[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1123 Introduced in Senate (IS)]
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117th CONGRESS
1st Session
S. 1123
To preserve non-interference under the Medicare part D Prescription
Drug Benefit program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 14, 2021
Mrs. Blackburn introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To preserve non-interference under the Medicare part D Prescription
Drug Benefit program.
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 ``Preserving Innovation for the Next
Generation Act'' or the ``PING Act''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Since implementation, the Medicare Prescription Drug
Benefit program under part D of title XVIII of the Social
Security Act (42 U.S.C. 1395w-101 et seq.) (referred to in this
section as ``Medicare part D'') has succeeded beyond
expectations in providing affordable prescription drug coverage
for more than 45,000,000 seniors and disabled individuals.
(2) The competitive market has kept total Medicare part D
costs below original estimates, while still offering
beneficiaries steady premiums and a variety of alternative
formularies and benefit design.
(3) This competitive pricing structure works, in large
part, due to the ``non-interference clause'' under Medicare
part D which provides for robust private market negotiation
without undue government interference.
(4) The Congressional Budget Office repeatedly has said
that government negotiation would have a negligible impact on
Medicare part D spending unless the government also restricted
access to medications.
(5) To achieve any significant savings, the government
would need to impose access or coverage restrictions on
medications. In fact, limiting options will likely result in
costs shifting to higher spending for other Medicare services
and negatively impact the health of seniors without helping to
reduce government spending.
(6) Having a broad range of treatment options is
fundamental to providing good care to all patients, but
particularly so for the Medicare population, who are more
likely to be affected by multiple chronic conditions. With the
advent of personalized medicines and targeted therapies--where
the underlying molecular drivers of disease help identify and
direct precise, targeted treatment choices--limiting access
reduces the vast potential of breakthrough science to
revolutionize care. Therefore, it is imperative to ensure
beneficiaries have access to a broader range of medicines to
best meet their health needs.
(7) Medicare beneficiaries would not be better off if
Medicare part D drug coverage were administered by the Federal
Government in the same way as the Veterans Administration. Many
veterans rely on other sources to supplement their Veterans
Administration drug coverage due to restrictions that limit
their access to needed medications. More than half of all
veterans supplement their Veterans Administration benefits with
other sources of drug coverage, including Medicare part D. A
recent Veterans Administration survey shows that approximately
80.4 percent of veterans had both Veterans Administration and
non-Veterans Administration health coverage and, among those in
Medicare, 33.2 percent have Medicare part D for prescription
drug coverage.
(8) Imposing a restrictive Veterans Administration-type
formulary on Medicare part D is unlikely to work for the
diverse group of more than 45,000,000 beneficiaries enrolled in
Medicare part D. Evidence show that seniors would have limited
choices and fewer medicines available to them. A recent
analysis by Xcenda found that of the top 200 part D brand name
drugs, 74 percent or more were covered across stand-alone
prescription drug plans and Medicare Advantage prescription
drug plans, compared with 52 percent that could be covered by
the Veterans Administration formulary.
(9) A national formulary would restrict access to
affordable and vital prescriptions many Medicare beneficiaries
rely on. Robust patient access to a full range of medicines has
been a cornerstone of Medicare part D. Restricting access to
medicines can significantly reduce adherence. Poorer medication
adherence, in turn, can lead to worse health outcomes and
higher overall spending.
(10) Price controls or large penalties to force companies
to comply with so-called ``negotiations'' have resulted in
restricted access abroad and threaten similar restrictions on
access in the United States. Research demonstrates that
government price setting reduces access for patients and
results in fewer or delayed treatment options--nearly 90
percent of new medicines launched globally in the past decade
are currently available to patients in the United States, only
about half are available to patients in other countries like
France and Canada.
(11) Limiting patient access to medicines contradicts the
foundational principles of Medicare part D and the value
beneficiaries derive from the program--a recent survey shows
that more than 90 percent of Medicare beneficiaries are
satisfied with their drug coverage and more than 80 percent
said it is important to them to have a variety of prescription
drug plans under Medicare part D from which to choose.
SEC. 3. SENSE OF THE SENATE.
It is the sense of the Senate that non-interference in the Medicare
part D Prescription Drug Benefit program under section 1860D-11(i) of
the Social Security Act (42 U.S.C. 1395w-111(i)) should not be
repealed.
SEC. 4. PROHIBITION ON CMI TESTING OF MODELS THAT WOULD REPEAL
NONINTERFERENCE.
Section 1115A(b) of the Social Security Act (42 U.S.C. 1315a(b)) is
amended by adding at the end the following new paragraph:
``(5) Prohibition on testing of models that would repeal
noninterference.--The CMI shall not test any model that would
repeal or require a waiver of section 1860D-11(i).''.
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