I 
113TH CONGRESS 
1ST SESSION H. R. 1239 
To amend part D of title XVIII of the Social Security Act to count the 
negotiated price of drugs provided free or at nominal charge under 
compassionate treatment programs towards incurred out-of-pocket costs. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 18, 2013 
Mr. CASSIDY (for himself and Ms. MATSUI) 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 part D of title XVIII of the Social Security 
Act to count the negotiated price of drugs provided free 
or at nominal charge under compassionate treatment 
programs towards incurred out-of-pocket costs. 
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 ‘‘Accessing Medicare 
Therapies Act of 2013’’. 
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SEC. 2. COUNTING THE NEGOTIATED PRICE OF DRUGS 
PROVIDED FREE OR AT NOMINAL CHARGE 
UNDER COMPASSIONATE TREATMENT PRO-
GRAMS TOWARDS INCURRED OUT-OF-POCK-
ET COSTS. 
(a) IN GENERAL.—Section 1860D–2(b)(4) of the So-
cial Security Act (42 U.S.C. 1395w–102(b)(4)) is amend-
ed— 
(1) in subparagraph (C), by striking ‘‘subpara-
graph (E)’’ and inserting ‘‘subparagraphs (E) and 
(F)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(F) INCLUSION
OF
NEGOTIATED
PRICE 
OF DRUGS PROVIDED UNDER COMPASSIONATE 
TREATMENT PROGRAMS.— 
‘‘(i) IN GENERAL.—In applying sub-
paragraph (A) with respect to an indi-
vidual enrolled in a prescription drug plan, 
incurred costs shall include the negotiated 
price described in clause (ii) of a covered 
part D drug if— 
‘‘(I) the drug is classified, for 
purposes of applying tiered copay-
ments consistent with section 1860D– 
2(b)(2)(B), in the highest copayment 
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tier (such as a tier 4 for specialty 
brand-name drugs); 
‘‘(II) the drug is furnished to the 
individual free or at nominal charge 
under a compassionate treatment pro-
gram (as defined in clause (iii)); and 
‘‘(III) the drug, if furnished 
other than through such program, is 
covered under the formulary of the 
plan or is available through exception 
or appeal. 
‘‘(ii) NEGOTIATED PRICE.—The nego-
tiated price described in this clause, for a 
covered part D drug which is dispensed to 
an enrollee— 
‘‘(I) by a pharmacy, is the nego-
tiated price at such pharmacy; or 
‘‘(II) other than by a pharmacy, 
is the average negotiated price for the 
drug in the prescription drug plan in 
the zip code of the enrollee as of the 
date the drug is dispensed. 
‘‘(iii) COMPASSIONATE
TREATMENT 
PROGRAM
DEFINED.—In this subpara-
graph, the term ‘compassionate treatment 
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program’ means, with respect to covered 
part D drugs, a program that— 
‘‘(I) is administered by an entity 
described in section 501(c)(3) of the 
Internal Revenue Code of 1986 that is 
exempt from tax under section 501(a) 
of such Code; 
‘‘(II) takes title to the drugs and 
distributes the drugs to eligible part 
D individuals free or at nominal 
charge on the basis of the entity’s as-
sessment of financial need of such in-
dividuals; 
‘‘(III) does not distribute the 
drugs to an individual unless the indi-
vidual’s household income (as deter-
mined under section 36B of the Inter-
nal Revenue Code of 1986) is less 
than the maximum income level for 
the taxpayer in the household to be el-
igible for a refundable credit under 
such section; and 
‘‘(IV) meets such additional re-
quirements as the Inspector General 
of the Department of Health and 
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