Title: Patient Shared Savings Act
Policy area: Health

Summary:
Patient Shared Savings Act
This bill allows a prescription drug plan (PDP) sponsor under the Medicare prescription drug benefit to share realized savings from an enrollee's switch to a lower-cost therapeutic alternative with the enrollee, in accordance with specified requirements. Among other requirements, the enrollee must have been taking the original prescription drug for at least two months and must have consulted with a physician before making the switch. PDP sponsors must share the savings in a tangible form that directly benefits the enrollee (e.g., a monetary rebate).

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3000 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                S. 3000

 To amend title XVIII of the Social Security Act to allow PDP sponsors 
    of prescription drug plans and Medicare Advantage organizations 
offering MA-PD plans to share with enrollees a portion of savings from 
      switching to lower cost therapeutic alternative medications.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            December 9, 2019

Mr. Cassidy (for himself and Ms. Hassan) 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 allow PDP sponsors 
    of prescription drug plans and Medicare Advantage organizations 
offering MA-PD plans to share with enrollees a portion of savings from 
      switching to lower cost therapeutic alternative medications.

    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 ``Patient Shared Savings Act''.

SEC. 2. ALLOWING PRESCRIPTION DRUG PLANS AND MA-PD PLANS TO SHARE WITH 
              ENROLLEES A PORTION OF SAVINGS FROM SWITCHING TO LOWER 
              COST THERAPEUTIC ALTERNATIVE MEDICATIONS.

    (a) In General.--Section 1860D-4 of the Social Security Act (42 
U.S.C. 1395w-104) is amended--
            (1) by redesignating subsection (m) (relating to program 
        integrity transparency measures), as added by section 6063(c) 
        of the Substance Use-Disorder Prevention that Promotes Opioid 
        Recovery and Treatment for Patients and Communities Act (Public 
        Law 115-271), as subsection (n); and
            (2) by adding at the end the following new subsection:
    ``(o) Sharing With Enrollees a Portion of Savings From Switching to 
a Lower Cost Therapeutic Alternative Medication.--
            ``(1) In general.--For plan years beginning on or after 
        January 1, 2021, a PDP sponsor of a prescription drug plan may 
        have a program under which the PDP sponsor shares with an 
        enrollee in the plan a portion of savings to the PDP sponsor as 
        a result of the enrollee switching from a covered part D drug 
        the enrollee is taking on an ongoing basis to a lower cost 
        therapeutic alternative covered part D drug.
            ``(2) Requirements.--If a PDP sponsor implements a program 
        described in paragraph (1), the following requirements shall 
        apply with respect to the program:
                    ``(A) Requirements with respect to enrollees.--The 
                enrollee--
                            ``(i) must have been taking the covered 
                        part D drug on an ongoing basis for at least 2 
                        months as confirmed by claims analysis by the 
                        PDP sponsor prior to switching to the lower 
                        cost therapeutic alternative covered part D 
                        drug; and
                            ``(ii) must have agreed to make such switch 
                        after consulting with their physician.
                    ``(B) Requirements with respect to pdp sponsors.--
                The PDP sponsor must--
                            ``(i) make available a shared savings 
                        report with therapeutic alternatives to 
                        eligible enrollees through Evidence of Benefits 
                        or other information sent to enrollees, or 
                        provide contracted providers with access to 
                        tools that include therapeutic alternatives and 
                        shared savings at the point of care;
                            ``(ii) ensure that the total amount of 
                        savings shared with an enrollee with respect to 
                        the switch to a particular lower cost 
                        therapeutic alternative covered part D drug 
                        does not exceed an amount equal to 10 percent 
                        of the annualized net savings to the PDP 
                        sponsor as a result of the enrollee making such 
                        switch;
                            ``(iii) only share such savings after the 
                        PDP sponsor confirms, based on claims analysis, 
                        that--
                                    ``(I) the enrollee has switched to 
                                the lower cost therapeutic alternative 
                                covered part D drug; and
                                    ``(II) the switch does not result 
                                in an increased cost to the program 
                                under this part;
                            ``(iv) provide a tangible reward or 
                        incentive for the amount of such shared 
                        savings, which--
                                    ``(I) shall directly benefit the 
                                enrollee;
                                    ``(II) such sponsor may not--
                                            ``(aa) use to reduce plan 
                                        premiums for the enrollee; or
                                            ``(bb) direct an enrollee 
                                        to use to pay such premiums; 
                                        and
                                    ``(III) may be in the form of a 
                                monetary rebate, gift card, discount 
                                coupon, or other item consistent with 
                                the President's Executive Order on 
                                Protecting and Improving Medicare for 
                                Our Nation's Seniors, issued on October 
                                3, 2019; and
                            ``(v) provide an annual report to the 
                        Secretary, with respect to the preceding plan 
                        year, on the number of enrollees who receive 
                        shared savings under this subsection as a 
                        result of switching to a lower cost therapeutic 
                        alternative covered part D drug, the total 
                        amount of such savings shared with the enrollee 
                        and in what form, and the total savings to the 
                        PDP sponsor as a result of enrollees making 
                        such switch.
            ``(3) Authority to provide with respect to certain sub-
        populations or geographic areas.--A PDP sponsor may provide 
        shared savings pursuant to this subsection for only a certain 
        sub-population of enrollees or a geographically limited 
        population of enrollees if the Secretary determines, based on a 
        showing by the PDP sponsor, that the PDP sponsor is not 
        discriminating based on the health status of enrollees.''.
    (b) Exclusion From Anti-Kickback Prohibition.--Section 1128B(b)(3) 
of the Social Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--
            (1) in subparagraph (J)--
                    (A) by moving such subparagraph 2 ems to the left; 
                and
                    (B) by striking ``and'' at the end;
            (2) in subparagraph (K)--
                    (A) by moving such subparagraph 2 ems to the left; 
                and
                    (B) by striking the period at the end and inserting 
                ``; and''; and
            (3) by adding at the end the following new subparagraph:
            ``(L) any shared savings provided under section 1860D-
        4(o).''.
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