113 S1365 IS: Part D Beneficiary Appeals Fairness Act U.S. Senate 2013-07-25 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

II 113th CONGRESS 1st Session S. 1365 IN THE SENATE OF THE UNITED STATES July 25, 2013 Mr. Nelson (for himself and Ms. Collins) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D.

1.

Short title

This Act may be cited as the Part D Beneficiary Appeals Fairness Act.

2.

Fair exceptions process for drug in tiers under Medicare part D

Section 1860D–4(g)(2) of the Social Security Act (42 U.S.C. 1395w–104(g)(2)) is amended— (1)in the first sentence— (A)by striking for tiered cost-sharing for drugs included within a formulary and and inserting for any tiered cost-sharing structure within a formulary (including a structure that; and (B)by inserting , or provides for different co-payment or coinsurance amounts for drugs in different tiers included within the formulary) before , a part D eligible individual; (2)in the second sentence, by inserting in any plan formulary before could be covered; and (3)by inserting the following before the last sentence: In no case may the Secretary allow a PDP sponsor to make any formulary tier of the tiered cost-sharing structure (including a formulary tier used for very high cost or unique items) ineligible for lower-cost sharing through an exception under this paragraph..