Real-Time Beneficiary Drug Cost Bill

Bill: 116-hr-3415
Sponsor: full_name: Rep. Slotkin, Elissa [D-MI-8]
Introduced: 2019-06-21
Policy area: Health
Subjects: Health care costs and insurance

Health care coverage and access

Health information and medical records

Health personnel

Medicare

Prescription drugs
Latest action: action_date: 2019-06-24
text: Referred to the Subcommittee on Health.

Summaries:
action_date: 2019-06-21
action_desc: Introduced in House
text: <p><b>Real-Time Beneficiary Drug Cost Bill</b></p> <p>This bill provides statutory authority for certain provisions of the Centers for Medicare &amp; Medicaid Services rule titled &quot;Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses,&quot; published on May 23, 2019. The rule requires, in part, Medicare prescription drug plan sponsors to implement an electronic, real-time benefit tool that is capable of integrating with at least one prescriber's electronic prescribing system or electronic health record. The tool must provide prescribers with patient-specific, real-time formulary and benefit information, including information regarding cost-sharing, formulary alternatives, and utilization management requirements. The rule takes effect January 1, 2021. </p>

tv_txt: I 116th CONGRESS 1st Session H. R. 3415 IN THE HOUSE OF REPRESENTATIVES June 21, 2019 Ms. Slotkin (for herself and Mr. Arrington ) 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 require prescription drug plan sponsors to include real-time benefit information as part of such sponsor’s electronic prescription program under the Medicare program.

1. Short title This Act may be cited as the Real-Time Beneficiary Drug Cost Bill . 2. Requiring prescription drug plan sponsors to include real-time benefit information as part of such sponsor’s electronic prescription program under the Medicare program Section 1860D–4(e)(2) of the Social Security Act ( 42 U.S.C. 1395w–104(e)(2) ) is amended— (1) in subparagraph (D), by striking To the extent and inserting Except as provided in subparagraph (F), to the extent ; and (2) by adding at the end the following new subparagraph: (F) Real-time benefit information (i) In general Not later than January 1, 2021, the program shall provide for the real-time electronic transmission to prescribing health care professionals, using technology capable of integrating with such professionals’ electronic prescribing and electronic health record systems, of individual-specific formulary and benefit information under a prescription drug plan with respect to an individual enrolled in such plan. Such information shall include, with respect to the prescribing of a covered part D drug to such individual, the following: (I) A description of any clinically appropriate alternatives to such drug included in the formulary of such plan. (II) Information relating to applicable cost-sharing requirements for such drug and such alternatives, including a description of any variance in such requirements based on the pharmacy dispensing such drug or such alternatives. (III) Information relating to any prior authorization or other utilization management requirements applicable to such drug and such alternatives within the formulary of such plan. (ii) Special rule for 2021 The program shall be deemed to be in compliance with clause (i) for 2021 if the program complies with the provisions of section 423.160(b)(7) of title 42, Code of Federal Regulations (or a successor regulation), for such year. .