Part D Beneficiary Appeals Fairness Act

Bill: 113-s-1365
Sponsor: full_name: Sen. Nelson, Bill [D-FL]
Introduced: 2013-07-25
Policy area: Health
Subjects: Health care costs and insurance

Health care coverage and access

Medicare

Prescription drugs
Latest action: action_date: 2013-07-25
text: Read twice and referred to the Committee on Finance.

Summaries:
action_date: 2013-07-25
action_desc: Introduced in Senate
text: <p>Part D Beneficiary Appeals Fairness Act - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act, with respect to a prescription drug plan (PDP) that provides for any tiered cost-sharing within a formulary (including a structure that provides for different co-payment or coinsurance amounts for drugs in different tiers included within the formulary), to authorize a Medicare part D eligible individual enrolled in the plan to request an exception to the tiered cost-sharing structure.</p> <p>States that in no case may the Secretary of Health and Human Services (HHS) allow a PDP sponsor to make any formulary tier of the tiered cost-sharing structure (including a formulary tier used for very high cost or unique items) ineligible for lower-cost sharing through an exception.</p>

tv_txt: II 113th CONGRESS 1st Session S. 1365 IN THE SENATE OF THE UNITED STATES July 25, 2013 Mr. Nelson (for himself and Ms. Collins ) 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 fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D.

1. Short title This Act may be cited as the Part D Beneficiary Appeals Fairness Act . 2. Fair exceptions process for drug in tiers under Medicare part D Section 1860D–4(g)(2) of the Social Security Act ( 42 U.S.C. 1395w–104(g)(2) ) is amended— (1) in the first sentence— (A) by striking for tiered cost-sharing for drugs included within a formulary and and inserting for any tiered cost-sharing structure within a formulary (including a structure that ; and (B) by inserting , or provides for different co-payment or coinsurance amounts for drugs in different tiers included within the formulary) before , a part D eligible individual ; (2) in the second sentence, by inserting in any plan formulary before could be covered ; and (3) by inserting the following before the last sentence: In no case may the Secretary allow a PDP sponsor to make any formulary tier of the tiered cost-sharing structure (including a formulary tier used for very high cost or unique items) ineligible for lower-cost sharing through an exception under this paragraph. .