Streamlining Part D Appeals Process Act

Bill: 116-hr-3924
Sponsor: full_name: Rep. Suozzi, Thomas R. [D-NY-3]
Introduced: 2019-07-23
Policy area: Health
Subjects: Administrative remedies

Department of Health and Human Services

Medicare

Prescription drugs
Latest action: action_date: 2019-07-24
text: Referred to the Subcommittee on Health.

Summaries:
action_date: 2019-07-23
action_desc: Introduced in House
text: <p><b>Streamlining Part D Appeals Process Act</b></p> <p>This bill allows a Medicare beneficiary to directly appeal a pharmacy's refusal to fill a prescription as a coverage determination under the Medicare prescription drug benefit. </p> <p>Currently, if a pharmacy refuses to fill a prescription, the pharmacy provides the beneficiary with a notice explaining how to contact the beneficiary's prescription drug plan (PDP); the beneficiary must then obtain a written coverage determination (i.e., a decision denying coverage) from the PDP before initiating the appeals process. </p>

tv_txt: I 116th CONGRESS 1st Session H. R. 3924 IN THE HOUSE OF REPRESENTATIVES July 23, 2019 Mr. Suozzi (for himself and Mr. Reed ) 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 provide for the treatment of a pharmacy counter refusal as a coverage determination under Medicare part D.

1. Short title This Act may be cited as the Streamlining Part D Appeals Process Act . 2. Providing for the treatment of a pharmacy counter refusal as a coverage determination under Medicare part D Section 1860D–4(g) of the Social Security Act ( 42 U.S.C. 1395w–104(g) ) is amended by adding at the end the following new paragraph: (3) Treatment of pharmacy counter refusal as coverage determination For plan years beginning on or after January 1, 2020, the refusal by a pharmacy to fill a prescription for a covered part D drug under a prescription drug plan shall be treated as a coverage determination subject to reconsideration and appeal pursuant to this subsection and subsection (h). .