Title: Encouraging Innovative Benefit Design to Lower Costs for Seniors Act
Policy area: Health

Summary:
Encouraging Innovative Benefit Design to Lower Costs for Seniors Act
This bill allows prescription drug plan (PDP) sponsors under the Medicare prescription drug benefit to offer additional plans in a region.
Specifically, the Centers for Medicare & Medicaid Services (CMS) must update guidance to allow PDP sponsors to offer up to four plans in a region; the CMS may also set a greater limit, as appropriate.
PDP sponsors may offer up to two additional plans beyond this limit if the PDP sponsor ensures that, under at least one of the plans, pharmacy benefit managers do not receive any remuneration unless at least 10% of price reductions received from drug manufacturers are reflected at the point-of-sale or otherwise used to reduce beneficiary cost-sharing.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3013 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                S. 3013

   To amend title XVIII of the Social Security Act to allow for the 
 offering of additional prescription drug plans under Medicare part D.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           December 10, 2019

 Mr. Toomey (for himself and Mr. Crapo) 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 for the 
 offering of additional prescription drug plans under Medicare part D.

    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 ``Encouraging Innovative Benefit 
Design to Lower Costs for Seniors Act''.

SEC. 2. ALLOWING THE OFFERING OF ADDITIONAL PRESCRIPTION DRUG PLANS 
              UNDER MEDICARE PART D.

    (a) Rescinding and Issuance of New Guidance.--Not later than one 
year after the date of the enactment of this Act, the Secretary of 
Health and Human Services (in this section referred to as the 
``Secretary'') shall--
            (1) rescind sections of any sub-regulatory guidance that 
        limit the number of prescription drug plans in each PDP region 
        that may be offered by a PDP sponsor under part D of title 
        XVIII of the Social Security Act (42 U.S.C. 1395w-101 et seq.); 
        and
            (2) issue new guidance specifying that a PDP sponsor may 
        offer up to 4 (or a greater number if determined appropriate by 
        the Secretary) prescription drug plans in each PDP region, 
        except in case where the PDP sponsor may offer up to 2 
        additional plans in a PDP region pursuant to section 1860D-
        11(d)(4) of the Social Security Act (42 U.S.C. 1395w-
        111(d)(4)), as added by subsection (b).
    (b) Offering of Additional Plans.--Section 1860D-11(d) of the 
Social Security Act (42 U.S.C. 1395w-111(d)) is amended by adding at 
the end the following new paragraph:
            ``(4) Offering of additional plans.--
                    ``(A) In general.--For plan year 2022 and each 
                subsequent plan year, a PDP sponsor may offer up to 2 
                additional prescription drug plans in a PDP region (in 
                addition to any limit established by the Secretary 
                under this part) provided that the PDP sponsor complies 
                with subparagraph (B) with respect to at least one such 
                prescription drug plan.
                    ``(B) Requirements.--In order to be eligible to 
                offer up to 2 additional plans in a PDP region pursuant 
                to subparagraph (A), a PDP sponsor must ensure that, 
                with respect to at least one such prescription drug 
                plan, the sponsor or any entity that provides pharmacy 
                benefits management services under a contract with any 
                such sponsor or plan does not receive direct or 
                indirect remuneration, as defined in section 423.308 of 
                title 42, Code of Federal Regulations (or any successor 
                regulation), unless at least 10 percent of the 
                aggregate reductions in price or other remuneration 
                received by the PDP sponsor or entity from drug 
                manufacturers with respect to the plan and plan year--
                            ``(i) are reflected at the point-of-sale to 
                        the enrollee; or
                            ``(ii) are used to reduce total beneficiary 
                        cost-sharing estimated by the PDP sponsor for 
                        prescription drug coverage under the plan in 
                        the annual bid submitted by the PDP sponsor 
                        under section 1860D-11(b).
                    ``(C) Definition of reductions in price.--For 
                purposes of subparagraph (B), the term `reductions in 
                price' refers only to collectible amounts, as 
                determined by the Secretary, which excludes amounts 
                which after adjudication and reconciliation with 
                pharmacies and manufacturers are duplicate in nature, 
                contrary to other contractual clauses, or otherwise 
                ineligible (such as due to beneficiary disenrollment or 
                coordination of benefits).''.
    (c) Rule of Construction.--Nothing in the provisions of, or 
amendments made by, this section shall be construed as limiting the 
ability of the Secretary to increase any limit otherwise applicable on 
the number of prescription drug plans that a PDP sponsor may offer, at 
the discretion of the PDP sponsor, in a PDP region under part D of 
title XVIII of the Social Security Act (42 U.S.C. 1395w-101 et seq.).
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