[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2405 Introduced in Senate (IS)]

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118th CONGRESS
  1st Session
                                S. 2405

  To amend title XVIII of the Social Security Act to assure pharmacy 
             access and choice for Medicare beneficiaries.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 20, 2023

  Mr. Thune (for himself, Mr. Brown, Mr. Barrasso, and Ms. Stabenow) 
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 assure pharmacy 
             access and choice for Medicare beneficiaries.

    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 ``Strengthening Pharmacy Access for 
Seniors Act''.

SEC. 2. ASSURING PHARMACY ACCESS AND CHOICE FOR MEDICARE BENEFICIARIES.

    Section 1860D-4(b)(1) of the Social Security Act (42 U.S.C. 1395w-
104(b)(1)) is amended by adding at the end the following new 
subparagraph:
                    ``(F) Limited access drugs.--
                            ``(i) Limitation on restrictions or limits 
                        on access.--For each plan year (beginning with 
                        plan year 2026), a PDP sponsor offering a 
                        prescription drug plan or pharmacy benefit 
                        manager--
                                    ``(I) may not restrict or limit 
                                access to any covered part D drug to a 
                                subset of their network pharmacies, 
                                other than with respect to a limited 
                                access drug, as defined in clause (v); 
                                and
                                    ``(II) shall record in writing the 
                                rationale for why a covered part D drug 
                                meets the definition of a limited 
                                access drug under clause (v) and 
                                maintain written records of any such 
                                rationales, if such plan restricts or 
                                limits access to a limited access drug 
                                to a subset of network pharmacies.
                            ``(ii) Annual submission of information to 
                        the secretary on limited access drugs.--For 
                        each plan year (beginning with plan year 2026), 
                        each PDP sponsor offering a prescription drug 
                        plan shall submit to the Secretary, at a time 
                        and in a manner specified by the Secretary, 
                        with respect to each prescription drug plan 
                        offered by the sponsor during such plan year--
                                    ``(I) a list of all covered part D 
                                drugs that the PDP sponsor designated 
                                as a limited access drug;
                                    ``(II) the written rationales for 
                                why any covered part D drugs listed 
                                under subclause (I) meet the definition 
                                of a limited access drug;
                                    ``(III) the requirements imposed on 
                                network pharmacies to ensure 
                                appropriate handling and dispensing of 
                                the covered part D drugs listed under 
                                subclause (I);
                                    ``(IV) the percentages of covered 
                                part D drugs listed under subclause (I) 
                                that are dispensed through retail 
                                pharmacies, specialty pharmacies, mail 
                                order pharmacies, or other dispensing 
                                channels as defined by the PDP sponsor, 
                                respectively, during the most recent 
                                plan year for which such data are 
                                available;
                                    ``(V) the annual percentage of 
                                covered part D drugs listed under 
                                subclause (I) that are dispensed 
                                through pharmacies wholly or partially 
                                owned by, or otherwise affiliated with 
                                (such as through common ownership), the 
                                plan or pharmacy benefit manager; and
                                    ``(VI) any other information 
                                determined appropriate by the 
                                Secretary.
                            ``(iii) Pharmacy access to limited access 
                        drug information.--For plan years beginning 
                        with plan year 2026, upon the request of a 
                        network pharmacy, a PDP sponsor of a 
                        prescription drug plan (or a pharmacy benefit 
                        manager acting on behalf of such sponsor) shall 
                        present such pharmacy, on a timely basis (as 
                        determined by the Secretary), with information 
                        specific to any covered part D drug listed 
                        under subclause (II) of clause (i) of this 
                        subparagraph, along with the rationale for its 
                        designation as a limited access drug (as 
                        described in subclause (II) of clause (ii)) and 
                        the requirements imposed with respect to such 
                        drug (as described in subclause (III) of clause 
                        (ii)). Any PDP sponsor or pharmacy benefit 
                        manager that provides false information upon 
                        such a request or that fails to provide the 
                        information requested on a timely basis shall 
                        be found in violation of this subsection.
                            ``(iv) HHS annual report on limited access 
                        drugs.--Not later than December 31, 2027, and 
                        annually thereafter, the Secretary shall submit 
                        to the Committee on Finance of the Senate, and 
                        the Committee on Ways and Means and the 
                        Committee on Energy and Commerce of the House 
                        of Representatives a report on compliance by 
                        PDP sponsors with the requirements under this 
                        subparagraph. Each such report shall include--
                                    ``(I) a description of the 
                                patterns, trends, variations, and 
                                rationales for the designation by PDP 
                                sponsors of certain covered part D 
                                drugs as limited access drugs described 
                                in clause (v), and the implications of 
                                such designations on beneficiary access 
                                to such covered part D drugs;
                                    ``(II) a description of the 
                                information submitted to the Secretary 
                                under clause (ii) (in a manner that 
                                does not disclose the identity of a 
                                pharmacy, a PDP sponsor, a prescription 
                                drug plan, or pharmacy benefit manager, 
                                or any proprietary pricing 
                                information); and
                                    ``(III) any other information 
                                determined appropriate by the 
                                Secretary.
                            ``(v) Limited access drug defined.--In this 
                        subparagraph, the term `limited access drug' 
                        means a covered part D drug that meets at least 
                        one of the following:
                                    ``(I) The Food and Drug 
                                Administration has restricted 
                                distribution of such covered part D 
                                drug to certain facilities or 
                                physicians.
                                    ``(II) The dispensing of such 
                                covered part D drug requires 
                                extraordinary special handling, 
                                provider coordination, or patient 
                                education that cannot be met by a 
                                network pharmacy.''.
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