be cited as the ‘‘Choice for America’s 
Seniors Act of 2006’’. 
SEC. 2. SIX-MONTH EXTENSION OF 2006 INITIAL ENROLL-
MENT PERIOD FOR MEDICARE PRESCRIP-
TION DRUG PLANS AND MA PLANS. 
(a) IN GENERAL.—Section 1851(e)(3)(B)(iii) of the 
Social Security Act (42 U.S.C. 1395w–21(e)(3)(B)(iii)) is 
amended by striking ‘‘May 15, 2006’’ and inserting ‘‘No-
vember 14, 2006’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect as if included in the enact-
ment of the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 (Public Law 108–173). 
SEC. 3. SUSPENSION OF MEDICARE PRESCRIPTION DRUG 
LATE ENROLLMENT PENALTY DURING 2006. 
(a) IN GENERAL.—Section 1860D–13(b)(3)(B) of 
the Social Security Act (42 U.S.C. 1395w–113(b)(3)(B)) 
is amended by inserting ‘‘(after December 2006)’’ after 
‘‘any month’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect as if included in the enact-
VerDate Aug 31 2005 
17:47 Apr 13, 2006
Jkt 049196
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5116.IH
H5116
dsatterwhite on PROD1PC76 with BILLS
ment of the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 (Public Law 108–173). 
SEC. 4. CHANGES OF ENROLLMENT IN PRESCRIPTION 
DRUG 
PLANS 
AND 
MA 
PLANS 
ALLOWED 
TWICE DURING YEAR. 
(a) ADDITIONAL ELECTION PERMITTED ONCE EACH 
YEAR OUTSIDE OF ANNUAL COORDINATED ELECTION 
PERIOD.—Section 1851(e)(4) of the Social Security Act 
(42 U.S.C. 1395w–21(e)(4)) is amended by inserting 
‘‘once every year, and in addition,’’ after ‘‘make a new 
election under this section’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect as of the date of the enact-
ment of this Act. 
SEC. 5. LIMITATION ON REMOVAL OR CHANGE OF COV-
ERED PART D DRUGS FROM THE PRESCRIP-
TION DRUG PLAN FORMULARY; NOTICE OF 
CHANGES IN COVERAGE. 
(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: 
VerDate Aug 31 2005 
17:47 Apr 13, 2006
Jkt 049196
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5116.IH
H5116
dsatterwhite on PROD1PC76 with BILLS
‘‘(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 
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 
VerDate Aug 31 2005 
17:47 Apr 13, 2006
Jkt 049196
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5116.IH
H5116
dsatterwhite on PROD1PC76 with BILLS
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-
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 
VerDate Aug 31 2005 
17:47 Apr 13, 2006
Jkt 049196
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5116.IH
H5116
dsatterwhite on PROD1PC76 with BILLS
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) if such 
generic drug is included in the for-
mulary without any restriction or limi-
tation placed on the coverage of such 
generic drug other than a restriction 
or limitation that would be placed on 
the coverage of the brand name drug 
during such period without the appli-
cation of this clause; 
‘‘(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; 
‘‘(IV) is a drug that the appro-
priate pharmacy and therapeutic com-
mittee determines, based on evidence 
from peer-reviewed medical research, 
to be unsafe or ineffective during such 
period; or 
VerDate Aug 31 2005 
17:47 Apr 13, 2006
Jkt 049196
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5116.IH
H5116
dsatterwhite on PROD1PC76 with BILLS
‘‘(V) is any other drug that satis-
fies any other requirement determined 
appropriate by the Secretary. 
‘‘(iii) NOTICE
OF
REMOVAL
UNDER 
APPLICATION
OF
EXCEPTION
TO
LIMITA-
TION.—Not later than 90 days before a 
PDP sponsor of a prescription drug plan 
removes a covered part D drug from the 
plan formulary (or restricts or limits such 
coverage) under clause (ii), the sponsor 
shall provide appropriate notice (such as 
under subsection (a)(3)) of such removal 
(or restriction or limitation) to the Sec-
retary, affected enrollees, physicians, phar-
macies, and pharmacists.’’. 
(a) ADVANCE NOTICE REQUIRED FOR CHANGE IN 
FORMULARY AND OTHER RESTRICTIONS OR LIMITATIONS 
ON COVERAGE.— 
(1) IN GENERAL.—Section 1860D–4(a) of the 
Social Security Act (42 U.S.C. 1395w–104(a)) is 
amended by adding 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-
VerDate Aug 31 2005 
17:47 Apr 13, 2006
Jkt 049196
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5116.IH
H5116
dsatterwhite on PROD1PC76 with BILLS
scription drug plan shall furnish to each enrollee 90 
days before 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.’’. 
(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, except that if this Act is en-
acted after September 15, 2006, and before January 
1, 2007, the notice required under such section shall 
apply with respect to the annual coordinated election 
period that begins on November 15, 2006, as of 
such date (as soon as possible after such date of en-
actment) as the Secretary of Health and Human 
Services shall specify. 
Æ 
VerDate Aug 31 2005 
17:47 Apr 13, 2006
Jkt 049196
PO 00000
Frm 00008
Fmt 6652
Sfmt 6301
E:\BILLS\H5116.IH
H5116
dsatterwhite on PROD1PC76 with BILLS