1.This Act may be cited as
the Drug Rebate Equalization Act of
2009
.
2.Extension of
prescription drug discounts to enrollees of Medicaid managed care
organizations
(a)Section 1903(m)(2)(A) (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)Section 1927 (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
the 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, and 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
Medicaid managed care organization with a contract under section 1903(m) may be
based on 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)Each
State with a contract with a Medicaid managed care organization under section
1903(m) of the Social Security Act (42 U.S.C. 1396b(m)) shall report to the
Secretary on a quarterly basis the total amount of rebates in dollars and
volume received from manufacturers (as defined in section 1927(k)(5) of such
Act (42 U.S.C. 1396r–8(k)(5)) for drugs provided to individuals enrolled with
such an organization as a result of the amendments made by this section for
both brand-name and generic drugs. The Secretary shall review the reports
submitted by States under this subsection and, after such review, make
publically available the aggregate data contained in such reports.
(d)This section and the amendments made by this section take
effect on the date of 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.