[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3757 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 3757

To amend title XVIII of the Social Security Act to provide for coverage 
 of pharmaceutical care services under part B of the Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              July 8, 1996

 Mr. Pallone (for himself, Mr. Brewster, Mr. Fox of Pennsylvania, Mr. 
    Frost, Mr. Engel, Mr. Torricelli, Mr. Lipinski, Mr. Frazer, Mr. 
Thompson, Ms. Brown of Florida, Mr. Ackerman, Mr. Cramer, Mr. Dellums, 
 and Mrs. Lowey) introduced the following bill; which was referred to 
the Committee on 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 coverage 
 of pharmaceutical care services under part B of the Medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Safe Medications for the Elderly 
Act''.

SEC. 2. MEDICARE COVERAGE OF PHARMACEUTICAL CARE SERVICES.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) by striking ``and'' at the end of subparagraph (N); and
            (2) by inserting after subparagraph (O) the following new 
        subparagraph:
            ``(P) covered pharmaceutical care services (as defined in 
        subsection (oo));''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
is amended by adding at the end the following new subsection:

                 ``Covered Pharmaceutical Care Services

    ``(oo)(1) The term `covered pharmaceutical care services' means 
pharmaceutical care services described in paragraph (2) which are 
furnished by a pharmacist who is legally authorized to furnish such 
services under State law (or the State regulatory mechanism provided by 
State law) of the State in which the services are furnished.
    ``(2) The pharmaceutical care services described in this paragraph 
are as follows:
            ``(A) Services covered under subsection (s)(10) (relating 
        to certain vaccines and their administration).
            ``(B) Consultation with a physician which results in the 
        physician taking any of the following actions with respect to 
        an outpatient prescription drug furnished to an individual 
        enrolled under part B (without regard to whether or not payment 
        is made for the drug under such part):
                    ``(i) A change in the individual's drug regimen to 
                avoid an adverse interaction with another drug or 
                medical condition.
                    ``(ii) A change in the dosage or form of an 
                outpatient prescription drug taken by the individual.
                    ``(iii) The elimination of a drug from the 
                individual's drug regimen.
                    ``(iv) The initiation of a drug therapy for a 
                medical condition.
            ``(C) Consultation with an individual enrolled under part B 
        which results in improved compliance by the individual with an 
        outpatient prescription drug regimen with respect to any drug 
        identified by the Secretary pursuant to paragraph (3), if the 
        pharmacist maintains documentation (in accordance with such 
        requirements as the Secretary may impose) that the improvement 
        in compliance is considered necessary by the prescriber of the 
        drug or under peer-reviewed medical literature.
    ``(3)(A) With respect to the consultations described in paragraph 
(2)(C), the Secretary shall, not later than one year after the date of 
the enactment of this subsection, identify and publish a list of 
outpatient prescription drugs (without regard to whether payment is 
made for such drug under part B) which are used in the treatment of the 
following conditions prevalent in the elderly:
            ``(i) Asthma and chronic obstructive pulmonary disease.
            ``(ii) Congestive heart failure.
            ``(iii) Depression.
            ``(iv) Hyperlipidemia.
            ``(v) Non-insulin-dependent diabetes.
            ``(vi) Prevention of stroke (including antihypertensive and 
        anticoagulant therapy).
            ``(vii) Simultaneous use of 4 or more drugs.
    ``(B) Beginning 5 years after the date of the enactment of this 
subsection, the Secretary may periodically update such list of drugs to 
reflect changes in medical and pharmaceutical practice, the development 
of new drugs, and other factors the Secretary considers appropriate.''.
    (c) Payment.--
            (1) In general.--Section 1833(a)(1) of such Act (42 U.S.C. 
        1395l(a)(1)) is amended--
                    (A) by striking ``and (P)'' and inserting ``(P)''; 
                and
                    (B) by striking the semicolon at the end and 
                inserting the following: ``, and (Q) with respect to 
                covered pharmaceutical care services (as defined in 
                section 1861(oo)), the amounts paid shall be the 
                amounts described in section 1834(k)(1);''.
            (2) Establishment of fee schedule.--Section 1834 of such 
        Act (42 U.S.C. 1395m) is amended by adding at the end the 
        following new subsection:
    ``(k) Fee Schedules for Pharmaceutical Care Services.--
            ``(1) Development.--The Secretary shall develop--
                    ``(A) a relative value scale to serve as the basis 
                for the payment of covered pharmaceutical care services 
                (as defined in section 1861(oo)) under this part; and
                    ``(B) using such scale and appropriate conversion 
                factors, fee schedules (on a regional, statewide, 
                locality, or carrier service area basis) for payment 
                for covered pharmaceutical care services under this 
                part, to be implemented for such services furnished 
                during years beginning after the expiration of the 3-
                year period which begins on the date of the enactment 
                of this subsection.
            ``(2) Considerations.--In developing the relative value 
        scale and fee schedules under paragraph (1), the Secretary 
        shall take into account--
                    ``(A) differences in the time required to perform 
                types of covered pharmaceutical care services;
                    ``(B) differences in the level of risk associated 
                with the use of particular outpatient prescription 
                drugs or groups of drugs; and
                    ``(C) differences in the health status of 
                individuals to whom covered pharmaceutical care 
                services are provided.
            ``(3) Payments prior to implementation of fee schedule.--In 
        the case of covered pharmaceutical care services described in 
        subparagraph (B) or (C) of section 1861(oo)(2) which are 
        furnished prior to the implementation of the fee schedule under 
        paragraph (1)(B), the amount of payment made under this part 
        shall be equal to 80 percent of the amount which would be paid 
        for the service under the fee schedule applicable under section 
        1848 if the service were furnished by a physician.''.
            (3) Report to congress.--Not later than 3 years after the 
        date of the enactment of this Act, the Secretary of Health and 
        Human Services shall submit a report to Congress on the 
        relative value scale and fee schedules developed pursuant to 
        section 1834(k)(1) of the Social Security Act (as added by 
        paragraph (2)) for covered pharmaceutical services under part B 
        of the Medicare program.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 1997.
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