Title: Improving Low Income Access to Prescription Drugs Act of 2019
Policy area: Health

Summary:
Improving Low-Income Access to Prescription Drugs Act of 2019
This bill provides statutory authority for the Centers for Medicare & Medicaid Services transition program under the Medicare prescription drug benefit for limited-income, newly eligible individuals (i.e., individuals who are eligible for subsidies and have not yet enrolled in, or whose coverage has not yet taken effect under, a Medicare or Medicare Advantage prescription drug plan). The program's coverage provides immediate access to covered drugs at the point of sale as soon as the individual becomes eligible for subsidies; coverage also applies retroactively for dual eligible individuals and for individuals who receive benefits under the Supplemental Security Income program.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1999 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                S. 1999

To amend title XVIII of the Social Security Act to provide transitional 
   coverage and retroactive Medicare part D coverage for certain low-
                         income beneficiaries.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 27, 2019

 Mr. Casey (for himself and Mr. Daines) 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 transitional 
   coverage and retroactive Medicare part D coverage for certain low-
                         income beneficiaries.

    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 ``Improving Low Income Access to 
Prescription Drugs Act of 2019''.

SEC. 2. TRANSITIONAL COVERAGE AND RETROACTIVE MEDICARE PART D COVERAGE 
              FOR CERTAIN LOW-INCOME BENEFICIARIES.

    Section 1860D-14 of the Social Security Act (42 U.S.C. 1395w-114) 
is amended--
            (1) by redesignating subsection (e) as subsection (f); and
            (2) by adding after subsection (d) the following new 
        subsection:
    ``(e) Limited Income Newly Eligible Transition Program.--
            ``(1) In general.--Beginning not later than January 1, 
        2021, the Secretary shall carry out a program to provide 
        transitional coverage for covered part D drugs for LI NET 
        eligible individuals in accordance with this subsection.
            ``(2) LI net eligible individual defined.--For purposes of 
        this subsection, the term `LI NET eligible individual' means a 
        part D eligible individual who--
                    ``(A) meets the requirements of clauses (ii) and 
                (iii) of subsection (a)(3)(A); and
                    ``(B) has not yet enrolled in a prescription drug 
                plan or an MA-PD plan, or, who has so enrolled, but 
                with respect to whom coverage under such plan has not 
                yet taken effect.
            ``(3) Transitional coverage.--For purposes of this 
        subsection, the term `transitional coverage' means with respect 
        to an LI NET eligible individual--
                    ``(A) immediate access to covered part D drugs at 
                the point of sale during the period that begins on the 
                first day of the month such individual is determined to 
                meet the requirements of clauses (ii) and (iii) of 
                subsection (a)(3)(A) and ends on the date that coverage 
                under a prescription drug plan or MA-PD plan takes 
                effect with respect to such individual; and
                    ``(B) in the case of an LI NET eligible individual 
                who is a full-benefit dual eligible individual (as 
                defined in section 1935(c)(6)) or a recipient of 
                supplemental security income benefits under title XVI, 
                retroactive coverage (in the form of reimbursement of 
                the amounts that would have been paid under this part 
                had such individual been enrolled in a prescription 
                drug plan or MA-PD plan) of covered part D drugs 
                purchased by such individual during the period that 
                begins on the date that is the later of--
                            ``(i) the date that such individual was 
                        first eligible for a low-income subsidy under 
                        this part; or
                            ``(ii) the date that is 36 months prior to 
                        the date such individual enrolls in a 
                        prescription drug plan or MA-PD plan,
                and ends on the date that coverage under such plan 
                takes effect.
            ``(4) Program administration.--
                    ``(A) Single point of contact.--The Secretary 
                shall, to the extent feasible, administer the program 
                under this subsection through a contract with a single 
                program administrator.
                    ``(B) Benefit design.--The Secretary shall ensure 
                that the transitional coverage provided to LI NET 
                eligible individuals under this subsection--
                            ``(i) provides access to all covered part D 
                        drugs under an open formulary;
                            ``(ii) permits all pharmacies determined by 
                        the Secretary to be in good standing to process 
                        claims under the program;
                            ``(iii) is consistent with such 
                        requirements as the Secretary considers 
                        necessary to improve patient safety and ensure 
                        appropriate dispensing of medication; and
                            ``(iv) meets such other requirements as the 
                        Secretary may establish.
            ``(5) Relationship to other provisions of this title; 
        waiver authority.--
                    ``(A) In general.--The following provisions shall 
                not apply with respect to the program under this 
                subsection:
                            ``(i) Paragraphs (1) and (3)(B) of section 
                        1860D-4(a) (relating to dissemination of 
                        general information; availability of 
                        information on changes in formulary through the 
                        internet).
                            ``(ii) Subparagraphs (A) and (B) of section 
                        1860D-4(b)(3) (relating to requirements on 
                        development and application of formularies; 
                        formulary development).
                            ``(iii) Paragraphs (1)(C) and (2) of 
                        section 1860D-4(c) (relating to medication 
                        therapy management program).
                    ``(B) Waiver authority.--The Secretary may waive 
                such other requirements of title XI and this title as 
                may be necessary to carry out the purposes of the 
                program established under this subsection.''.
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