[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 904 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 904
To amend title XIX of the Social Security Act to reduce the costs of
prescription drugs for enrollees of Medicaid managed care organizations
by extending the discounts offered under fee-for-service Medicaid to
such organizations.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 4, 2009
Mr. Stupak (for himself and Mr. Ryan of Ohio) introduced the following
bill; which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to reduce the costs of
prescription drugs for enrollees of Medicaid managed care organizations
by extending the discounts offered under fee-for-service Medicaid to
such 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 ``Medicaid Prescription Drug Rebate
Equalization Act of 2009''.
SEC. 2. EXTENSION OF PRESCRIPTION DRUG DISCOUNTS TO ENROLLEES OF
MEDICAID MANAGED CARE ORGANIZATIONS.
(a) In General.--Section 1903(m)(2)(A) of the Social Security Act
(42 U.S.C. 1396b(m)(2)(A)) is amended--
(1) in clause (xi), by striking ``and'' at the end;
(2) in clause (xii), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(xiii) such contract provides that (I)
payment for covered outpatient drugs dispensed
to individuals eligible for medical assistance
who are enrolled with the entity shall be
subject to the same rebate required by the
agreement entered into under section 1927 as
the State is subject to, and (II) capitation
rates paid to the entity shall be based on
actual cost experience related to rebates and
subject to the Federal regulations requiring
actuarially sound rates.''.
(b) Conforming Amendments.--Section 1927 of the Social Security Act
(42 U.S.C. 1396r-8) is amended--
(1) in subsection (d)--
(A) in paragraph (1), by adding at the end the
following:
``(C) Notwithstanding subparagraphs (A) and (B)--
``(i) a Medicaid managed care organization
with a contract under section 1903(m) may
exclude or otherwise restrict coverage of a
covered outpatient drug on the basis of
policies or practices of the organization, such
as those affecting utilization management,
formulary adherence, and cost sharing or
dispute resolution, in lieu of any State
policies or practices relating to the exclusion
or restriction of coverage of such drugs,
provided, however, that any such exclusions and
restrictions of coverage shall be subject to
any contractual requirements and oversight by
the State. As contained in the Medicaid managed
care organization's contract with the State,
the State shall maintain approval authority
over the formulary used by the Medicaid managed
care organization; and
``(ii) nothing in this section or paragraph
(2)(A)(xiii) of section 1903(m) shall be
construed as requiring a Medicaid managed care
organization with a contract under such section
to maintain the same such policies and
practices as those established by the State for
purposes of individuals who receive medical
assistance for covered outpatient drugs on a
fee-for-service basis.''; and
(B) in paragraph (4), by inserting after
subparagraph (E) the following:
``(F) Notwithstanding the preceding subparagraphs
of this paragraph, any formulary established by a
Medicaid managed care organization with a contract
under section 1903(m) may be based on the positive
inclusion of drugs selected by a formulary committee
consisting of physicians, pharmacists, and other
individuals with appropriate clinical experience as
long as drugs excluded from the formulary are available
through prior authorization, as described in paragraph
(5).''; and
(2) in subsection (j), by striking paragraph (1) and
inserting the following:
``(1) Covered outpatients drugs are not subject to the
requirements of this section if such drugs are--
``(A) dispensed by health maintenance
organizations, including Medicaid managed care
organizations that contract under section 1903(m); and
``(B) subject to discounts under section 340B of
the Public Health Service Act.''.
(c) Reporting.--On a quarterly basis, the States shall report to
the Department of Health and Human Services the total amount of rebates
in dollars and volume received from pharmacy manufacturers for drugs
provided to individuals enrolled with Medicaid managed care
organizations that contract under section 1903(m) of the Social
Security Act (42 U.S.C. 1396b(m)) as a result of this section for both
brand-name and generic drugs. This report shall be made publicly
available.
(d) Effective Date.--The amendments made by this section take
effect on the date of the enactment of this Act and apply to rebate
agreements entered into or renewed under section 1927 of the Social
Security Act (42 U.S.C. 1396r-8) on or after such date.
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