[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1495 Introduced in House (IH)]
106th CONGRESS
1st Session
H. R. 1495
To amend title XVIII of the Social Security Act to provide for coverage
of outpatient prescription drugs under the Medicare Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 20, 1999
Mr. Stark (for himself, Mr. Dingell, Mr. Waxman, Mr. Rangel, Mr. Brown
of Ohio, Mr. McDermott, Mr. Lewis of Georgia, Mr. Baldacci, Mr. Frost,
Mr. Filner, Mr. Allen, Mr. Moakley, Mr. DeFazio, Ms. Kaptur, Mr. Frank
of Massachusetts, Mr. Meehan, Mr. Boucher, Ms. Schakowsky, Ms. Pelosi,
Mr. Tierney, Mr. Delahunt, Mrs. Thurman, Mr. Capuano, and Mr. Markey)
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 outpatient prescription drugs under 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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Access to
Prescription Medications in Medicare Act of 1999''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Medicare coverage of outpatient prescription drugs.
Sec. 3. Selection of entities to provide outpatient drug benefit.
Sec. 4. Optional coverage for certain beneficiaries.
Sec. 5. Medigap revisions.
Sec. 6. Improved medicaid assistance for low-income individuals.
Sec. 7. Waiver of additional portion of part B premium for certain
Medicare beneficiaries having actuarially
equivalent coverage.
Sec. 8. Elimination of time limitation on medicare benefits for
immunosuppressive drugs.
Sec. 9. Expansion of membership of MEDPAC to 19.
Sec. 10. GAO study and report to Congress.
Sec. 11. Effective date.
SEC. 2. MEDICARE COVERAGE OF OUTPATIENT PRESCRIPTION DRUGS.
(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 (S);
(2) by striking the period at the end of subparagraph (T)
and inserting ``; and''; and
(3) by adding at the end the following:
``(U) covered outpatient drugs (as defined in subsection
(i)(1) of section 1849) pursuant to the procedures established
under such section;''.
(b) Payment.--Section 1833(a)(1) of the Social Security Act (42
U.S.C. 1395l(a)(1)) is amended--
(1) by striking ``and (S)'' and inserting ``(S)''; and
(2) by striking the semicolon at the end and inserting the
following: ``, and (T) with respect to covered outpatient drugs
(as defined in subsection (i)(1) of section 1849), the amounts
paid shall be the amounts established by the Secretary pursuant
to such section;''.
SEC. 3. SELECTION OF ENTITIES TO PROVIDE OUTPATIENT DRUG BENEFIT.
Part B of title XVIII of the Social Security Act (42 U.S.C. 1395j
et seq.) is amended by adding at the end the following:
``SEC. 1849. SELECTION OF ENTITIES TO PROVIDE OUTPATIENT DRUG BENEFIT.
``(a) Establishment of Bidding Process.--
``(1) In general.--The Secretary shall establish procedures
under which the Secretary accepts bids from eligible entities
and awards contracts to such entities in order to provide
covered outpatient drugs to eligible beneficiaries in an area.
Such contracts may be awarded based on shared risk, capitation,
or performance.
``(2) Area.--
``(A) Regional basis.--The contract entered into
between the Secretary and an eligible entity shall
require the eligible entity to provide covered
outpatient drugs on a regional basis.
``(B) Determination.--In determining coverage areas
under this section, the Secretary shall take into
account the number of eligible beneficiaries in an area
in order to encourage participation by eligible
entities.
``(3) Submission of bids.--Each eligible entity desiring to
provide covered outpatient drugs under this section shall
submit a bid to the Secretary at such time, in such manner, and
accompanied by such information as the Secretary may reasonably
require. Such bids shall include the amount the eligible entity
will charge enrollees under subsection (e)(2) for covered
outpatient drugs under the contract.
``(4) Access.--The Secretary shall ensure that--
``(A) an eligible entity complies with the access
requirements described in subsection (f)(5);
``(B) if an eligible entity employs formularies
pursuant to subsection (f)(6)(A), such entity complies
with the requirements of subsection (f)(6)(B); and
``(C) an eligible entity makes available to each
beneficiary covered under the contract the full scope
of benefits required under paragraph (5).
``(5) Scope of benefits.--The Secretary shall ensure that
all covered outpatient drugs that are reasonable and necessary
to prevent or slow the deterioration of, and improve or
maintain, the health of eligible beneficiaries are offered
under a contract entered into under this section.
``(6) Number of contracts.--The Secretary shall, consistent
with the requirements of this section and the goal of
containing Medicare Program costs, award at least 2 contracts
in an area, unless only 1 bidding entity meets the minimum
standards specified under this section and by the Secretary.
``(7) Duration of contracts.--Each contract under this
section shall be for a term of at least 2 years but not more
than 5 years, as determined by the Secretary.
``(8) Benchmark for contracts.--The Secretary shall not
enter into a contract with an eligible entity under this
section unless the Secretary determines that the average cost
(excluding any cost-sharing) for all covered outpatient drugs
provided to beneficiaries under the contract is comparable to
the average cost charged (exclusive of any cost-sharing) by
large private sector purchasers for such drugs.
``(b) Enrollment.--
``(1) In general.--The Secretary shall establish a process
through which an eligible beneficiary shall make an election to
enroll with any eligible entity that has been awarded a
contract under this section and serves the geographic area in
which the beneficiary resides. In establishing such process,
the Secretary shall use rules similar to the rules for
enrollment and disenrollment with a Medicare+Choice plan under
section 1851.
``(2) Requirement of enrollment.--Excluding an eligible
beneficiary enrolled in a group health plan described in
section 4 of the Access to Prescription Medications in Medicare
Act of 1999, an eligible beneficiary not enrolled in a
Medicare+Choice plan under part C must enroll with an eligible
entity under this section in order to be eligible to receive
covered outpatient drugs under this title.
``(3) Enrollment in absence of election by eligible
beneficiary.--In the case of an eligible beneficiary that fails
to make an election pursuant to paragraph (1), the Secretary
shall provide, pursuant to procedures developed by the
Secretary, for the enrollment of such beneficiary with an
eligible entity that has a contract under this section that
covers the area in which such beneficiary resides.
``(4) Areas not covered by contracts.--The Secretary shall
develop procedures for the provision of covered outpatient
drugs under this title to eligible beneficiaries that reside in
an area that is not covered by any contract under this section.
``(5) Beneficiaries residing in different locations.--The
Secretary shall develop procedures to ensure that an eligible
beneficiary that resides in different regions in a year is
provided benefits under this section throughout the entire
year.
``(c) Providing Information to Beneficiaries.--The Secretary shall
provide for activities under this section to broadly disseminate
information to Medicare beneficiaries on the coverage provided under
this section. Such activities shall be similar to the activities
performed by the Secretary under section 1851(d).
``(d) Payments to Eligible Entities.--The Secretary shall establish
procedures for making payments to an eligible entity under a contract.
``(e) Cost-Sharing.--
``(1) Deductible.--Benefits under this section shall not
begin until the eligible beneficiary has met a $200 deductible.
``(2) Copayment.--
``(A) In general.--Subject to subparagraph (B), the
eligible beneficiary shall be responsible for making
payments in an amount not greater than 20 percent of
the cost (as stated in the contract) of any covered
outpatient drug that is provided to the beneficiary.
Pursuant to subsection (a)(4)(B), an eligible entity
may reduce the payment amount that an eligible
beneficiary is responsible for making to the entity.
``(B) Basic benefit.--Subject to subparagraph (C),
if the aggregate amount of covered outpatient drugs
provided to an eligible beneficiary under this section
for any calendar year (based on the cost of covered
outpatient drugs stated in the contract) exceeds
$1,700--
``(i) the beneficiary may continue to
purchase covered outpatient drugs under the
contract based on the contract price, but
``(ii) the copayment under subparagraph (A)
shall be 100 percent.
``(C) Stop-loss protection.--The copayment amount
under subparagraph (A) shall be 0 percent once an
eligible beneficiary's out-of-pocket expenses for
covered outpatient drugs under this section reach
$3,000.
``(D) Inflation adjustment.--
``(i) In general.--In the case of any
calendar year beginning after 2000, each of the
dollar amounts in subparagraphs (B) and (C)
shall be increased by an amount equal to--
``(I) such dollar amount,
multiplied by
``(II) an adjustment, as determined
by the Secretary, for changes in the
per capita cost of prescription drugs
for beneficiaries under this title.
``(ii) Rounding.--If any dollar amount
after being increased under clause (i) is not a
multiple of $10, such dollar amount shall be
rounded to the nearest multiple of $10.
``(f) Conditions for Awarding Contract.--The Secretary shall not
award a contract to an eligible entity under subsection (a) unless the
Secretary finds that the eligible entity is in compliance with such
terms and conditions as the Secretary shall specify, including the
following:
``(1) Quality and financial standards.--The eligible entity
meets quality and financial standards specified by the
Secretary.
``(2) Information.--The eligible entity provides the
Secretary with information that the Secretary determines is
necessary in order to carry out the bidding process under this
section, including data needed to implement subsection (a)(8)
and data regarding utilization, expenditures, and costs.
``(3) Education.--The eligible entity establishes
educational programs that meet the criteria established by the
Secretary pursuant to subsection (g)(1).
``(4) Procedures to ensure proper utilization and to avoid
adverse drug reactions.--The eligible entity has in place
procedures to ensure the--
``(A) appropriate utilization by eligible
beneficiaries of the benefits to be provided under the
contract; and
``(B) avoidance of adverse drug reactions among
eligible beneficiaries enrolled with the entity.
``(5) Access.--The eligible entity ensures that the covered
outpatient drugs are accessible and convenient to eligible
beneficiaries covered under the contract, including by offering
the services in the following manner:
``(A) Services during emergencies.--The offering of
services 24 hours a day and 7 days a week for
emergencies.
``(B) Contracts with retail pharmacies.--The
offering of services--
``(i) at a sufficient (as determined by the
Secretary) number of retail pharmacies; and
``(ii) to the extent feasible, at retail
pharmacies located throughout the eligible
entity's service area.
``(6) Rules relating to provision of benefits.--
``(A) Provision of benefits.--In providing benefits
under a contract under this section, an eligible entity
may--
``(i) employ mechanisms to provide benefits
economically, including the use of--
``(I) formularies (pursuant to
subparagraph (B));
``(II) alternative methods of
distribution; and
``(III) generic drug substitution;
and
``(ii) use incentives to encourage eligible
beneficiaries to select cost-effective drugs or
less costly means of receiving drugs.
``(B) Formularies.--If an eligible entity uses a
formulary to contain costs under this Act--
``(i) the eligible entity shall--
``(I) ensure participation of
practicing physicians and pharmacists
in the development of the formulary;
``(II) include in the formulary at
least 1 drug from each therapeutic
class;
``(III) provide for coverage of
otherwise covered non-formulary drugs
when recommended by prescribing
providers; and
``(IV) disclose to current and
prospective beneficiaries and to
providers in the service area the
nature of the formulary restrictions,
including information regarding the
drugs included in the formulary,
copayment amounts, and any difference
in the cost-sharing for different types
of drugs; but
``(ii) nothing shall preclude an entity
from--
``(I) requiring higher cost-sharing
for drugs provided under clause
(i)(III), subject to limits established
in subsection (e)(2)(A), except that an
entity shall provide for coverage of a
nonformulary drug on the same basis as
a drug within the formulary if such
nonformulary drug is determined by the
prescribing provider to be medically
indicated;
``(II) educating prescribing
providers, pharmacists, and
beneficiaries about medical and cost
benefits of formulary products; and
``(III) requesting prescribing
providers to consider a formulary
product prior to dispensing of a
nonformulary drug, as long as such
request does not unduly delay the
provision of the drug.
``(7) Procedures to compensate pharmacists for
counseling.--The eligible entity shall compensate pharmacists
for providing the counseling described in subsection (g)(2)(B).
``(8) Clinical outcomes.--
``(A) Requirement.--The eligible entity shall
comply with clinical quality standards as determined by
the Secretary.
``(B) Development of standards.--The Secretary, in
consultation with appropriate medical specialty
societies, shall develop clinical quality standards
that are applicable to eligible entities. Such
standards shall be based on current standards of care.
``(9) Procedures regarding denials of care.--The eligible
entity has in place procedures to ensure--
``(A) the timely review and resolution of denials
of care and complaints (including those regarding the
use of formularies under paragraph (6)) by enrollees,
or providers, pharmacists, and other individuals acting
on behalf of such individual (with the individual's
consent) in accordance with requirements (as
established by the Secretary) that are comparable to
such requirements for Medicare+Choice organizations
under part C; and
``(B) that beneficiaries are provided with
information regarding the appeals procedures under this
section at the time of enrollment.
``(g) Educational Requirements To Ensure Appropriate Utilization.--
``(1) Establishment of program criteria.--The Secretary
shall establish a model for comprehensive educational programs
in order to assure the appropriate--
``(A) prescribing and dispensing of covered
outpatient drugs under this section; and
``(B) use of such drugs by eligible beneficiaries.
``(2) Elements of model.--The model established under
paragraph (1) shall include the following elements:
``(A) On-line prospective review available 24 hours
a day and 7 days a week in order to evaluate each
prescription for drug therapy problems due to
duplication, interaction, or incorrect dosage or
duration of therapy.
``(B) Consistent with State law, guidelines for
counseling eligible beneficiaries enrolled under a
contract under this section regarding--
``(i) the proper use of prescribed covered
outpatient drugs; and
``(ii) interactions and contra-indications.
``(C) Methods to identify and educate providers,
pharmacists, and eligible beneficiaries regarding--
``(i) instances or patterns concerning the
unnecessary or inappropriate prescribing or
dispensing of covered outpatient drugs;
``(ii) instances or patterns of substandard
care;
``(iii) potential adverse reactions to
covered outpatient drugs;
``(iv) inappropriate use of antibiotics;
``(v) appropriate use of generic products;
and
``(vi) the importance of using covered
outpatient drugs in accordance with the
instruction of prescribing providers.
``(h) Protection of Patient Confidentiality.--Insofar as an
eligible organization maintains individually identifiable medical
records or other health information regarding enrollees under a
contract entered into under this section, the organization shall--
``(1) safeguard the privacy of any individually
identifiable enrollee information;
``(2) maintain such records and information in a manner
that is accurate and timely; and
``(3) assure timely access of such enrollees to such
records and information.
``(i) Definitions.--In this section:
``(1) Covered outpatient drug.--
``(A) In general.--Except as provided in
subparagraph (B), the term `covered outpatient drug'
means any of the following products:
``(i) A drug which may be dispensed only
upon prescription, and--
``(I) which is approved for safety
and effectiveness as a prescription
drug under section 505 of the Federal
Food, Drug, and Cosmetic Act;
``(II)(aa) which was commercially
used or sold in the United States
before the date of enactment of the
Drug Amendments of 1962 or which is
identical, similar, or related (within
the meaning of section 310.6(b)(1) of
title 21 of the Code of Federal
Regulations) to such a drug, and (bb)
which has not been the subject of a
final determination by the
Secretary that it is a `new drug' (within the meaning of section 201(p)
of the Federal Food, Drug, and Cosmetic Act) or an action brought by
the Secretary under section 301, 302(a), or 304(a) of such Act to
enforce section 502(f) or 505(a) of such Act; or
``(III)(aa) which is described in
section 107(c)(3) of the Drug
Amendments of 1962 and for which the
Secretary has determined there is a
compelling justification for its
medical need, or is identical, similar,
or related (within the meaning of
section 310.6(b)(1) of title 21 of the
Code of Federal Regulations) to such a
drug, and (bb) for which the Secretary
has not issued a notice of an
opportunity for a hearing under section
505(e) of the Federal Food, Drug, and
Cosmetic Act on a proposed order of the
Secretary to withdraw approval of an
application for such drug under such
section because the Secretary has
determined that the drug is less than
effective for all conditions of use
prescribed, recommended, or suggested
in its labeling.
``(ii) A biological product which--
``(I) may only be dispensed upon
prescription;
``(II) is licensed under section
351 of the Public Health Service Act;
and
``(III) is produced at an
establishment licensed under such
section to produce such product.
``(iii) Insulin approved under appropriate
Federal law.
``(iv) A prescribed drug or biological
product that would meet the requirements of
clause (i) or (ii) but that is available over-
the-counter in addition to being available upon
prescription.
``(B) Exclusion.--The term `covered outpatient
drug' does not include any product--
``(i) except as provided in subparagraph
(A)(iv), which may be distributed to
individuals without a prescription;
``(ii) when furnished as part of, or as
incident to, a diagnostic service or any other
item or service for which payment may be made
under this title;
``(iii) that was covered under this title
on the day before the date of enactment of the
Access to Prescription Medications in Medicare
Act of 1999; or
``(iv) that is a therapeutically equivalent
replacement for a product described in clause
(ii) or (iii), as determined by the Secretary.
``(2) Eligible beneficiary.--The term `eligible
beneficiary' means an individual that is enrolled under part B
of this title.
``(3) Eligible entity.--The term `eligible entity' means
any entity that the Secretary determines to be appropriate,
including--
``(A) pharmaceutical benefit management companies;
``(B) wholesale and retail pharmacist delivery
systems;
``(C) insurers;
``(D) other entities; or
``(E) any combination of the entities described in
subparagraphs (A) through (D).''.
SEC. 4. OPTIONAL COVERAGE FOR CERTAIN BENEFICIARIES.
(a) In General.--If drug coverage under a group health plan that
provides health insurance coverage for retirees is equivalent to or
greater than the coverage provided under section 1849 of the Social
Security Act (as added by section 3), beneficiaries receiving coverage
through the group health plan may continue to receive such coverage
from the plan and the Secretary may make payments to such plans,
subject to the requirements of this section.
(b) Requirements.--To receive payment under this section, group
health plans shall--
(1) comply with certain requirements of this Act and other
reasonable, necessary, and related requirements that are needed
to administer this section, as determined by the Secretary;
(2) to the extent that there is a contractual obligation to
provide drug coverage to retirees that is equal to or greater
than the drug coverage provided under this Act, reimburse or
otherwise arrange to compensate beneficiaries during the life
of the contract for the portion of the part B premium
under section 1839 of the Social Security Act that is identified by the
Secretary of Health and Human Services as attributable to the drug
coverage provided under section 1849 of that Act (as added by section
3); or
(3) for group health plans that are in existence prior to
enactment of this section and provide drug coverage to retirees
that is equal to or greater than the drug coverage provided
under section 1849 of the Social Security Act (as added by
section 3), reimburse or otherwise arrange to compensate
beneficiaries for the portion of the part B premium under
section 1839 of the Social Security Act that is identified by
the Secretary of Health and Human Services as attributable to
the drug coverage provided under section 1849 of that Act (as
added by section 3) for at least 1 year from the date that the
group health plan begins participation under this section.
(c) Payments.--The Secretary shall establish a process to provide
payments to eligible group health plans under this section on behalf of
enrolled beneficiaries. Such payments shall not exceed the amount that
would otherwise be paid to a private entity serving similar
beneficiaries in the same service area under section 1849 of the Social
Security Act (as added by section 3).
SEC. 5. MEDIGAP REVISIONS.
(a) Required Coverage of Covered Outpatient Drugs.--Section
1882(p)(2)(B) of the Social Security Act (42 U.S.C. 1395ss(p)(2)(B)) is
amended by inserting before ``and'' at the end the following:
``including a requirement that an appropriate number of policies
provide coverage of drugs which compliments but does not duplicate the
drug benefits that beneficiaries are otherwise entitled to under this
title (with the Secretary and the National Association of Insurance
Commissioners determining the appropriate level of drug benefits that
each benefit package must provide and ensuring that policies providing
such coverage remain affordable for beneficiaries);''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on July 1, 2000.
(c) Transition Provisions.--
(1) In general.--If the Secretary of Health and Human
Services identifies a State as requiring a change to its
statutes or regulations to conform its regulatory program to
the amendments made by this section, the State regulatory
program shall not be considered to be out of compliance with
the requirements of section 1882 of the Social Security Act due
solely to failure to make such change until the date specified
in paragraph (4).
(2) NAIC standards.--If, within 9 months after the date of
enactment of this Act, the National Association of Insurance
Commissioners (in this subsection referred to as the ``NAIC'')
modifies its NAIC Model Regulation relating to section 1882 of
the Social Security Act (referred to in such section as the
1991 NAIC Model Regulation, as subsequently modified) to
conform to the amendments made by this section, such revised
regulation incorporating the modifications shall be considered
to be the applicable NAIC model regulation (including the
revised NAIC model regulation and the 1991 NAIC Model
Regulation) for the purposes of such section.
(3) Secretary standards.--If the NAIC does not make the
modifications described in paragraph (2) within the period
specified in such paragraph, the Secretary of Health and Human
Services shall make the modifications described in such
paragraph and such revised regulation incorporating the
modifications shall be considered to be the appropriate
regulation for the purposes of such section.
(4) Date specified.--
(A) In general.--Subject to subparagraph (B), the
date specified in this paragraph for a State is the
earlier of--
(i) the date the State changes its statutes
or regulations to conform its regulatory
program to the changes made by this section; or
(ii) 1 year after the date the NAIC or the
Secretary first makes the modifications under
paragraph (2) or (3), respectively.
(B) Additional legislative action required.--In the
case of a State which the Secretary identifies as--
(i) requiring State legislation (other than
legislation appropriating funds) to conform its
regulatory program to the changes made in this
section; but
(ii) having a legislature which is not
scheduled to meet in 2000 in a legislative
session in which such legislation may be
considered;
the date specified in this paragraph is the first day
of the first calendar quarter beginning after the close
of the first legislative session of the State
legislature that begins on or after July 1, 2000. For
purposes of the previous sentence, in the case of a State that has a 2-
year legislative session, each year of such session shall be deemed to
be a separate regular session of the State legislature.
SEC. 6. IMPROVED MEDICAID ASSISTANCE FOR LOW-INCOME INDIVIDUALS.
(a) Increase in SLMB Eligibility to 135 Percent of Poverty
Level.--.
(1) In general.--Section 1902(a)(10)(E) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(E)) is amended--
(A) in clause (iii), by striking ``and 120 percent
in 1995 and years thereafter'' and inserting ``, 120
percent in 1995 and through July 1, 2000, and 135
percent for subsequent periods''; and
(B) in clause (iv)--
(i) by striking the dash and all that
follows through ``(II)'', and
(ii) by striking ``who would be described
in subclause (I) if `135 percent' and `175
percent' were substituted for `120 percent' and
`135 percent' respectively'' and inserting
``who would be described in clause (iii) but
for the fact that their income exceeds 135
percent, but is less than 175 percent, of the
official poverty line (referred to in such
clause) for a family of the size involved''.
(2) Conforming amendment.--Section 1933(c)(2)(A) of such
Act (42 U.S.C. 1396v(c)(2)(A)) is amended by striking ``the
sum'' and all that follows and inserting ``the total number of
individuals described in section 1902(a)(10)(E)(iv) in the
State; to''.
(b) Provision of Medicaid Prescription Drug Benefits for QMBs and
SLMBs as Wrap-Around Benefit.--
(1) In general.--Section 1902(a)(10) of such Act (42 U.S.C.
1396a(a)(10)) is amended--
(A) in subparagraph (E)(i), by inserting ``and for
prescribed drugs (in the same amount, duration, and
scope as for individuals described in subparagraph
(A)(i))'' after ``1905(p)(3))'';
(B) in subparagraph (E)(iii), by inserting ``and
for prescribed drugs (in the same amount, duration, and
scope as for individuals described in subparagraph
(A)(i))'' after ``section 1905(p)(3)(A)(ii)''; and
(C) in the clause (VIII) following subparagraph
(F), by inserting ``and to medical assistance for
prescribed drugs described in subparagraph (E)(i)''
after ``1905(p)(3))''.
(2) Conforming amendment.--Section 1916(a) of such Act (42
U.S.C. 1396o(a)) is amended, in the matter before paragraph
(1), by striking ``(E)(i)'' and inserting ``(E)''.
(c) Effective Dates.--
(1) The amendments made by subsections (a)(1) and (b) take
effect on July 1, 2000, and apply to prescribed drugs furnished
on or after such date.
(2) The amendment made by subsection (a)(2) applies to the
allocation for the portion of fiscal year 2000 that occurs on
or after July 1, 2000, and to the allocation for subsequent
fiscal years.
(3) The amendments made by this section apply without
regard to whether or not regulations to implement such
amendments are promulgated by July 1, 2000.
SEC. 7. WAIVER OF ADDITIONAL PORTION OF PART B PREMIUM FOR CERTAIN
MEDICARE BENEFICIARIES HAVING ACTUARIALLY EQUIVALENT
COVERAGE.
(a) In General.--The Secretary of Health and Human Services shall
establish a method under which the portion of the part B premium under
section 1839 of the Social Security Act that is identified by the
Secretary of Health and Human Services as attributable to the drug
coverage provided under section 1849 of that Act (as added by section
3) is waived (and not collected) for any individual enrolled under part
B of title XVIII of the Social Security Act who demonstrates that the
individual has drug coverage that is actuarially equivalent to the
coverage provided under that part.
(b) Limitation.--Subsection (a) shall not apply to an individual
with coverage through a group health plan if the group health plan
receives payments for such individual pursuant to section 4.
SEC. 8. ELIMINATION OF TIME LIMITATION ON MEDICARE BENEFITS FOR
IMMUNOSUPPRESSIVE DRUGS.
(a) Revision.--
(1) In general.--Section 1861(s)(2)(J) of the Social
Security Act (42 U.S.C. 1395x(s)(2)(J)) is amended by striking
``, but only'' and all that follows up to the semicolon at the
end.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to drugs furnished on or after the date of
enactment of this Act.
(b) Extension of Certain Secondary Payer Requirements.--Section
1862(b)(1)(C) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)) is
amended by adding at the end the following: ``With regard to
immunosuppressive drugs furnished on or after the date of enactment of
the Access to Prescription Medications in Medicare Act of 1999, this
subparagraph shall be applied without regard to any time limitation.''.
SEC. 9. EXPANSION OF MEMBERSHIP OF MEDPAC TO 19.
(a) In General.--Section 1805(c) of the Social Security Act (42
U.S.C. 1395b-6(c)), as amended by section 5202 of the Tax and Trade
Relief Extension Act of 1998 (contained in division J of Public Law
105-277), is amended--
(1) in paragraph (1), by striking ``17'' and inserting
``19''; and
(2) in paragraph (2)(B), by inserting ``experts in the area
of pharmacology and prescription drug benefit programs,'' after
``other health professionals,''.
(b) Initial Terms of Additional Members.--
(1) In general.--For purposes of staggering the initial
terms of members of the Medicare Payment Advisory Commission
under section 1805(c)(3) of the Social Security Act (42 U.S.C.
1395b-6(c)(3)), the initial terms of the 2 additional members
of the Commission provided for by the amendment under
subsection (a)(1) are as follows:
(A) One member shall be appointed for 1 year.
(B) One member shall be appointed for 2 years.
(2) Commencement of terms.--Such terms shall begin on
January 1, 2000.
SEC. 10. GAO STUDY AND REPORT TO CONGRESS.
(a) Study.--The Comptroller General of the United States shall
conduct a study and analysis of the implementation of the competitive
bidding process for covered outpatient drugs under section 1849 of the
Social Security Act (as added by section 3), including an analysis of--
(1) the reduction of hospital visits (or lengths of such
visits) by beneficiaries as a result of providing coverage of
covered outpatient drugs under such section;
(2) prices paid by the Medicare Program relative to
comparable private and public sector programs; and
(3) any other savings to the medicare program as a result
of--
(A) such coverage; and
(B) the education and counseling provisions of
section 1849(g).
(b) Report.--Not later than January 1, 2001, and annually
thereafter, the Comptroller General of the United States shall submit a
report to Congress on the study and analysis conducted pursuant to
subsection (a), and shall include in the report such recommendations
regarding the coverage of covered outpatient drugs under the medicare
program as the Comptroller General determines to be appropriate.
SEC. 11. EFFECTIVE DATE.
Except as otherwise provided, the amendments made by this Act apply
to items and services furnished on or after July 1, 2000.
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