A bill to amend title XIX of the Social Security Act to add standards for drug compendia for physician use for purposes of Medicaid payment for certain drugs, and for other purposes.

Bill: 114-s-2981
Sponsor: full_name: Sen. Grassley, Chuck [R-IA]
Introduced: 2016-05-25
Policy area: Health
Subjects: Health information and medical records

Medicaid

Medicare

Prescription drugs
Latest action: action_date: 2016-05-25
text: Read twice and referred to the Committee on Finance.

Summaries:
action_date: 2016-05-25
action_desc: Introduced in Senate
text: <p>This bill amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to add standards for drug compendia&nbsp;used by physicians with respect to&nbsp;payment for certain drugs under the Medicare and Medicaid programs. </p> <p>Specifically, such compendia shall include compendia that, as determined by the Centers for Medicare &amp; Medicaid Services: (1) are used by health care providers and&nbsp;utilized nationwide by the health insurance industry; (2) have a publicly available policy on disclosures of conflicts of interest; (3) use an international, widely recognized standard to evaluate clinical evidence for inclusion; and (4) are accepted by at least one state board of pharmacy or equivalent licensing body.</p>

tv_txt: II 114th CONGRESS 2d Session S. 2981 IN THE SENATE OF THE UNITED STATES May 25, 2016 Mr. Grassley (for himself and Mr. Casey ) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XIX of the Social Security Act to add standards for drug compendia for physician use for purposes of Medicaid payment for certain drugs, and for other purposes.

1. Adding standards for drug compendia for physician use for purposes of payment under Medicaid for certain drugs (a) In general Section 1927(g)(1)(B)(i) of the Social Security Act ( 42 U.S.C. 1396r–8(g)(1)(B)(i) ) is amended— (1) in subclause (I), by striking the semicolon at the end and inserting a period; (2) in subclause (II), by striking ); and at the end and inserting ). ; (3) in subclause (III)— (A) by striking the DRUGDEX and inserting The DRUGDEX ; and (B) by striking ; and at the end and inserting a period; and (4) by adding at the end the following: (IV) Other compendia that, as determined by the Secretary— (aa) are utilized nationwide by the private health insurance industry; (bb) are used by health care providers, such as long-term care facilities or academic health centers; (cc) have a publicly available policy on the disclosure of conflicts of interest that may exist between such a health care provider and drug manufacturers; (dd) use an international, widely recognized standard to systematically evaluate the clinical evidence for inclusion in the compendia; and (ee) are accepted as professional drug compendia by at least one State board of pharmacy (or an equivalent State licensing body). . (b) Technical amendments Section 1927(g)(1)(B) of the Social Security Act ( 42 U.S.C. 1396r–8(g)(1)(B) ) is amended— (1) in clause (i), by striking compendia and inserting Compendia ; and (2) in clause (ii), by striking the peer-reviewed and inserting The peer-reviewed . 2. Revising definition of medically accepted indication for Medicare Part D drugs Section 1860D–2(e)(4) of the Social Security Act ( 42 U.S.C. 1395w–102(e)(4) ) is amended— (1) in subparagraph (A)(i)(II), by striking section 1927(g)(1)(B)(i)(III) and inserting subclauses (III) and (IV) of section 1927(g)(1)(B)(i) ; and (2) in subparagraph (B), by striking subparagraph (A)(i)(II) and all that follows through 1927(g)(1)(B)(i)(III) and inserting a compendium described in subclause (III) or (IV) of section 1927(g)(1)(B)(i) shall not be included in the list of compendia described in section 1861(t)(2)(B)(ii)(I) unless such compendium .