‘‘(4) REQUIRED
COVERAGE
OF
DRUGS
IN-
CLUDED IN SPECIFIED THERAPEUTIC CATEGORIES 
DURING
DETERMINATIONS, 
RECONSIDERATIONS, 
AND APPEALS.—If a part D eligible individual en-
rolled in a prescription drug plan offered by a PDP 
sponsor requests a redetermination or reconsider-
ation under this subsection (or an appeal under sub-
section (h)) with respect to an utilization manage-
ment requirement or denial of coverage (in whole or 
in part) of a drug in a category specified in sub-
section (b)(3)(G)(i), such sponsor shall provide such 
individual with coverage of such drug as prescribed 
during the pendency of such redetermination, recon-
sideration, or appeal until 60 days after the date of 
receipt of a written notification of— 
‘‘(A) in the case that the individual does 
not request a reconsideration or appeal, the de-
termination on such redetermination; 
‘‘(B) in the case that the individual re-
quests a reconsideration but not an appeal, the 
determination on such reconsideration; or 
‘‘(C) in the case that the individual re-
quests an appeal, the determination on such ap-
peal or the dismissal of the appeal; 
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except that in no case shall such coverage end before 
the end of the period in which an individual may file 
an appeal with respect to the determination in-
volved.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to requests for redeter-
minations, reconsiderations, and appeal hearings 
made on or after the effective date described in sub-
section (a)(2). 
(c) REPORTING REQUIREMENTS
FOR DRUGS IN-
CLUDED IN SPECIFIED THERAPEUTIC CATEGORIES.— 
(1) IN GENERAL.—Section 1860D–4(b) of the 
Social Security Act (42 U.S.C. 1395w–104(b)) is 
amended by adding at the end the following new 
paragraph: 
‘‘(4) REPORTING
REQUIREMENTS
FOR
DRUGS 
INCLUDED
IN
SPECIFIED
THERAPEUTIC
CAT-
EGORIES.— 
‘‘(A) REPORTS
BY
PDP
SPONSORS.—A 
PDP sponsor offering a prescription drug plan 
shall submit to the Secretary (in a form and 
manner specified by the Secretary), with respect 
to drugs in a category of covered part D drugs 
specified in subsection (b)(3)(G)(i), information 
on the number of favorable and unfavorable de-
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cisions under the plan relating to coverage de-
terminations, 
redeterminations, 
reconsider-
ations, appeals, and enrollee requests for excep-
tions to formulary policies for such drugs. 
‘‘(B) REPORT
TO
CONGRESS.—The Sec-
retary shall submit an annual report to Con-
gress summarizing the information submitted 
under subparagraph (A) and shall publish each 
report in the Federal Register.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to prescription drug 
plans and MA plans for plan years beginning on or 
after the effective date described in subsection 
(a)(2). 
Æ 
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