[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5888 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 5888

  To establish an America Rx program to establish fairer pricing for 
prescription drugs for individuals without access to prescription drugs 
                         at discounted prices.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 27, 2010

   Mr. Michaud (for himself, Ms. Pingree of Maine, and Mr. Grijalva) 
 introduced the following bill; which was referred to the Committee on 
                          Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
  To establish an America Rx program to establish fairer pricing for 
prescription drugs for individuals without access to prescription drugs 
                         at discounted prices.

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

SECTION 1. SHORT TITLE; PURPOSE.

    (a) Short Title.--This Act may be cited as the ``America Rx Act of 
2010''.
    (b) Purpose.--The purpose of this Act is to establish an America Rx 
program that utilizes manufacturer rebates and pharmacy discounts to 
reduce prescription drug prices to those residents who are without 
access to discounted prices for outpatient prescription drugs.

SEC. 2. AMERICA RX PROGRAM.

    (a) Establishment.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, the Secretary of Health and Human 
        Services shall establish a program (in this section referred to 
        as the ``America Rx program'') consistent with the provisions 
        of this section to provide qualified residents with access to 
        discounted prices for outpatient prescription drugs through 
        rebate agreements that the Secretary has negotiated with 
        prescription drug manufacturers.
            (2) Outreach.--The Secretary shall provide for--
                    (A) outreach efforts to build public awareness of 
                the program and maximize enrollment of qualified 
                residents; and
                    (B) simplified eligibility procedures and uniform 
                eligibility standards for qualified residents.
    (b) Rebate Agreements With Manufacturers.--
            (1) In general.--Under the America Rx program the Secretary 
        shall negotiate with manufacturers of outpatient prescription 
        drugs rebate agreements with respect to drugs offered under the 
        program to qualified residents.
            (2) Minimum amount of rebates.--In negotiating the amount 
        of such a rebate under paragraph (1), the Secretary shall take 
        into consideration the amount of the rebate calculated under 
        the Medicaid program, the average manufacturer price of 
        prescription drugs, and other information on prescription drug 
        prices and price discounts. The Secretary shall negotiate the 
        amount of such rebates in a manner so that the rebates on 
        average are comparable to the average percentage rebate 
        obtained in outpatient prescription drugs provided under 
        section 1927(c) of the Social Security Act (42 U.S.C. 1396r-
        8(c)).
            (3) Discounted prices.--The Secretary shall specify the 
        method for computing and applying such discounts, including a 
        method for computing and applying discounts on a uniform, 
        average percentage basis.
            (4) Payment.--Rebates under such agreements shall be 
        payable to the Secretary according to a schedule (not less 
        often than quarterly) negotiated with manufacturers and shall 
        be paid, directly or through States, to participating 
        pharmacies that provide discounts to qualified residents.
            (5) Incentive.--In order to induce manufacturers of 
        outpatient prescription drugs to enter into such rebate 
        agreements to carry out the purpose described in section 1(b), 
        the Secretary shall provide, in the case of a manufacturer that 
        has not entered into such an agreement, for a denial of a 
        deduction under chapter 1 of the Internal Revenue Code of 1986 
        for the amount of expenses of the manufacturer for advertising 
        and marketing of drugs of the manufacturer, other than expenses 
        for free samples of drugs subject to section 503(b)(1) of the 
        Federal Food Drug, and Cosmetic Act intended to be distributed 
        to patients.
            (6) Application of rebates.--Amounts received by the 
        Secretary as rebates under this subsection shall be placed into 
        an appropriate account in the Treasury and shall be available 
        in advance of appropriations to the Secretary for the payment 
        of discounts and other costs of participating pharmacies in 
        carrying out the America Rx program and for the payment of 
        administrative costs in carrying out the program. Under the 
        America Rx program, participating pharmacies shall be ensured 
        reasonable and timely payment of discounts they provide to 
        qualified residents under the program.
    (c) Role of States in Administering Program.--
            (1) In general.--Under the America Rx program the Secretary 
        may enter into appropriate arrangements with States under which 
        States provide for the administration of the program in return 
        for payment of the reasonable administrative expenses 
        associated with such administration.
            (2) Administrative functions.--Such administration 
        functions may include--
                    (A) determinations of eligibility of qualified 
                residents;
                    (B) arrangements with participating pharmacies; and
                    (C) such other functions as the Secretary 
                determines appropriate.
            (3) Contractual authority.--In carrying out 
        responsibilities under this section, the Secretary and States 
        may enter into agreements with pharmacy benefit managers and 
        other third parties.
    (d) Program Eligibility.--
            (1) Qualified resident defined.--For purposes of this 
        section, the term ``qualified resident'' means an individual 
        who--
                    (A) is a citizen or national of the United States 
                or is lawfully present in the United States (as 
                determined in accordance with section 1411 of the 
                Patient Protection and Affordable Care Act); and
                    (B) as determined under regulations of the 
                Secretary, is not covered under any public or private 
                program that provides substantial benefits (which may 
                be discounted prices) towards the purchase of 
                outpatient prescription drugs.
            (2) Screening.--
                    (A) For other governmental programs.--Individuals 
                who apply for benefits under the America Rx program 
                shall be screened for eligibility under the Medicaid 
                program and other applicable Governmental health care 
                programs and, if found eligible, shall be enrolled in 
                such program or programs.
                    (B) Screening by health insurance exchanges.--In 
                the case of individuals enrolling in a qualified health 
                plan through a Health Insurance Exchange under title I 
                of the Patient Protection and Affordable Care Act, the 
                Exchange shall provide (at the time of enrollment) for 
                a screening of the individual to determine if the 
                individual is a qualified resident for purposes of the 
                America Rx program.
            (3) Relation to other coverage.--In order not to discourage 
        employers and health insurance issuers from providing 
        comprehensive prescription drug coverage through a group health 
        plan or health insurance coverage, no such employer or issuer 
        may participate in a Health Insurance Exchange if the Secretary 
        determines that the prescription drug benefits under the plan 
        or coverage have been reduced as a result of the America Rx 
        program.
            (4) Protection of the low income.--Nothing in this section 
        shall be construed as reducing the prescription drug benefits 
        available to low-income individuals, as well as senior citizens 
        and the disabled, under the Medicare or Medicaid programs as a 
        result of the implementation of the America Rx program.
    (e) Arrangements With Participating Pharmacies.--
            (1) In general.--Under the America Rx program arrangements 
        are made with pharmacies for the provision of prescription 
        drugs at discounted prices to qualified residents in a 
        reasonably accessible manner. Such arrangements shall provide 
        that--
                    (A) each participating pharmacy shall--
                            (i) provide discounts on prices for 
                        outpatient prescription drugs for qualified 
                        residents in return for prompt reimbursement of 
                        the amount of such discounts and a reasonable 
                        dispensing fee;
                            (ii) not charge qualified residents more 
                        (before such discounts) for outpatient 
                        prescription drugs than the amount that 
                        individuals who are not qualified residents are 
                        charged for such drugs; and
                            (iii) report to the Secretary (or the 
                        Secretary's designee) information regarding the 
                        discounts provided and fees incurred; and
                    (B) the program shall--
                            (i) ensure the reasonable and timely 
                        payment to a participating retail pharmacy on a 
                        prompt basis (no less promptly than as provided 
                        under the Medicare program) for discounted 
                        prices provided to qualified residents under 
                        the program and for reasonable dispensing fees; 
                        and
                            (ii) not impose any additional fees on such 
                        pharmacies in connection with participation in 
                        the program.
            (2) Discounted prices.--The amount of the discount provided 
        to enrolled qualifying residents shall reflect the amount of 
        rebates obtained, reduced by expenses relating to 
        administrative costs of the Federal and State governments and 
        of participating pharmacies.
    (f) Definitions.--For purposes of this section:
            (1) The term ``Health Insurance Exchange'' means such an 
        Exchange as established and operated under part 3 of subtitle D 
        of title I of the Patient Protection and Affordable Care Act.
            (2) The term ``manufacturer'' has the meaning given such 
        term in section 1927(k)(5) of the Social Security Act (42 
        U.S.C. 1396r-8(k)(5)).
            (3) The term ``Medicaid program'' means a State program 
        under title XIX of the Social Security Act, including such a 
        program operating under a Statewide waiver under section 1115 
        of such Act.
            (4) The term ``outpatient prescription drug'' has the 
        meaning given the term ``covered outpatient drug'' in section 
        1927(k)(2) of the Social Security Act (42 U.S.C. 1396r-
        8(k)(2)).
            (5) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (6) The term ``State'' has the meaning given such term for 
        purposes of title XIX of the Social Security Act.
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