Title: Seniors Prescription Drug Relief Act of 2019
Policy area: Health

Summary:
Seniors Prescription Drug Relief Act of 2019
This bill allows beneficiaries whose monthly costs under the Medicare prescription drug benefit equal or exceed a significant percentage of the annual out-of-pocket spending threshold to pay down such costs in installments over the course of the remaining plan year. The Centers for Medicare & Medicaid Services must determine what constitutes a significant percentage; however, such percentage must be between 50% and 100%.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2911 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                S. 2911

 To amend title XVIII of the Social Security Act to provide a monthly 
     out-of-pocket cost sharing maximum for enrollees who incur a 
   significant portion of costs for covered part D drugs towards the 
             annual out-of-pocket threshold during a month.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           November 20, 2019

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

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to provide a monthly 
     out-of-pocket cost sharing maximum for enrollees who incur a 
   significant portion of costs for covered part D drugs towards the 
             annual out-of-pocket threshold during a month.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Seniors Prescription Drug Relief Act 
of 2019''.

SEC. 2. MONTHLY OUT-OF-POCKET COST SHARING MAXIMUM FOR ENROLLEES WHO 
              INCUR A SIGNIFICANT PORTION OF COSTS TOWARDS ANNUAL OUT-
              OF-POCKET THRESHOLD.

    (a) Standard Prescription Drug Coverage.--Section 1860D-2(b)(2) of 
the Social Security Act (42 U.S.C. 1395w-102(b)(2)) is amended--
            (1) in subparagraph (A), by striking ``and (D)'' and 
        inserting ``, (D), and (E)'';
            (2) in each of subparagraphs (C)(i) and (D)(i), by striking 
        ``paragraph (4)'' and inserting ``paragraph (4), and subject to 
        subparagraph (E)''; and
            (3) by adding at the end the following new subparagraph:
                    ``(E) Monthly out-of-pocket cost sharing maximum.--
                            ``(i) In general.--For plan years beginning 
                        on or after January 1, 2022, the Secretary 
                        shall through regulation establish a process to 
                        allow an enrollee in a prescription drug plan 
                        who incurs costs (as described in paragraph 
                        (4)(C)) equal to or greater than a significant 
                        percentage of the annual out-of-pocket 
                        threshold specified in paragraph (4)(B) within 
                        a one month time period to choose to pay the 
                        total amount of such costs owed, in equal 
                        installments in the remaining months of the 
                        plan year up to the total amount of such annual 
                        out-of-pocket threshold.
                            ``(ii) Definition of significant percent.--
                        For purposes of the process described in clause 
                        (i), the Secretary shall through regulation 
                        provide for a definition of the term 
                        `significant percentage' with respect to a 
                        percentage of the annual out-of-pocket 
                        threshold specified in paragraph (4)(B) but in 
                        no case shall the `significant percentage' be 
                        less than 50 percent or more than 100 percent 
                        of the annual out-of-pocket threshold.''.
    (b) Alternative Prescription Drug Coverage.--Section 1860D-2(c) of 
the Social Security Act (42 U.S.C. 1395w-102(c)) is amended by adding 
at the end the following new paragraph:
            ``(4) Same monthly out-of-pocket cost sharing maximum.--For 
        plan years beginning on or after January 1, 2022, the coverage 
        provides the monthly out-of-pocket cost sharing maximum 
        required under subsection (b)(2)(E).''.
                                 <all>