[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1239 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 1239

To amend part D of title XVIII of the Social Security Act to count the 
  negotiated price of drugs provided free or at nominal charge under 
 compassionate treatment programs towards incurred out-of-pocket costs.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 18, 2013

Mr. Cassidy (for himself and Ms. Matsui) 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 part D of title XVIII of the Social Security Act to count the 
  negotiated price of drugs provided free or at nominal charge under 
 compassionate treatment programs towards incurred out-of-pocket costs.

    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 ``Accessing Medicare Therapies Act of 
2013''.

SEC. 2. COUNTING THE NEGOTIATED PRICE OF DRUGS PROVIDED FREE OR AT 
              NOMINAL CHARGE UNDER COMPASSIONATE TREATMENT PROGRAMS 
              TOWARDS INCURRED OUT-OF-POCKET COSTS.

    (a) In General.--Section 1860D-2(b)(4) of the Social Security Act 
(42 U.S.C. 1395w-102(b)(4)) is amended--
            (1) in subparagraph (C), by striking ``subparagraph (E)'' 
        and inserting ``subparagraphs (E) and (F)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(F) Inclusion of negotiated price of drugs 
                provided under compassionate treatment programs.--
                            ``(i) In general.--In applying subparagraph 
                        (A) with respect to an individual enrolled in a 
                        prescription drug plan, incurred costs shall 
                        include the negotiated price described in 
                        clause (ii) of a covered part D drug if--
                                    ``(I) the drug is classified, for 
                                purposes of applying tiered copayments 
                                consistent with section 1860D-
                                2(b)(2)(B), in the highest copayment 
                                tier (such as a tier 4 for specialty 
                                brand-name drugs);
                                    ``(II) the drug is furnished to the 
                                individual free or at nominal charge 
                                under a compassionate treatment program 
                                (as defined in clause (iii)); and
                                    ``(III) the drug, if furnished 
                                other than through such program, is 
                                covered under the formulary of the plan 
                                or is available through exception or 
                                appeal.
                            ``(ii) Negotiated price.--The negotiated 
                        price described in this clause, for a covered 
                        part D drug which is dispensed to an enrollee--
                                    ``(I) by a pharmacy, is the 
                                negotiated price at such pharmacy; or
                                    ``(II) other than by a pharmacy, is 
                                the average negotiated price for the 
                                drug in the prescription drug plan in 
                                the zip code of the enrollee as of the 
                                date the drug is dispensed.
                            ``(iii) Compassionate treatment program 
                        defined.--In this subparagraph, the term 
                        `compassionate treatment program' means, with 
                        respect to covered part D drugs, a program 
                        that--
                                    ``(I) is administered by an entity 
                                described in section 501(c)(3) of the 
                                Internal Revenue Code of 1986 that is 
                                exempt from tax under section 501(a) of 
                                such Code;
                                    ``(II) takes title to the drugs and 
                                distributes the drugs to eligible part 
                                D individuals free or at nominal charge 
                                on the basis of the entity's assessment 
                                of financial need of such individuals;
                                    ``(III) does not distribute the 
                                drugs to an individual unless the 
                                individual's household income (as 
                                determined under section 36B of the 
                                Internal Revenue Code of 1986) is less 
                                than the maximum income level for the 
                                taxpayer in the household to be 
                                eligible for a refundable credit under 
                                such section; and
                                    ``(IV) meets such additional 
                                requirements as the Inspector General 
                                of the Department of Health and Human 
                                Services establishes, consistent with 
                                guidance and advisory opinions issued 
                                under section 1128D, to prevent fraud 
                                or abuse in the application of this 
                                subparagraph.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to drugs furnished in plan years beginning on or after January 1, 
2014.
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