[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4841 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 4841

    To amend title XVIII of the Social Security Act to provide for 
electronic prior authorization under Medicare part D for covered part D 
                     drugs, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 18, 2018

   Mr. Schweikert (for himself, Mr. Ben Ray Lujan of New Mexico, Mr. 
    Johnson of Ohio, and Mr. Thompson of California) 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 provide for 
electronic prior authorization under Medicare part D for covered part D 
                     drugs, and for other purposes.

    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 ``Standardizing Electronic Prior 
Authorization for Safe Prescribing Act of 2018''.

SEC. 2. ELECTRONIC PRIOR AUTHORIZATION FOR COVERED PART D DRUGS.

    (a) Inclusion in Electronic Prescription Program.--Section 1860D-
4(e)(2) of the Social Security Act (42 U.S.C. 1395w-104(e)(2)) is 
amended by adding at the end the following new subparagraph:
                    ``(E) Electronic prior authorization.--
                            ``(i) In general.--Effective on and after 
                        January 1, 2020, the program shall provide for 
                        the secure electronic transmittal of--
                                    ``(I) a prior authorization request 
                                from the prescribing health care 
                                professional for coverage of a covered 
                                part D drug for a part D eligible 
                                individual enrolled in a part D plan 
                                (as defined in section 1860D-23(a)(5)) 
                                to the PDP sponsor or Medicare 
                                Advantage organization offering such 
                                plan; and
                                    ``(II) a response, in accordance 
                                with this subparagraph, from such PDP 
                                sponsor or Medicare Advantage 
                                organization, respectively, to such 
                                professional.
                            ``(ii) Electronic transmission.--
                                    ``(I) Exclusions.--For purposes of 
                                this subparagraph, a facsimile, 
                                proprietary payer portal, or electronic 
                                form shall not be treated as an 
                                electronic transmission described in 
                                clause (i).
                                    ``(II) Standards.--In order to be 
                                treated, for purposes of this 
                                subparagraph, as an electronic 
                                transmission described in clause (i), 
                                such transmission shall comply with 
                                technical standards adopted by the 
                                Secretary in consultation with the 
                                National Council for Prescription Drug 
                                Programs, other standard setting 
                                organizations determined appropriate by 
                                the Secretary, and stakeholders 
                                including PDP sponsors, Medicare 
                                Advantage organizations, health care 
                                professionals, and health information 
                                technology software vendors.''.
    (b) Sense of Congress Regarding Electronic Prior Authorization.--It 
is the sense of the Congress that--
            (1) there should be increased use of electronic prior 
        authorizations for coverage of covered part D drugs for part D 
        eligible individuals enrolled in prescription drug plans under 
        part D of title XVIII of the Social Security Act and MA-PD 
        plans under part C of such title to reduce access delays by 
        resolving coverage issues before prescriptions for such drugs 
        are transmitted; and
            (2) greater priority should be placed on increasing the 
        adoption of use of such electronic prior authorizations among 
        prescribers of such drugs, pharmacies, PDP sponsors, and 
        Medicare Advantage organizations.
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