[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 1365 Introduced in Senate (IS)]

113th CONGRESS
  1st Session
                                S. 1365

   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.


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                   IN THE SENATE OF THE UNITED STATES

                             July 25, 2013

Mr. Nelson (for himself and Ms. Collins) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 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.

    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 ``Part D Beneficiary Appeals Fairness 
Act''.

SEC. 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-
104(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 
        formulary tier of the tiered cost-sharing structure (including 
        a formulary tier used for very high cost or unique items) 
        ineligible for lower-cost sharing through an exception under 
        this paragraph.''.
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