Title: A bill to amend title XIX of the Social Security Act to add standards for drug compendia for physician use for purposes of Medicaid payment for certain drugs, and for other purposes.
Policy area: Health

Summary:
This bill amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to add standards for drug compendia used by physicians with respect to payment for certain drugs under the Medicare and Medicaid programs.
Specifically, such compendia shall include compendia that, as determined by the Centers for Medicare & Medicaid Services: (1) are used by health care providers and utilized nationwide by the health insurance industry, (2) have a publicly available policy on disclosures of conflicts of interest,  and (3) are accepted by at least one state board of pharmacy or equivalent licensing body.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 1003 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  1st Session
                                S. 1003

To amend title XIX of the Social Security Act to add standards for drug 
   compendia for physician use for purposes of Medicaid payment for 
                 certain drugs, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 2, 2017

Mr. Grassley (for himself and Mr. Casey) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XIX of the Social Security Act to add standards for drug 
   compendia for physician use for purposes of Medicaid payment for 
                 certain drugs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. ADDING STANDARDS FOR DRUG COMPENDIA FOR PHYSICIAN USE FOR 
              PURPOSES OF PAYMENT UNDER MEDICAID FOR CERTAIN DRUGS.

    (a) In General.--Section 1927(g)(1)(B)(i) of the Social Security 
Act (42 U.S.C. 1396r-8(g)(1)(B)(i)) is amended--
            (1) in subclause (I), by striking the semicolon at the end 
        and inserting a period;
            (2) in subclause (II), by striking ``); and'' at the end 
        and inserting ``).'';
            (3) in subclause (III)--
                    (A) by striking ``the DRUGDEX'' and inserting ``The 
                DRUGDEX''; and
                    (B) by striking ``; and'' at the end and inserting 
                a period; and
            (4) by adding at the end the following:
                                    ``(IV) Other compendia, as 
                                determined by the Secretary in a manner 
                                consistent with the revision process 
                                provided for in section 1861(t), that--
                                            ``(aa) are utilized 
                                        nationwide by the private 
                                        health insurance industry;
                                            ``(bb) are used by health 
                                        care providers, such as long-
                                        term care facilities or 
                                        academic health centers;
                                            ``(cc) have a publicly 
                                        available policy on the 
                                        disclosure of conflicts of 
                                        interest that may exist between 
                                        such a health care provider and 
                                        drug manufacturers; and
                                            ``(dd) are accepted as 
                                        professional drug compendia by 
                                        at least one State board of 
                                        pharmacy (or an equivalent 
                                        State licensing body).''.
    (b) Technical Amendments.--Section 1927(g)(1)(B) of the Social 
Security Act (42 U.S.C. 1396r-8(g)(1)(B)) is amended--
            (1) in clause (i), by striking ``compendia'' and inserting 
        ``Compendia''; and
            (2) in clause (ii), by striking ``the peer-reviewed'' and 
        inserting ``The peer-reviewed''.

SEC. 2. REVISING DEFINITION OF MEDICALLY ACCEPTED INDICATION FOR 
              MEDICARE PART D DRUGS.

    Section 1860D-2(e)(4) of the Social Security Act (42 U.S.C. 1395w-
102(e)(4)) is amended--
            (1) in subparagraph (A)(i)(II), by striking ``section 
        1927(g)(1)(B)(i)(III)'' and inserting ``subclauses (III) and 
        (IV) of section 1927(g)(1)(B)(i)''; and
            (2) in subparagraph (B), by striking ``subparagraph 
        (A)(i)(II)'' and all that follows through 
        ``1927(g)(1)(B)(i)(III)'' and inserting ``a compendium 
        described in subclause (III) or (IV) of section 
        1927(g)(1)(B)(i) shall not be included in the list of compendia 
        described in section 1861(t)(2)(B)(ii)(I) unless such 
        compendium''.
                                 <all>