306 
(d) TREATMENT OF CERTAIN COMPLAINTS FOR PUR-
POSES OF QUALITY OR PERFORMANCE ASSESSMENT.— 
Section 1860D–42 of the Social Security Act (42 U.S.C. 
1395w–152) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(d) TREATMENT
OF CERTAIN COMPLAINTS
FOR 
PURPOSES
OF
QUALITY
OR
PERFORMANCE
ASSESS-
MENT.—In conducting a quality or performance assess-
ment of a PDP sponsor, the Secretary shall develop or 
utilize existing screening methods for reviewing and con-
sidering complaints that are received from enrollees in a 
prescription drug plan offered by such PDP sponsor and 
that are complaints regarding the lack of access by the 
individual to prescription drugs due to a drug manage-
ment program for at-risk beneficiaries.’’. 
(e) SENSE OF CONGRESS REGARDING USE OF TECH-
NOLOGY TOOLS TO COMBAT FRAUD.—It is the sense of 
Congress that MA organizations and PDP sponsors 
should consider using e-prescribing and other health infor-
mation technology tools to support combating fraud under 
MA–PD plans and prescription drug plans under parts C 
and D of the Medicare program. 
(f) EFFECTIVE DATE.— 
(1) IN GENERAL.—The amendments made by 
this section shall apply to prescription drug plans 
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307 
(and MA–PD plans) for plan years beginning more 
than 1 year after the date of the enactment of this 
Act. 
(2) STAKEHOLDER MEETINGS PRIOR TO EFFEC-
TIVE DATE.— 
(A) IN GENERAL.—Not later than January 
1, 2016, the Secretary of Health and Human 
Services shall convene stakeholders, including 
individuals entitled to benefits under part A of 
title XVIII of the Social Security Act or en-
rolled under part B of such title of such Act, 
advocacy groups representing such individuals, 
physicians, pharmacists, and other clinicians, 
retail pharmacies, plan sponsors, entities dele-
gated by plan sponsors, and biopharmaceutical 
manufacturers for input regarding the topics 
described in subparagraph (B). 
(B) TOPICS DESCRIBED.—The topics de-
scribed in this subparagraph are the topics of— 
(i) the impact on cost-sharing and en-
suring accessibility to prescription drugs 
for enrollees in prescription drug plans of 
PDP sponsors, and enrollees in MA–PD 
plans, who are at-risk beneficiaries for pre-
scription drug abuse (as defined in sub-
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308 
paragraph (C) of paragraph (5) of section 
1860D–4(c) of the Social Security Act (42 
U.S.C. 1395w–104(c))); 
(ii) the use of an expedited appeals 
process under which such an enrollee may 
appeal an identification of such enrollee as 
an at-risk beneficiary for prescription drug 
abuse under such paragraph (similar to the 
processes established under the Medicare 
Advantage program under part C of title 
XVIII of the Social Security Act that allow 
an automatic escalation to external review 
of claims submitted under such part); 
(iii) the types of enrollees that should 
be treated as exempted individuals, as de-
scribed in subparagraph (C)(ii) of such 
paragraph; 
(iv) the manner in which terms and 
definitions in such paragraph should be ap-
plied, such as the use of clinical appro-
priateness in determining whether an en-
rollee is an at-risk beneficiary for prescrip-
tion drug abuse as defined in subpara-
graph (C) of such paragraph; 
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309 
(v) the information to be included in 
the notices described in subparagraph (B) 
of such paragraph and the standardization 
of such notices; and 
(vi) with respect to a PDP sponsor 
(or Medicare Advantage organization) that 
establishes a drug management program 
for at-risk beneficiaries under such para-
graph, the responsibilities of such PDP 
sponsor (or organization) with respect to 
the implementation of such program. 
(g) RULEMAKING.—The Secretary of Health and 
Human Services shall promulgate regulations based on the 
input gathered pursuant to subsection (f)(2)(A). 
Æ 
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