record and include data on timeliness of plan’s 
response in public reports. 
‘‘(C) REPORT
TO
CONGRESS.—The Sec-
retary shall annually report to Congress regard-
ing complaints compiled under this para-
graph.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to contract years beginning on 
or after the date of the enactment of this Act. 
SEC. 510. FILL OF DRUGS FOR DUAL ELIGIBLES. 
(a) IN GENERAL.—Section 1860D–4(g) of the Social 
Security Act (42 U.S.C. 1395w–104(g)) is amended by 
adding at the end the following new paragraph: 
‘‘(3) FILL OF DRUGS FOR FULL-BENEFIT DUAL 
ELIGIBLE INDIVIDUALS.—In the case of a reconsid-
eration under paragraph (1) or an exception under 
paragraph (2) sought with respect to a covered part 
D drug on behalf of a full-benefit dual eligible indi-
vidual (as defined in section 1935(c)(6)), the PDP 
sponsor shall provide for coverage of the drug (or 
treatment of the drug as a preferred drug under a 
tiered formulary) pending disposition of the recon-
sideration or exception.’’. 
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ccoleman on PROD1PC71 with BILLS
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to contract years beginning on 
or after the date of the enactment of this Act. 
TITLE 
W—FAIR 
AND 
SPEEDY 
TREATMENT 
OF 
MEDICARE 
PRESCRIPTION DRUG CLAIMS 
SEC. 601. PROMPT PAYMENT BY MEDICARE PRESCRIPTION 
DRUG PLANS AND MA–PD PLANS UNDER 
PART D. 
(a) APPLICATION TO PRESCRIPTION DRUG PLANS.— 
Section 1860D–12(b) of the Social Security Act (42 
U.S.C. 1395w–112 (b)), as amended by section 301(b), 
is amended by adding at the end the following new para-
graph: 
‘‘(5) PROMPT PAYMENT OF CLEAN CLAIMS.— 
‘‘(A) PROMPT
PAYMENT.—Each contract 
entered into with a PDP sponsor under this 
subsection with respect to a prescription drug 
plan offered by such sponsor shall provide that 
payment shall be issued, mailed, or otherwise 
transmitted with respect to all clean claims sub-
mitted under this part within the applicable 
number of calendar days after the date on 
which the claim is received. 
‘‘(B) DEFINITIONS.—In this paragraph: 
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‘‘(i) CLEAN CLAIM.—The term ‘clean 
claim’ means a claim, with respect to a 
covered part D drug, that has no apparent 
defect or impropriety (including any lack 
of any required substantiating documenta-
tion) or particular circumstance requiring 
special treatment that prevents timely pay-
ment from being made on the claim under 
this part. 
‘‘(ii) APPLICABLE
NUMBER
OF
CAL-
ENDAR DAYS.—The term ‘applicable num-
ber of calendar days’ means— 
‘‘(I) with respect to claims sub-
mitted 
electronically, 
calendar 
days; and 
‘‘(II) with respect to claims sub-
mitted otherwise, 30 calendar days. 
‘‘(C) INTEREST PAYMENT.—If payment is 
not issued, mailed, or otherwise transmitted 
within the applicable number of calendar days 
(as defined in subparagraph (B)) after a clean 
claim is received, interest shall be paid at a rate 
used for purposes of section 3902(a) of title 31, 
United States Code (relating to interest pen-
alties for failure to make prompt payments), for 
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the period beginning on the day after the re-
quired payment date and ending on the date on 
which payment is made. 
‘‘(D) PROCEDURES INVOLVING CLAIMS.— 
‘‘(i) CLAIMS DEEMED TO BE CLEAN 
CLAIMS.— 
‘‘(I) IN GENERAL.—A claim for a 
covered part D drug shall be deemed 
to be a clean claim for purposes of 
this paragraph if the PDP sponsor in-
volved does not provide a notification 
of deficiency to the claimant by the 
10th day that begins after the date on 
which the claim is submitted. 
‘‘(II) NOTIFICATION
OF
DEFI-
CIENCY.—For purposes of subclause 
(II), the term ‘notification of defi-
ciency’ means a notification that 
specifies all defects or improprieties in 
the claim involved and that lists all 
additional information or documents 
necessary for the proper processing 
and payment of the claim. 
‘‘(ii) PAYMENT OF CLEAN PORTIONS 
OF CLAIMS.—A PDP sponsor shall, as ap-
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ccoleman on PROD1PC71 with BILLS
propriate, pay any portion of a claim for a 
covered part D drug that would be a clean 
claim but for a defect or impropriety in a 
separate portion of the claim in accordance 
with subparagraph (A). 
‘‘(iii) OBLIGATION TO PAY.—A claim 
for a covered part D drug submitted to a 
PDP sponsor that is not paid or contested 
by the provider within the applicable num-
ber of calendar days (as defined in sub-
paragraph (B)) shall be deemed to be a 
clean claim and shall be paid by the PDP 
sponsor in accordance with subparagraph 
(A). 
‘‘(iv) DATE OF PAYMENT OF CLAIM.— 
Payment of a clean claim under subpara-
graph (A) is considered to have been made 
on the date on which full payment is re-
ceived by the provider. 
‘‘(E) 
ELECTRONIC
TRANSFER
OF 
FUNDS.—A PDP sponsor shall pay all clean 
claims submitted electronically by an electronic 
funds transfer mechanism.’’. 
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ccoleman on PROD1PC71 with BILLS
(b) APPLICATION
TO
MA–PD PLANS.—Section 
1857(f) of such Act (42 U.S.C. 1395w–27) is amended 
by adding at the end the following new paragraph: 
‘‘(3) INCORPORATION
OF
CERTAIN
PRESCRIP-
TION DRUG PLAN CONTRACT REQUIREMENTS.—The 
provisions of section 1860D–12(b)(5) shall apply to 
contracts with a Medicare Advantage Organization 
in the same manner as they apply to contracts with 
a PDP sponsor offering a prescription drug plan 
under part D.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to contracts entered into or re-
newed on or after the date of the enactment of this Act. 
SEC. 602. RESTRICTION ON CO-BRANDING. 
(a) IN GENERAL.—Section 1860D–4(b)(2)(A) of the 
Social Security Act (42 U.S.C. 1395w–104(b)(2)(A)) is 
amended by adding at the end the following new sen-
tences: ‘‘It is unlawful for a PDP sponsor of a prescription 
drug plan to display on such a card the name, brand, or 
trademark of any pharmacy.’’ 
(b) EFFECTIVE DATE.—With respect to cards dis-
pensed before, on, or after the date of the enactment of 
this Act, the amendment made by this section shall apply 
to such cards on and after the date that is 90 days after 
such date of enactment. Any card dispensed before such 
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ccoleman on PROD1PC71 with BILLS
date that is 90 days after the date of enactment that vio-
lates the second sentence of section 1860D–4(b)(2)(A) of 
the Social Security Act, as added by subsection (a), shall 
be reissued by such 90-day date. 
SEC. 603. PROVISION OF MEDICATION THERAPY MANAGE-
MENT SERVICES UNDER PART D. 
(a) PROVISION OF MEDICATION THERAPY MANAGE-
MENT SERVICES UNDER PART D.— 
(1) IN
GENERAL.—Section 1860D–4(c)(2) of 
the Social Security Act (42 U.S.C. 1395w– 
104(c)(2)) is amended— 
(A) in subparagraph (A)— 
(i) in clause (i)— 
(I) by inserting ‘‘or other health 
care provider with advanced training 
in medication management’’ after 
‘‘furnished by a pharmacist’’; and 
(II) by striking ‘‘targeted bene-
ficiaries described in clause (ii)’’ and 
inserting ‘‘targeted beneficiaries speci-
fied under clause (ii)’’ 
(ii) by striking clause (ii) and insert-
ing the following: 
‘‘(ii) TARGETED
BENEFICIARIES.— 
The Secretary shall specify the population 
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ccoleman on PROD1PC71 with BILLS
of part D eligible individuals appropriate 
for services under a medication therapy 
management program based on the fol-
lowing characteristics: 
‘‘(I) Having a disease state in 
which evidence-based medicine has 
demonstrated the benefit of medica-
tion therapy management intervention 
based on objective outcome measures. 
‘‘(II) Taking multiple covered 
part D drugs or having a disease state 
in which a complex combination medi-
cation regimen is utilized. 
‘‘(III) Being identified as likely 
to incur annual costs for covered part 
D drugs that exceed a level specified 
by the Secretary or where acute or 
chronic decompensation of disease 
would likely increase expenditures 
under the Federal Hospital Insurance 
Trust Fund or the Federal Supple-
mentary Medical Insurance Trust 
Fund under sections 1817 and 1841, 
respectively, such as through the re-
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ccoleman on PROD1PC71 with BILLS
quirement of emergency care or acute 
hospitalization.’’; 
(B) by striking subparagraph (B) and in-
serting the following: 
‘‘(B) ELEMENTS.— 
‘‘(i) MINIMUM DEFINED PACKAGE OF 
SERVICES.—The Secretary shall specify a 
minimum defined package of medication 
therapy management services that shall be 
provided to each enrollee. Such package 
shall be based on the following consider-
ations: 
‘‘(I) Performing necessary assess-
ments of the health status of each en-
rollee. 
‘‘(II) Providing medication ther-
apy review to identify, resolve, and 
prevent medication-related problems, 
including adverse events. 
‘‘(III) Increasing enrollee under-
standing to promote the appropriate 
use of medications by enrollees and to 
reduce the risk of potential adverse 
events associated with medications, 
through beneficiary and family edu-
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cation, counseling, and other appro-
priate means. 
‘‘(IV) Increasing enrollee adher-
ence with prescription medication 
regimens through medication refill re-
minders, special packaging, and other 
compliance programs and other appro-
priate means. 
‘‘(V) Promoting detection of ad-
verse drug events and patterns of 
overuse and underuse of prescription 
drugs. 
‘‘(VI) Developing a medication 
action plan which may alter the medi-
cation regimen, when permitted by the 
State licensing authority. This infor-
mation should be provided to, or ac-
cessible by, the primary health care 
provider of the enrollee. 
‘‘(VII) Monitoring and evaluating 
the response to therapy and evalu-
ating the safety and effectiveness of 
the therapy, which may include lab-
oratory assessment. 
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‘‘(VIII) Providing disease-specific 
medication therapy management serv-
ices when appropriate. 
‘‘(IX) Coordinating and inte-
grating medication therapy manage-
ment services within the broader scope 
of health care management services 
being provided to each enrollee. 
‘‘(ii) DELIVERY OF SERVICES.— 
‘‘(I) PERSONAL
DELIVERY.—To 
the extent feasible, face-to-face inter-
action shall be the preferred method 
of delivery of medication therapy man-
agement services. 
‘‘(II) 
INDIVIDUALIZED.—Such 
services shall be patient-specific and 
individualized and shall be provided 
directly to the patient by a pharmacist 
or other health care provider with ad-
vanced training in medication man-
agement. 
‘‘(III) DISTINCT
FROM
OTHER 
ACTIVITIES.—Such services shall be 
distinct from any activities related to 
formulary development and use, gen-
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ccoleman on PROD1PC71 with BILLS
eralized patient education and infor-
mation activities, and any population- 
focused quality assurance measures 
for medication use. 
‘‘(iii) OPPORTUNITY TO IDENTIFY PA-
TIENTS IN NEED OF MEDICATION THERAPY 
MANAGEMENT
SERVICES.—The program 
shall provide opportunities for health care 
providers to identify patients who should 
receive medication therapy management 
services.’’; 
(C) by striking subparagraph (E) and in-
serting the following: 
‘‘(E) PHARMACY FEES.— 
‘‘(i) IN GENERAL.—The PDP sponsor 
of a prescription drug plan shall pay phar-
macists and others providing services 
under the medication therapy management 
program under this paragraph based on 
the time and intensity of services provided 
to enrollees. 
‘‘(ii) SUBMISSION ALONG WITH PLAN 
INFORMATION.—Each such sponsor shall 
disclose to the Secretary upon request the 
amount of any such payments and shall 
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