[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2851 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 2851

  To prohibit application of a payment limit to a drug or biological 
under part B of the Medicare Program based on a less costly alternative 
      for courses of treatment begun before the change in payment.


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                    IN THE HOUSE OF REPRESENTATIVES

                            November 6, 1997

 Mrs. Kennelly of Connecticut 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 prohibit application of a payment limit to a drug or biological 
under part B of the Medicare Program based on a less costly alternative 
      for courses of treatment begun before the change in payment.

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

SECTION 1. RESTRICTING CHANGES IN MEDICARE REIMBURSEMENT RATES FOR 
              DRUGS AND BIOLOGICALS BASED ON A LESS COSTLY ALTERNATIVE 
              DURING COURSE OF TREATMENT.

    (a) In General.--If the Secretary of Health and Human Services or a 
carrier reduces a recognized rate for a drug or biological under part B 
of title XVIII of the Social Security Act based solely on the 
identification of an alternative drug or biological that is less costly 
for treatment of the same condition, the Secretary shall provide that 
such reduction shall not apply during a course of treatment to an 
individual who, as of the effective date of the reduction in payment 
rate, was entitled to benefits under such part and was in a course of 
treatment with such drug or biological for which such benefits are 
available.
    (b) Exception for Generic Substitution.--Subsection (a) shall not 
apply in the case of substitution of a generic drug for another.
    (c) Effective Date.--This section shall apply to payment for drugs 
or biologicals furnished on or after the date of the enactment of this 
Act, with respect to courses of treatment beginning before, on, or 
after such date.

SEC. 2. REPORT ON MEDICARE CARRIER DETERMINATIONS OF COVERAGE.

    The Secretary of Health and Human Services shall submit to 
Congress, not later than 1 year after the date of the enactment of this 
Act, a report that--
            (1) describes the types of coverage decisions that are 
        being made by carriers under part B of title XVIII of the 
        Social Security Act;
            (2) describes the legal authority for carriers to make such 
        decisions; and
            (3) specifies whether further Federal guidance is needed to 
        prevent regional disparities in coverage under part B of such 
        title.
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