Title: Shop Rx Act of 2019
Policy area: Health

Summary:
Shop Rx Act of 2019
This bill provides statutory authority for certain provisions of the Centers for Medicare & Medicaid Services rule titled "Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses," published on May 23, 2019. The rule requires, in part, Medicare prescription drug plan sponsors to implement an electronic, real-time benefit tool that is capable of integrating with at least one prescriber's electronic prescribing system or electronic health record. The tool must provide prescribers with patient-specific, real-time formulary and benefit information, including information regarding cost-sharing, formulary alternatives, and utilization management requirements. The rule takes effect January 1, 2021.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3408 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 3408

To amend title XVIII of the Social Security Act to require prescription 
drug plan sponsors to include real-time benefit information as part of 
   such sponsor's electronic prescription program under the Medicare 
                                program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 21, 2019

  Mr. Arrington (for himself and Mr. Olson) introduced the following 
 bill; which was referred to the Committee on Energy and Commerce, and 
  in addition to the Committee on Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to require prescription 
drug plan sponsors to include real-time benefit information as part of 
   such sponsor's electronic prescription program under the Medicare 
                                program.

    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 ``Shop Rx Act of 2019''.

SEC. 2. REQUIRING PRESCRIPTION DRUG PLAN SPONSORS TO INCLUDE REAL-TIME 
              BENEFIT INFORMATION AS PART OF SUCH SPONSOR'S ELECTRONIC 
              PRESCRIPTION PROGRAM UNDER THE MEDICARE PROGRAM.

    Section 1860D-4(e)(2) of the Social Security Act (42 U.S.C. 1395w-
104(e)(2)) is amended--
            (1) in subparagraph (D), by striking ``To the extent'' and 
        inserting ``Except as provided in subparagraph (F), to the 
        extent''; and
            (2) by adding at the end the following new subparagraph:
                    ``(F) Real-time benefit information.--
                            ``(i) In general.--Not later than January 
                        1, 2021, the program shall provide for the 
                        real-time electronic transmission to 
                        prescribing health care professionals, using 
                        technology capable of integrating with such 
                        professionals' electronic prescribing and 
                        electronic health record systems, of 
                        individual-specific formulary and benefit 
                        information under a prescription drug plan with 
                        respect to an individual enrolled in such plan. 
                        Such information shall include, with respect to 
                        the prescribing of a covered part D drug to 
                        such individual, the following:
                                    ``(I) A description of any 
                                clinically appropriate alternatives to 
                                such drug included in the formulary of 
                                such plan.
                                    ``(II) Information relating to 
                                applicable cost-sharing requirements 
                                for such drug and such alternatives, 
                                including a description of any variance 
                                in such requirements based on the 
                                pharmacy dispensing such drug or such 
                                alternatives.
                                    ``(III) Information relating to any 
                                prior authorization or other 
                                utilization management requirements 
                                applicable to such drug and such 
                                alternatives within the formulary of 
                                such plan.
                            ``(ii) Special rule for 2021.--The program 
                        shall be deemed to be in compliance with clause 
                        (i) for 2021 if the program complies with the 
                        provisions of section 423.160(b)(7) of title 
                        42, Code of Federal Regulations (or a successor 
                        regulation), for such year.''.
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