drug deductible established under paragraph
(1) whether or not, at the time the expenses
were incurred, the beneficiary was enrolled in a
plan under section 1833(a)(1)(A) or under sec-
tion 1876.
‘‘(B) TREATMENT OF DRUG BUY-OUT PLAN
EXPENSES.—In the case of a medicare bene-
ficiary enrolled in a month in a drug buy-out
plan (as defined in subparagraph (D))—
‘‘(i) expenses incurred by the bene-
ficiary for covered outpatient drugs reim-
bursed under the plan shall not be counted
towards the prescription drug deductible,
but
‘‘(ii) if the individual disenrolls from
the plan during the year, the beneficiary is
deemed to have incurred, for each month
of such enrollment, expenses for covered
outpatient drugs in an amount equal to the
actuarial value (with respect to such
month) of the deductible for covered out-
patient drugs (as computed by the Sec-
retary for purposes of section 1876(e)(1))
applicable on the average to individuals in
the United States.
‘‘(C) TREATMENT OF EXPENSES FOR COV-
ERED
OUTPATIENT
DRUGS
INCURRED
WHILE
ENROLLED IN A PREPAID PLAN OTHER THAN A
DRUG BUY-OUT PLAN.—The Secretary may not
enter into a contract with an organization
under section 1876, or provide for payment
under section 1833(a)(1)(A) with respect to an
organization which provides reimbursement for
covered outpatient drugs, with respect to a plan
that is not a drug buy-out plan, unless the or-
ganization provides assurances, satisfactory to
the Secretary, that—
‘‘(i) the organization will maintain
and make available, for its enrollees and in
coordination with the appropriate carriers
under this part, an accounting of expenses
incurred by (or on behalf of) enrollees
under the plan for covered outpatient
drugs; and
‘‘(ii) the organization will take into
account, in any deductibles established
under the plan in a year with respect to
covered outpatient drugs under this part,
the amounts of expenses for covered out-
patient drugs incurred in the year by (or
on behalf of) the beneficiary and otherwise
counted towards the prescription drug de-
ductible in the year.
‘‘(D) DRUG BUY-OUT PLAN DEFINED.—In
this paragraph, the term ‘drug buy-out plan’
means a plan under section 1833(a)(1)(A) or
offered by an organization under section 1876
and with respect to which—
‘‘(i) the amount of any deductible
under the plan with respect to covered out-
patient drugs under this title,
is less than 50 percent of—
‘‘(ii) the prescription drug deductible
specified in paragraph (1)(C).
‘‘(E) MEDICARE BENEFICIARY DEFINED.—
In this subsection, the term ‘medicare bene-
ficiary’ means, with respect to a month, an in-
dividual covered for benefits under this part for
the month.
‘‘(F) TREATMENT OF PLAN CHARGES.—In
the case of covered outpatient drugs furnished
by an eligible organization under section
1876(b) or an organization described in section
1833(a)(1)(A) which does not impose charges
on covered outpatient drugs dispensed to its
members, for purposes of this subsection the
actual charges of the organization shall be the
organization’s standard charges to members,
and other individuals, not entitled to benefits
with respect to such drugs.
‘‘(7) PHYSICIAN GUIDE.—
‘‘(A) IN
GENERAL.—The Secretary shall
develop, and update annually, an information
guide for physicians concerning the comparative
average wholesale prices of at least 500 of the
most commonly prescribed covered outpatient
drugs. Such guide shall, to the extent prac-
ticable, group covered outpatient drugs (includ-
ing multiple source drugs) in a manner useful
to physicians by therapeutic category or with
respect to the conditions for which they are pre-
scribed. Such guide shall specify the average
wholesale prices on the basis of the amount of
the drug required for a typical daily therapeutic
regimen.
‘‘(B) MAILING
GUIDE.—The Secretary
shall provide for mailing, in January of each
year (beginning with 1995), a copy of the guide
developed and updated under subparagraph
(A)—
‘‘(i) to each hospital with an agree-
ment in effect under section 1866;
‘‘(ii) to each physician (as defined in
section 1861(r)(1)) who routinely provides
services under this part; and
‘‘(iii) to Social Security offices, senior
citizen centers, and other appropriate
places.
‘‘(8) REPORTS ON UTILIZATION AND EFFECTS
ON PRICES.—
‘‘(A) COMPILATION
OF
INFORMATION.—
The Secretary shall compile information on—
‘‘(i) manufacturers’ prices for covered
outpatient drugs, and on charges of phar-
macists for covered outpatient drugs, and
‘‘(ii) the use of covered outpatient
drugs by individuals entitled to benefits
under this part.
The information compiled under clause (i) shall
include a comparison of the increases in prices
and charges for covered outpatient drugs dur-
ing each 6 month period (beginning with Janu-
ary 1993) with the semiannual average increase
in such prices and charges during the 5 years
beginning with 1987.