II 110th CONGRESS 1st Session S. 137 IN THE SENATE OF THE UNITED STATES January 4, 2007 Mr. Cardin introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to provide additional beneficiary protections.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Preserving Medicare for All Act of 2007. (b)

Table of contents

The table of contents of this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Negotiation of prices for medicare prescription drugs. Sec. 3. Guaranteed prescription drug benefits. Sec. 4. Full reimbursement for qualified retiree prescription drug plans. Sec. 5. Repeal of comparative cost adjustment (cca) program. Sec. 6. Repeal of MA Regional Plan Stabilization Fund. Sec. 7. Repeal of cost containment provisions. Sec. 8. Removal of exclusion of benzodiazepines from required coverage under the Medicare prescription drug program.

2.

Negotiation of prices for medicare prescription drugs

Section 1860D–11 of the Social Security Act (42 U.S.C. 1395w–111) is amended by striking subsection (i) (relating to noninterference) and inserting the following: (i)

Negotiation; no national formulary or price structure

(1)

Negotiation of prices with manufacturers

In order to ensure that beneficiaries enrolled under prescription drug plans and MA–PD plans pay the lowest possible price, the Secretary shall have and exercise authority similar to that of other Federal entities that purchase prescription drugs in bulk to negotiate contracts with manufacturers of covered part D drugs, consistent with the requirements and in furtherance of the goals of providing quality care and containing costs under this part. (2)

No national formulary or price structure

In order to promote competition under this part and in carrying out this part, the Secretary may not require a particular formulary or institute a price structure for the reimbursement of covered part D drugs. .

3.

Guaranteed prescription drug benefits

(a)

In general

Section 1860D–3 of the Social Security Act (42 U.S.C. 1395w–103) is amended to read as follows:

1860D–3.

Access to a choice of qualified prescription drug coverage

(a)

Assuring access to a choice of coverage

(1)

Choice of at least three plans in each area

Beginning on January 1, 2008, the Secretary shall ensure that each part D eligible individual has available, consistent with paragraph (2), a choice of enrollment in— (A)a nationwide prescription drug plan offered by the Secretary in accordance with subsection (b); and (B)at least 2 qualifying plans (as defined in paragraph (3)) in the area in which the individual resides, at least one of which is a prescription drug plan. (2)

Requirement for different plan sponsors

The requirement in paragraph (1)(B) is not satisfied with respect to an area if only one entity offers all the qualifying plans in the area. (3)

Qualifying plan defined

For purposes of this section, the term qualifying plan means— (A)a prescription drug plan; (B)an MA–PD plan described in section 1851(a)(2)(A)(i) that provides— (i)basic prescription drug coverage; or (ii)qualified prescription drug coverage that provides supplemental prescription drug coverage so long as there is no MA monthly supplemental beneficiary premium applied under the plan, due to the application of a credit against such premium of a rebate under section 1854(b)(1)(C); or (C)a nationwide prescription drug plan offered by the Secretary in accordance with subsection (b). (b)

HHS as PDP sponsor for a nationwide prescription drug plan

(1)

In general

The Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, shall take such steps as may be necessary to qualify and serve as a PDP sponsor and to offer a prescription drug plan that offers basic prescription drug coverage throughout the United States. Such a plan shall be in addition to, and not in lieu of, other prescription drug plans offered under this part. (2)

Premium; solvency; authorities

In carrying out paragraph (1), the Secretary— (A)shall establish a premium in the amount of $35 for months in 2008 and, for months in subsequent years, in the amount specified in this paragraph for months in the previous year increased by the annual percentage increase described in section 1860D–2(b)(6) (relating to growth in medicare prescription drug costs per beneficiary) for the year involved; (B)is deemed to have met any applicable solvency and capital adequacy standards; and (C)shall exercise such authorities (including the use of regional or other pharmaceutical benefit managers) as the Secretary determines necessary to offer the prescription drug plan in the same or a comparable manner as is the case for prescription drug plans offered by private PDP sponsors. (c)

Flexibility in risk assumed

In order to ensure access pursuant to subsection (a) in an area the Secretary may approve limited risk plans under section 1860D–11(f) for the area.

. (b)

Conforming amendment

Section 1860D–11(g) of the Social Security Act (42 U.S.C. 1395w–111(g)) is amended by adding at the end the following new paragraph: (8)

Application

This subsection shall not apply on or after January 1, 2008. .

4.

Full reimbursement for qualified retiree prescription drug plans

(a)

Elimination of true Out-of-Pocket limitation

Section 1860D–2(b)(4)(C)(ii) of the Social Security Act (42 U.S.C. 1395w–102(b)(4)(C)(ii) is amended— (1)by inserting under a qualified retiree prescription drug plan (as defined in section 1860D–22(a)(2)), after under section 1860D–14,; and (2)by inserting , under such a qualified retiree prescription drug plan, after (other than under such section. (b)

Equalization of subsidies

Notwithstanding any other provision of law, the Secretary of Health and Human Services shall provide for such increase in the special subsidy payment amounts under section 1860D–22(a)(3) of the Social Security Act (42 U.S.C. 1395w–132(a)(3)) as may be appropriate to provide for payments in the aggregate equivalent to the payments that would have been made under section 1860D–15 of such Act (42 U.S.C. 1395w–115) if the individuals were not enrolled in a qualified retiree prescription drug plan. In making such computation, the Secretary shall not take into account the application of the amendments made by section 1202 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173; 117 Stat. 2480). (c)

Effective date

This section, and the amendments made by this section, shall take effect on January 1, 2008.

5.

Repeal of comparative cost adjustment (cca) program

Subtitle E of title II of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173; 117 Stat. 2214), and the amendments made by such subtitle, are repealed.

6.

Repeal of MA Regional Plan Stabilization Fund

(a)

In general

Subsection (e) of section 1858 of the Social Security Act (42 U.S.C. 1395w–27a) is repealed. (b)

Conforming Amendment

Section 1858(f)(1) of the Social Security Act (42 U.S.C. 1395w–27a(f)(1)) is amended by striking subject to subsection (e),.

7.

Repeal of cost containment provisions

Subtitle A of title VIII of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173; 117 Stat. 2357) is repealed and any provisions of law amended by such subtitle are restored as if such subtitle had not been enacted.

8.

Removal of exclusion of benzodiazepines from required coverage under the Medicare prescription drug program

(a)

Removal of exclusion

(1)

In general

Section 1860D–2(e)(2) of the Social Security Act (42 U.S.C. 1395w–102(e)(2)) is amended— (A)by striking subparagraph (E) and inserting subparagraphs (E) and (J); and (B)by inserting and benzodiazepines after smoking cessation agents. (2)

Effective date

The amendments made by paragraph (1) shall apply to prescriptions dispensed on or after January 1, 2008. (b)

Review of benzodiazepine prescription policies to assure appropriateness and to avoid abuse

The Secretary of Health and Human Services shall review the policies of Medicare prescription drug plans (and MA–PD plans) under parts C and D of title XVIII of the Social Security Act regarding the filling of prescriptions for benzodiazepine to ensure that these policies are consistent with accepted clinical guidelines, are appropriate to individual health histories, and are designed to minimize long term use, guard against over-prescribing, and prevent patient abuse. (c)

Development by medicare quality improvement organizations of educational guidelines for physicians regarding prescribing of benzodiazepines

The Secretary of Health and Human Services shall provide, in contracts entered into with Medicare quality improvement organizations under part B of title XI of the Social Security Act, for the development by such organizations of appropriate educational guidelines for physicians regarding the prescribing of benzodiazepines.