‘‘(I) one or more individuals who 
are authorized to prescribe frequently 
abused drugs (referred to in this para-
graph as ‘prescribers’) who may write 
prescriptions for such drugs for such 
beneficiary; and 
‘‘(II) one or more pharmacies that 
may dispense such drugs to such bene-
ficiary. 
‘‘(ii) REASONABLE ACCESS.—In mak-
ing the selection under this subparagraph, a 
PDP sponsor shall ensure that the bene-
ficiary continues to have reasonable access 
to drugs described in subparagraph (G), 
taking into account geographic location, 
beneficiary preference, impact on cost-shar-
ing, and reasonable travel time. 
‘‘(iii) BENEFICIARY PREFERENCES.— 
‘‘(I) IN GENERAL.—If an at-risk 
beneficiary for prescription drug abuse 
submits preferences for which in-net-
work prescribers and pharmacies the 
beneficiary would prefer the PDP 
sponsor select in response to a notice 
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asabaliauskas on DSK5VPTVN1PROD with BILLS
under subparagraph (B), the PDP 
sponsor shall— 
‘‘(aa) 
review 
such 
pref-
erences; 
‘‘(bb) select or change the se-
lection of a prescriber or phar-
macy 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 a 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 selec-
tion of a prescriber or pharmacy for 
the beneficiary without regard to the 
preferences of the beneficiary described 
in subclause (I). 
‘‘(iv) CONFIRMATION.—Before selecting 
a prescriber or pharmacy under this sub-
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asabaliauskas on DSK5VPTVN1PROD with BILLS
paragraph, a PDP sponsor must request 
and receive confirmation from the pre-
scriber or pharmacy acknowledging and ac-
cepting that the beneficiary involved is in 
the drug management program for at-risk 
beneficiaries. 
‘‘(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 a 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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asabaliauskas on DSK5VPTVN1PROD with BILLS
‘‘(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.—Noth-
ing in clause (i) shall be construed as pre-
venting 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 occur-
ring after the date of notice of such termi-
nation. 
‘‘(G) FREQUENTLY
ABUSED
DRUG.—For 
purposes of this subsection, the term ‘frequently 
abused drug’ means a drug that is determined by 
the Secretary to be frequently abused or diverted 
and that is— 
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asabaliauskas on DSK5VPTVN1PROD with BILLS
‘‘(i) a Controlled Drug Substance in 
Schedule CII; or 
‘‘(ii) within the same class or category 
of drugs as a Controlled Drug Substance in 
Schedule CII, as determined through notice 
and comment rulemaking. 
‘‘(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 identifiable health 
information, in a form and manner specified by 
the Secretary, about the decision to impose such 
limitations and the limitations imposed by the 
sponsor under this part. 
‘‘(I) EDUCATION.—The Secretary shall pro-
vide education to enrollees in prescription drug 
plans of PDP sponsors and providers regarding 
the drug management program for at-risk bene-
ficiaries described in this paragraph, including 
education— 
‘‘(i) provided by medicare administra-
tive contractors through the improper pay-
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asabaliauskas on DSK5VPTVN1PROD with BILLS
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 Improvements 
for Patients and Providers Act of 2008 (42 
U.S.C. 1395b–3 note)) and materials di-
rected toward such enrollees.’’. 
(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.—Section 
1860D–4(c) of the Social Security Act (42 U.S.C. 1395w– 
104(c)), as amended by subsection (a)(1) and section 8, is 
further amended— 
(1) in paragraph (1), by inserting after subpara-
graph (D) the following new subparagraph: 
‘‘(E) A utilization management tool to pre-
vent drug abuse (as described in paragraph 
(6)(A)).’’; and 
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