II 109th CONGRESS 2d Session S. 3703 IN THE SENATE OF THE UNITED STATES July 20, 2006 Ms. Snowe (for herself and Mr. Wyden) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To provide for a temporary process for individuals entering the Medicare coverage gap to switch to a plan that provides coverage in the gap.

1.

Short title

This Act may be cited as the Medicare Prescription Drug Lifeline Act of 2006.

2.

Temporary process for individuals entering the Medicare coverage gap to switch to a plan that provides coverage in the gap

(a)

Process

Notwithstanding any other provision of law, by not later than 30 days after the date of enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the Secretary) shall establish a process under which an applicable individual may terminate enrollment in the prescription drug plan or the MA–PD plan in which they are enrolled and enroll in any prescription drug plan or MA–PD plan— (1)that provides some coverage of covered part D drugs (as defined in subsection (e) of section 1860D–2 of the Social Security Act (42 U.S.C. 1395w–102)) after the individual has reached the initial coverage limit under the plan but has not reached the annual out-of-pocket threshold under subsection (b)(4)(B) of such section; and (2)subject to subsection (b), that serves the area in which the individual resides. (b)

Special rule permitting applicable individuals to enroll in a prescription drug plan outside of the region in which the individual resides

In the case of an applicable individual that resides in a PDP region under section 1860D–11(a)(2) of the Social Security Act (42 U.S.C. 1395w–111(a)(2)) in which there is no prescription drug plan available that provides some coverage of brand name covered part D drugs (as so defined) after the individual has reached the initial coverage limit under the plan but before the individual has reached such annual out-of-pocket threshold, the Secretary shall ensure that the process established under subsection (a) permits the individual to enroll in a prescription drug plan that provides such coverage but is in another PDP region. The Secretary shall determine the PDP region in which the individual may enroll in such a prescription drug plan. (c)

Notification of applicable individuals

Under the process established under subsection (a), the Secretary shall notify, or require sponsors of prescription drug plans and organizations offering MA–PD plans to notify, applicable individuals of the option to change plans under such process. Such notice shall be provided to an applicable individual within 30 days of meeting the definition of such an individual. (d)

Process in effect for remaining portion of 2006

The process established under subsection (a) shall remain in effect through December 31, 2006. (e)

Definitions

In this section: (1)

Applicable individual

The term applicable individual means a part D eligible individual (as defined in section 1860D–1(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w–101(a)(3)(A)) who, with respect to a year— (A)is enrolled in a prescription drug plan or an MA–PD plan that does not provide any coverage of covered part D drugs (as so defined) after the individual has reached the initial coverage limit under the plan but has not reached such annual out-of-pocket threshold; and (B)has reached such initial coverage limit or is within $750 of reaching such limit. (2)

Prescription drug plan; MA–PD plan

The terms prescription drug plan and MA–PD plan have the meanings given those terms in section 1860D–41(a)(14) of the Social Security Act (42 U.S.C. 1395w–151(a)(14)) and section 1860D–1(a)(3)(C) of such Act (42 U.S.C. 1395w–101(a)(3)(C)), respectively.

3.

GAO study and report on the elimination of the Medicare part D coverage gap

(a)

Study

The Comptroller General of the United States shall conduct a study on— (1)the costs to the Medicare program of eliminating the initial coverage limit under paragraph (3) of section 1860D–2(b) of the Social Security Act (42 U.S.C. 1395w–102(b)) (and providing that standard prescription drug coverage included the coverage described in paragraph (2) of such section until the individual reached the annual out-of-pocket threshold under subsection (b)(4)(B) of such section); and (2)the adjustment to the coinsurance under paragraph (2) of such section that would be necessary to eliminate the initial coverage limit (and provide that standard prescription drug coverage included such adjusted coinsurance amount until the individual reached such annual out-of-pocket threshold) without increasing the costs to the Medicare program. (b)

Report

Not later than May 1, 2007, the Comptroller General of the United States shall submit a report to Congress on the study conducted under subsection (a) together with such recommendations as the Comptroller General determines to be appropriate.