I 
109TH CONGRESS 
1ST SESSION H. R. 4395 
To amend titles XVIII and XIX of the Social Security Act to provide for 
an improved voluntary Medicare prescription drug benefit, to provide 
greater access to affordable pharmaceuticals, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 18, 2005 
Mr. CONYERS introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, for a period to be subsequently 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 titles XVIII and XIX of the Social Security Act 
to provide for an improved voluntary Medicare prescrip-
tion drug benefit, to provide greater access to affordable 
pharmaceuticals, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; REFERENCES IN ACT; TABLE OF 
CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Medicare Prescription Drug Affordability Act of 2005’’.
(b) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex-
cept as otherwise specifically provided, whenever in this 
Act an amendment is expressed in terms of an amendment 
to or repeal of a section or other provision, the reference 
shall be considered to be made to that section or other 
provision of the Social Security Act. 
(c) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; references in act; table of contents. 
TITLE I—MEDICARE PRESCRIPTION DRUG BENEFIT 
Sec. 101. Substitution of voluntary Medicare outpatient prescription drug pro-
gram. 
‘‘PART D—VOLUNTARY PRESCRIPTION DRUG BENEFIT FOR THE AGED AND 
DISABLED 
‘‘Sec. 1860D–1. Medicare outpatient prescription drug benefit. 
‘‘Sec. 1860D–2. Negotiating fair prices with pharmaceutical manufactur-
ers. 
‘‘Sec. 1860D–3. Contract authority. 
‘‘Sec. 1860D–4. Eligibility; voluntary enrollment; coverage. 
‘‘Sec. 1860D–5. Provision of, and entitlement to, benefits; reduction in co-
insurance for lower income beneficiaries. 
‘‘Sec. 1860D–6. Administration; quality assurance. 
‘‘Sec. 1860D–7. Federal Medicare Prescription Drug Trust Fund. 
‘‘Sec. 1860D–8. Compensation for employers covering retiree drug costs. 
‘‘Sec. 1860D–9. Medicare Prescription Drug Advisory Committee. 
Sec. 102. Provision of Medicare outpatient prescription drug coverage under 
the MedicareAdvantage program. 
Sec. 103. Medigap revisions. 
Sec. 104. Assistance for low income beneficiaries. 
Sec. 105. Expansion of membership and duties of Medicare Payment Advisory 
Commission (MEDPAC). 
TITLE II—AFFORDABLE PHARMACEUTICALS 
Subtitle A—Importation of Prescription Drugs 
Sec. 201. Short title. 
Sec. 202. Findings. 
Sec. 203. Purposes. 
Sec. 204. Importation of prescription drugs. 
Sec. 205. Use of counterfeit-resistant technologies to prevent counterfeiting. 
‘‘Sec. 505C. Counterfeit-resistant technologies.
Subtitle B—Quality Control and Cost Containment Blue Ribbon Task Force 
Sec. 211. Task Force. 
TITLE III—DEFENSE OF MEDICARE 
Sec. 301. Elimination of privatization of Medicare. 
Sec. 302. Repeal of MA regional plan stabilization fund. 
Sec. 303. Repeal of health savings accounts. 
Sec. 304. Application of risk adjustment reflecting characteristics for the entire 
Medicare population. 
Sec. 305. Phase-in to payment at 100 percent of fee-for-service rate. 
Sec. 306. Repeal of Medicare expenditure cap. 
Sec. 307. Continuous open enrollment in MedicareAdvantage plans. 
Sec. 308. Effective date. 
TITLE I—MEDICARE 
PRESCRIPTION DRUG BENEFIT 
SEC. 101. SUBSTITUTION OF VOLUNTARY MEDICARE OUT-
PATIENT PRESCRIPTION DRUG PROGRAM. 
(a) IN GENERAL.—Subject to subsection (b), part D 
of title XVIII, as inserted by section 101(a)(2) of the 
Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173), is amended 
to read as follows: 
‘‘PART D—VOLUNTARY PRESCRIPTION DRUG BENEFIT 
FOR THE AGED AND DISABLED 
‘‘MEDICARE OUTPATIENT PRESCRIPTION DRUG BENEFIT 
‘‘SEC. 1860D–1. 
Subject to the succeeding provisions of this part, the 
voluntary prescription drug benefit program under this 
part provides the following: 
‘‘(1) NO PREMIUM.—There is no monthly pre-
mium.
‘‘(2) NO DEDUCTIBLE.—There is no annual de-
ductible. 
‘‘(3) COINSURANCE.—The coinsurance is 10 
percent. 
‘‘(4) OUT-OF-POCKET LIMIT.—The annual limit 
on out-of-pocket spending on covered drugs is 
$1,500. 
‘‘(5) REDUCED COST-SHARING FOR LOWER-IN-
COME INDIVIDUALS.—Under the provisions of the 
medicaid program, for individuals with income not 
exceeding 150 percent of the poverty level, coinsur-
ance is reduced to not exceed a copayment of $1 for 
a generic drug or $3 for a brand name drug. 
‘‘NEGOTIATING FAIR PRICES WITH PHARMACEUTICAL 
MANUFACTURERS 
‘‘SEC. 1860D–2. (a) AUTHORITY
TO NEGOTIATE 
PRICES WITH MANUFACTURERS.—The Secretary shall, 
consistent with the requirements of this part and the goals 
of providing quality care and containing costs under this 
part, negotiate contracts with manufacturers of covered 
outpatient prescription drugs that provide for the max-
imum prices that may be charged to individuals enrolled 
under this part by participating pharmacies for dispensing 
such drugs to such individuals. 
‘‘(b) PROMOTION OF BREAKTHROUGH DRUGS.—In 
conducting negotiations with manufacturers under this
part, the Secretary shall take into account the goal of pro-
moting the development of breakthrough drugs (as defined 
in section 1860D–9(b)). 
‘‘CONTRACT AUTHORITY 
‘‘SEC. 1860D–3. (a) CONTRACT AUTHORITY.— 
‘‘(1) IN GENERAL.—The Secretary is respon-
sible for the administration of this part and shall 
enter into contracts with appropriate pharmacy con-
tractors on a national or regional basis to administer 
the benefits under this part. 
‘‘(2) PROCEDURES.—The Secretary shall estab-
lish procedures under which the Secretary— 
‘‘(A) accepts bids submitted by entities to 
serve as pharmacy contractors under this part 
in a region or on a national basis; 
‘‘(B) awards contracts to such contractors 
to administer benefits under this part to eligible 
beneficiaries in the region or on a national 
basis; and 
‘‘(C) provides for the termination (and 
nonrenewal) of a contract in the case of a con-
tractor’s failure to meet the requirements of the 
contract and this part. 
‘‘(3) COMPETITIVE PROCEDURES.—Competitive 
procedures (as defined in section 4(5) of the Office 
of Federal Procurement Policy Act (41 U.S.C.
403(5))) shall be used to enter into contracts under 
this part. 
‘‘(4) TERMS AND CONDITIONS.—Such contracts 
shall have such terms and conditions as the Sec-
retary shall specify and shall be for such terms (of 
at least 2 years, but not to exceed 5 years) as the 
Secretary shall specify consistent with this part. 
‘‘(5) USE
OF
PHARMACY
CONTRACTORS
IN 
PRICE NEGOTIATIONS.—Such contracts shall require 
the contractor involved to negotiate contracts with 
manufacturers that provide for maximum prices for 
covered outpatient prescription drugs that are lower 
than the maximum prices negotiated under section 
1860D–2(a), if applicable. The price reductions shall 
be passed on to eligible beneficiaries and the Sec-
retary shall hold the contractor accountable for 
meeting performance requirements with respect to 
price reductions and limiting price increases. 
‘‘(6) AREA FOR CONTRACTS.— 
‘‘(A) REGIONAL BASIS.— 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii) and subject to subpara-
graph (B), the contract entered into be-
tween the Secretary and a pharmacy con-
tractor shall require the contractor to ad-