[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4187 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 4187

 To amend title XVIII of the Social Security Act to require disclosure 
of certain information about benefit management for prescription drugs 
                   by Medicare+Choice organizations.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 25, 1998

  Mr. Stark introduced the following bill; which was referred to the 
   Committee on Ways and Means, and in addition to the Committee on 
Commerce, 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 require disclosure 
of certain information about benefit management for prescription drugs 
                   by Medicare+Choice organizations.

    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 ``Medicare+Choice Pharmaceutical 
Management Act of 1998''.

SEC. 2. DISCLOSURE OF PHARMACEUTICAL BENEFIT MANAGEMENT ACTIVITIES 
              UNDER MEDICARE+CHOICE PLANS.

    (a) In General.--Section 1852 of the Social Security Act (42 U.S.C. 
1395w-22) is amended by adding at the end the following new subsection:
    ``(l) Disclosure of Pharmaceutical Benefit Management Activities.--
            ``(1) To the secretary.--If a Medicare+Choice plan offered 
        by a Medicare+Choice organization provides benefits with 
        respect to prescription drugs, the organization shall provide 
        to the Secretary on an annual basis the following information:
                    ``(A) A description of the pharmacy and therapeutic 
                committee (if any) used to develop and oversee drug 
                formularies, including the composition of the committee 
                and the reasoning behind formulary decisions.
                    ``(B) A description of any financial incentives to 
                the organization (or any contractor) from any source, 
                including pharmaceutical manufacturers, associated with 
                the use of any of the drugs listed on such formulary.
                    ``(C) A description of any incentives to physicians 
                and pharmacists to choose from a subset of preferred 
                medications from a drug formulary and to induce 
                patients to change medications. The description shall 
                include a discussion of reasonable medical 
                effectiveness and possible health risks associated with 
                these incentives.
                    ``(D) A description of all policies and procedures 
                for any drug utilization reviews of physicians and 
                pharmacists, including any counseling, intervention, 
                enforcement actions, or penalties associated with the 
                results of these profiling activities.
                    ``(E) A description of any expedited process for 
                amending drug formularies to include new drugs that 
                become available during a plan year, particularly drugs 
                to treat or alleviate potentially life-threatening 
                illnesses.
                    ``(F) A description of any requirements for prior 
                treatment failures of a particular drug before 
                approving alternative therapies.
            ``(2) To the public upon request.--In the case of a plan 
        described in paragraph (1), the Medicare+Choice organization 
        shall make available to the public on request the information 
        described in paragraph (1) as well as a description of any of 
        its drug formularies and any preferred medications from such 
        formularies.''
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to contracts for contract periods beginning on or after January 
1, 1999.
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