Streamlining Part D Appeals Process Act

Bill: 116-s-1861
Sponsor: full_name: Sen. Cardin, Benjamin L. [D-MD]
Introduced: 2019-06-13
Policy area: Health
Subjects: Administrative law and regulatory procedures

Administrative remedies

Department of Health and Human Services

Department of Labor

Department of the Treasury

Employee benefits and pensions

Federal preemption

Financial services and investments

Government information and archives

Income tax credits

Medicare

Prescription drugs

Securities

Small business

Tax administration and collection, taxpayers
Latest action: action_date: 2019-06-13
text: Read twice and referred to the Committee on Finance.

Summaries:
action_date: 2019-06-13
action_desc: Introduced in Senate
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: II 116th CONGRESS 1st Session S. 1861 IN THE SENATE OF THE UNITED STATES June 13, 2019 Mr. Cardin (for himself and Mr. Cornyn ) introduced the following bill; which was read twice and referred to the Committee on Finance 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). .