Maximizing Drug Coverage for Low-Income Seniors Act of 2019

Bill: 116-hr-4669
Sponsor: full_name: Rep. Stevens, Haley M. [D-MI-11]
Introduced: 2019-10-11
Policy area: Health
Subjects: Health care costs and insurance

Health care coverage and access

Health care quality

Medicare

Prescription drugs
Latest action: action_date: 2019-10-14
text: Referred to the Subcommittee on Health.

Summaries:
action_date: 2019-10-11
action_desc: Introduced in House
text: <p><b>Maximizing Drug Coverage for Low-Income Seniors Act of 2019</b></p> <p>This bill provides for an alternative process by which the Centers for Medicare &amp; Medicaid Services (CMS) may automatically enroll certain individuals who are eligible for low-income subsidies under the Medicare prescription drug benefit in prescription drug plans. Specifically, the CMS may use a process that actively matches such individuals with prescription drug plans based on the individual's needs in relation to certain factors (e.g., formularies), rather than the current random assignment process.</p>

tv_txt: I 116th CONGRESS 1st Session H. R. 4669 IN THE HOUSE OF REPRESENTATIVES October 11, 2019 Ms. Stevens (for herself, Mrs. Hayes , Ms. Kuster of New Hampshire , and Ms. Sewell of Alabama ) 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 provide for intelligent assignment of certain subsidy eligible individuals auto-enrolled under Medicare prescription drug plans and MA–PD plans.

1. Short title This Act may be cited as the Maximizing Drug Coverage for Low-Income Seniors Act of 2019 . 2. Providing for intelligent assignment of certain subsidy eligible individuals auto-enrolled under Medicare prescription drug plans and MA–PD plans (a) In general Section 1860D–1(b)(1) of the Social Security Act ( 42 U.S.C. 1395w–101(b)(1) ) is amended— (1) in subparagraph (C)— (A) by inserting after PDP region the following: or through use of an intelligent assignment process that is designed to maximize the access of such individual to necessary prescription drugs while minimizing costs to such individual and to the program under this part to the greatest extent possible. In the case the Secretary enrolls such individuals through use of an intelligent assignment process, such process shall take into account the extent to which prescription drugs necessary for the individual are covered in the case of a PDP sponsor of a prescription drug plan that uses a formulary, the use of prior authorization or other restrictions on access to coverage of such prescription drugs by such a sponsor, and the overall quality of a prescription drug plan as measured by quality ratings established by the Secretary ; and (B) by striking Nothing in the previous sentence and inserting Nothing in this subparagraph ; and (2) in subparagraph (D)— (A) by inserting after PDP region the following: or through use of an intelligent assignment process that is designed to maximize the access of such individual to necessary prescription drugs while minimizing costs to such individual and to the program under this part to the greatest extent possible. In the case the Secretary enrolls such individuals through use of an intelligent assignment process, such process shall take into account the extent to which prescription drugs necessary for the individual are covered in the case of a PDP sponsor of a prescription drug plan that uses a formulary, the use of prior authorization or other restrictions on access to coverage of such prescription drugs by such a sponsor, and the overall quality of a prescription drug plan as measured by quality ratings established by the Secretary ; and (B) by striking Nothing in the previous sentence and inserting Nothing in this subparagraph . (b) Effective date The amendments made by subsection (a) shall apply with respect to plan years beginning with plan year 2022.