I 
109TH CONGRESS 
2D SESSION 
H. R. 5193 
To amend titles XVIII and XIX of the Social Security Act to provide for 
continuity of Medicare prescription drug coverage for full-benefit dual 
eligible individuals, for Medicare prescription drug coverage of 
benzodiazepines and off-label uses of certain prescription drugs and bio-
logical products, for optional Medicaid coverage of Medicare prescription 
drug cost-sharing for full-benefit dual eligible individuals, for authoriza-
tion to the Secretary of Health and Human Services to waive certain 
determinations denying Medicare prescription drug coverage, and for 
holding pharmacies harmless for certain costs incurred during implemen-
tation of Medicare part D. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 25, 2006 
Mrs. WILSON of New Mexico introduced the following bill; which was referred 
to the Committee on Energy and Commerce, and in addition to the Com-
mittee 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 continuity of Medicare prescription drug 
coverage for full-benefit dual eligible individuals, for 
Medicare prescription drug coverage of benzodiazepines 
and off-label uses of certain prescription drugs and bio-
logical products, for optional Medicaid coverage of Medi-
care prescription drug cost-sharing for full-benefit dual 
eligible individuals, for authorization to the Secretary 
of Health and Human Services to waive certain deter-
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minations denying Medicare prescription drug coverage, 
and for holding pharmacies harmless for certain costs 
incurred during implementation of Medicare part D. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. CONTINUITY OF MEDICARE PRESCRIPTION 
DRUG COVERAGE FOR FULL-BENEFIT DUAL 
ELIGIBLE INDIVIDUALS. 
(a) IN GENERAL.—Section 1860D–2(a) of the Social 
Security Act (42 U.S.C. 1395w–102(a)) is amended— 
(1) in paragraph (1), by inserting ‘‘subject to 
paragraph (6),’’ after ‘‘part C’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(6) CONTINUATION OF MEDICARE COVERAGE 
FOR
CERTAIN
PRESCRIPTIONS
FOR
FULL-BENEFIT 
DUAL ELIGIBLE INDIVIDUALS.—In the case of an in-
dividual who, as of the date the individual is first 
enrolled under a prescription drug plan under this 
part (or an MA–PD plan under part D), is a full- 
benefit dual eligible individual and is being provided 
medical assistance for a covered part D drug under 
title XIX, qualified prescription drug coverage must 
include coverage for such drug unless a prescribing 
physician certifies that the coverage of such drug is 
not medically necessary, regardless of whether the 
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individual subsequently remains a full-benefit dual 
eligible individual.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall be effective as if included in the enact-
ment of Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108–173). 
SEC. 2. MEDICARE PRESCRIPTION DRUG COVERAGE OF 
BENZODIAZEPINES. 
(a) IN GENERAL.—Section 1860D–2(e)(2)(A) of the 
Social Security Act (42 U.S.C. 1395w–112(e)(2)(A)) is 
amended by inserting after ‘‘agents)’’ the following: ‘‘and 
other than subparagraph (J) of such section (relating to 
benzodiazepines)’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall be effective as if included in the enact-
ment of Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108–173). 
SEC. 3. PERMITTING STATE MEDICAID PROGRAMS TO 
COVER MEDICARE PRESCRIPTION DRUG CO-
PAYMENTS FOR FULL-BENEFIT DUAL ELIGI-
BLE INDIVIDUALS. 
(a) IN GENERAL.—Section 1935(d) of the Social Se-
curity Act (42 U.S.C. 1396u–5(d)) is amended by adding 
at the end the following new paragraph: 
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