Title: Maximizing Drug Coverage for Low-Income Seniors Act of 2019
Policy area: Health

Summary:
Maximizing Drug Coverage for Low-Income Seniors Act of 2019
This bill provides for an alternative process by which the Centers for Medicare & Medicaid Services (CMS) may automatically enroll certain individuals who are eligible for low-income subsidies under the Medicare prescription drug benefit in prescription drug plans. Specifically, the CMS may use a process that actively matches such individuals with prescription drug plans based on the individual's needs in relation to certain factors (e.g., formularies), rather than the current random assignment process.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4669 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 4669

    To amend title XVIII of the Social Security Act to provide for 
  intelligent assignment of certain subsidy eligible individuals auto-
    enrolled under Medicare prescription drug plans and MA-PD plans.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 11, 2019

Ms. Stevens (for herself, Mrs. Hayes, Ms. Kuster of New Hampshire, and 
    Ms. Sewell of Alabama) 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 provide for 
  intelligent assignment of certain subsidy eligible individuals auto-
    enrolled under Medicare prescription drug plans and MA-PD plans.

    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 ``Maximizing Drug Coverage for Low-
Income Seniors Act of 2019''.

SEC. 2. PROVIDING FOR INTELLIGENT ASSIGNMENT OF CERTAIN SUBSIDY 
              ELIGIBLE INDIVIDUALS AUTO-ENROLLED UNDER MEDICARE 
              PRESCRIPTION DRUG PLANS AND MA-PD PLANS.

    (a) In General.--Section 1860D-1(b)(1) of the Social Security Act 
(42 U.S.C. 1395w-101(b)(1)) is amended--
            (1) in subparagraph (C)--
                    (A) by inserting after ``PDP region'' the 
                following: ``or through use of an intelligent 
                assignment process that is designed to maximize the 
                access of such individual to necessary prescription 
                drugs while minimizing costs to such individual and to 
                the program under this part to the greatest extent 
                possible. In the case the Secretary enrolls such 
                individuals through use of an intelligent assignment 
                process, such process shall take into account the 
                extent to which prescription drugs necessary for the 
                individual are covered in the case of a PDP sponsor of 
                a prescription drug plan that uses a formulary, the use 
                of prior authorization or other restrictions on access 
                to coverage of such prescription drugs by such a 
                sponsor, and the overall quality of a prescription drug 
                plan as measured by quality ratings established by the 
                Secretary''; and
                    (B) by striking ``Nothing in the previous 
                sentence'' and inserting ``Nothing in this 
                subparagraph''; and
            (2) in subparagraph (D)--
                    (A) by inserting after ``PDP region'' the 
                following: ``or through use of an intelligent 
                assignment process that is designed to maximize the 
                access of such individual to necessary prescription 
                drugs while minimizing costs to such individual and to 
                the program under this part to the greatest extent 
                possible. In the case the Secretary enrolls such 
                individuals through use of an intelligent assignment 
                process, such process shall take into account the 
                extent to which prescription drugs necessary for the 
                individual are covered in the case of a PDP sponsor of 
                a prescription drug plan that uses a formulary, the use 
                of prior authorization or other restrictions on access 
                to coverage of such prescription drugs by such a 
                sponsor, and the overall quality of a prescription drug 
                plan as measured by quality ratings established by the 
                Secretary''; and
                    (B) by striking ``Nothing in the previous 
                sentence'' and inserting ``Nothing in this 
                subparagraph''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to plan years beginning with plan year 2022.
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