I 112th CONGRESS 1st Session H. R. 3613 IN THE HOUSE OF REPRESENTATIVES December 8, 2011 Mr. Johnson of Georgia (for himself, Mr. Farr, Mr. Kissell, Ms. Jackson Lee of Texas, Mr. Conyers, Ms. Lee of California, Mr. Honda, Mr. Grijalva, Mr. Michaud, Ms. Richardson, Ms. Fudge, Mr. Ryan of Ohio, Mrs. Christensen, Mr. Carson of Indiana, Mr. Towns, Mr. Olver, Mr. Frank of Massachusetts, Mr. Clay, Ms. Roybal-Allard, Mr. Boswell, Mr. Filner, Ms. Slaughter, Ms. Schakowsky, Ms. Norton, Mr. Deutch, Mr. Hinchey, Ms. Moore, Mr. Jackson of Illinois, Ms. Woolsey, Mr. Davis of Illinois, Mr. Ellison, Mr. Lewis of Georgia, Mr. Kildee, and Mr. Jones) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D.

1.

Short title

This Act may be cited as the Part D Beneficiary Appeals Fairness Act.

2.

Fair exceptions process for drug in tiers under Medicare part D

Section 1860D–4(g)(2) of the Social Security Act (42 U.S.C. 1395w–103(g)(2)) is amended— (1)in the first sentence— (A)by striking for tiered cost-sharing for drugs included within a formulary and and inserting for any tiered cost-sharing structure within a formulary (including a structure that; and (B)by inserting , or provides for different co-payment or coinsurance amounts for drugs in different tiers included within the formulary) before , a part D eligible individual; (2)in the second sentence, by inserting in any plan formulary before could be covered; and (3)by inserting the following before the last sentence: In no case may the Secretary allow a PDP sponsor to make any element of the tiered cost-sharing structure (including a tier used for very high cost or unique items) ineligible for lower-cost sharing through an exception under this paragraph..