[Congressional Record Volume 149, Number 78 (Friday, May 23, 2003)]
[Senate]
[Pages S7147-S7149]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SPECTER (for himself and Mr. BOND):
  S. 1153. A bill to amend title 38, United States Code, to permit 
medicare-eligible veterans to receive an out-patient medication 
benefit, to provide that certain veterans who receive such benefit are 
not otherwise eligible for medical care and services from the 
Department of Veterans Affairs, and for other purposes; to the 
Committee on Veterans' Affairs.
  Mr. SPECTER. Mr. President, I have sought recognition to explain the 
provisions of the ``Veterans Prescription Drugs Assistance Act of 
2003,'' a bill that I have introduced today to assist Medicare-eligible 
veterans struggling with the costs of prescription medications.
  I fully understand that Congress, and the President, are working very 
hard on legislation to take on the larger issue of providing a 
prescription drug benefit for all American seniors. I applaud that 
effort, and I will continue to work with my colleagues to see that 
Congress enacts legislation to help all seniors who struggle with the 
ever-increasing costs of necessary medications. But in the meantime, as 
Chairman of the Committee on Veterans Affairs, I offer legislation to 
allow Medicare-eligible veterans to obtain prescription drugs from the 
Department of Veterans Affairs, VA, at the significantly discounted 
costs that VA, as a high-volume purchaser of prescriptions medications, 
is able to secure in the marketplace.
  Earlier this year, VA Secretary Anthony J. Principi was forced to 
limit access to VA care by suspending new enrollments of non-service-
disabled middle and higher income veterans who were not enrolled for 
care as of January 17, 2003. The Secretary was forced to so act because 
the number of patients provided care by VA has more than doubled in 
just five years. And as a result, VA's medical care system has been 
overwhelmed and, as a consequence, VA has been unable to provide timely 
access to healthcare for all veterans who have sought it and 
appointment waiting times have grown to alarming levels. But in almost 
every news story that followed the Secretary's difficult decision, it 
was noted that many of the new enrollees who had overwhelmed VA's 
capacity to provide care were Medicare-eligible veterans who were able 
to get Medicare-financed care elsewhere--but who were seeking access to 
the relatively generous prescription drug program provided to veterans 
under VA care.
  Currently, VA provides enrolled patients with prescription 
medications for $7.00 for each 30-day supply. But to get such 
prescriptions, the veteran must obtain the full range of medical care 
from VA. This fact, coupled with the Secretary's decision to close 
enrollment, means that veterans who are now--or who will be--eligible 
for Medicare who had not enrolled for VA care prior to January 17, 
2003, will be unable to access VA's generous prescription drug 
benefits. This legislation would provide some relief for those 
veterans. In addition, I anticipate that it may induce some VA-enrolled 
Medicare-eligible veterans--those who were happy with their Medicare-
financed care but who enrolled for VA care to gain access to VA-
supplied drugs--to return to non-VA care with knowledge that they will 
be able to get their non-VA prescriptions filled through VA. Enactment 
of this provision, then, would reduce--not exacerbate--VA patient 
backlog numbers.
  The premise of this legislation is straightforward: VA fills and 
distributes more than 100 million prescriptions each year for its 4.5 
million veteran-patients. As a result, it has significant purchasing 
power--power which, coupled with VA's formulary program, allows it to 
negotiate very favorable prices for prescription drugs. According to 
the National Association of Chain Drug Stores, the average ``cash 
cost'' of a prescription in 2001 was $40.22. The average VA per-
prescription cost in 2001 was $22.87--almost 50 percent less. The 
average per-prescription price paid by VA this year is up to just under 
$25--a slower growth rate than the 6.7 percent annual growth 
experienced in the population at large since 2001.
  My purpose is to afford Medicare-eligible veterans access to such 
discounts. I do not propose that VA be directed to supply drugs to all 
Medicare-eligible veterans at VA expense, or even with a partial VA 
subsidy. VA has stated that such a mandate would divert VA funding--
which, clearly, is already stretched to the limit--away from VA 
priority patients: the service-connected, the poor, and those with 
special needs. I accept VA's statement of concern; I accept and I 
insist--that scarce funding be directed, first, to meet the needs of 
priority patients. This legislation, therefore, requires that VA 
recover the costs of drugs it supplies under this program from veterans 
who bring their prescriptions from outside doctors to VA.
  I do not propose to tell VA in this bill how to recover these costs. 
VA is better positioned than I to make such judgments. Thus, my 
legislation provides flexibility to VA to design and test payment 
mechanisms to best accomplish cost recovery while still easing 
veterans' access to the drugs they need. It might be that enrollment 
fees, a copayment structure, or a simple ``cost-plus''--for 
administrative expenses pricing format--or some combination of those 
mechanisms--works best. And it might be that different approaches work 
best in different regions of the country. I intend for the VA to 
experiment with different pricing structures to determine what works 
best. But I also intend that veterans get a break on prescription drug 
pricing.
  Those who would benefit from this program are World War II and Korean 
War veterans who answered their country's call over 50 years ago. As 
they age, many desperately need relief from high drug prices. My 
purpose is not to disparage the drug companies; their discoveries have 
truly been marvels. But that is precious little comfort to a Medicare 
participant who, whatever the drug's overall utility might be, cannot 
afford both the drug and food or shelter or heat. Many such persons 
reside in the Commonwealth of Pennsylvania where, just last month, a 
genuine titan in the industrial history of the United States, Bethlehem 
Steel, ceased to exist. Many retired steelworkers who are also 
veterans--and who never needed VA because of company-paid

[[Page S7148]]

benefits--have lost their health insurance coverage and, with it, 
prescription drug benefits. These people need a break. This bill could 
provide it.
  The premise of this legislation is simple: veteran access to VA 
market-driven discounts. Yet, the assistance it could provide might be 
profound. I do hope that Congress will find a way to provide 
prescription drug benefits to all seniors. But for now, I urge my 
colleagues to support this bill so that the problem might be solved--or 
at least reduced--for seniors who served. They deserve it, and we 
should do it.
  I ask unanimous consent that the text of this bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Rcord, as follows:

                                S. 1153

       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 ``Veterans Prescription Drugs 
     Assistance Act''.

     SEC. 2. ELIGIBILITY OF MEDICARE-ELIGIBLE VETERANS FOR OUT-
                   PATIENT MEDICATION BENEFIT.

       (a) Restatement of Current Law on Drugs and Medications and 
     Provision of Out-Patient Medication Benefit.--Chapter 17 of 
     title 38, United States Code, is amended by inserting after 
     section 1710B the following new section:

     ``Sec. 1710C. Drugs and medications; vaccines

       ``(a)(1) The Secretary shall furnish to each veteran who is 
     receiving additional compensation or allowance under chapter 
     11 of this title, or increased pension as a veteran of a 
     period of war, by reason of being permanently housebound or 
     in need of regular aid and attendance, such drugs and 
     medicines as may be ordered on prescription of a duly 
     licensed physician as specific therapy in the treatment of 
     any illness or injury suffered by such veteran.
       ``(2) The Secretary shall continue to furnish such drugs 
     and medicines ordered under paragraph (1) to any such veteran 
     in need of regular aid and attendance whose pension payments 
     have been discontinued solely because such veteran's annual 
     income is greater than the applicable maximum annual income 
     limitation, but only so long as such veteran's annual income 
     does not exceed such maximum annual income limitation by more 
     than $1,000.
       ``(b)(1) Any medicare-eligible veteran may elect to be 
     furnished by the Secretary, on an out-patient basis, such 
     drugs and medicines as may be ordered on prescription of a 
     duly licensed physician as specific therapy in the treatment 
     of any illness or injury suffered by such veteran.
       ``(2) In this subsection, the term `medicare-eligible 
     veteran' means any veteran who--
       ``(A) is entitled to or enrolled in hospital insurance 
     benefits under part A of title XVIII of the Social Security 
     Act (42 U.S.C. 1395 et seq.); or
       ``(B) is enrolled in the supplementary medical insurance 
     program under part B of such title (42 U.S.C. 1395j et seq.).
       ``(3) The Secretary shall furnish to any veteran who makes 
     an election under paragraph (1), on an out-patient basis, 
     such drugs and medicines as may be ordered on prescription of 
     a duly licensed physician as specific therapy in the 
     treatment of any illness or injury suffered by such veteran.
       ``(4)(A) Notwithstanding any other provision of law and 
     except as provided in subparagraph (B), a veteran who makes 
     an election under paragraph (1) shall not be eligible for 
     care and services under this chapter during the year covered 
     by the election.
       ``(B) Subparagraph (A) shall not apply with respect to any 
     veteran who has a compensable service-connected disability.
       ``(5) The furnishing of drugs and medicines under this 
     subsection shall be subject to the provisions of section 
     1722A(b) of this title.
       ``(6)(A) An election under paragraph (1) shall be for a 
     calendar year, and shall be irrevocable for the year covered 
     by such election. An election may be renewed.
       ``(B) The Secretary shall prescribe the form, manner, and 
     timing of an election.
       ``(7) Before permitting a veteran to make an election under 
     paragraph (1), the Secretary shall provide the veteran such 
     educational materials and other information on the furnishing 
     and receipt of drugs and medicines under this subsection as 
     the Secretary considers appropriate to inform the veteran of 
     the benefits and costs of being furnished drugs and medicines 
     under this subsection, including materials and information on 
     the consequences of making an election under paragraph (1) 
     and on the fees, copayments, or other amounts required under 
     section 1722A(b) of this title for drugs and medicines 
     furnished under this subsection.
       ``(c)(1) In order to assist the Secretary of Health and 
     Human Services in carrying out national immunization programs 
     under other provisions of law, the Secretary may authorize 
     the administration of immunizations to eligible veterans who 
     voluntarily request such immunizations in connection with the 
     provision of care for a disability under this chapter in any 
     Department health care facility.
       ``(2) Any immunization under paragraph (1) shall be made 
     using vaccine furnished by the Secretary of Health and Human 
     Services at no cost to the Department. For such purpose, 
     notwithstanding any other provision of law, the Secretary of 
     Health and Human Services may provide such vaccine to the 
     Department at no cost.
       ``(3) Section 7316 of this title shall apply to claims 
     alleging negligence or malpractice on the part of Department 
     personnel granted immunity under such section.''.
       (b) Copayment Requirements.--
       (1) In general.--Section 1722A of such title is amended--
       (A) in subsection (a)(1), by inserting ``(other than a 
     veteran covered by subsection (b))'' after ``require a 
     veteran'';
       (B) by redesignating subsections (b), (c), and (d), as 
     subsections (c), (d), and (e), respectively;
       (C) by inserting after subsection (a) the following new 
     subsection (b):
       ``(b)(1) In the case of a veteran who is furnished 
     medications on an out-patient basis under section 1710C(b) of 
     this title, the Secretary shall require the veteran to pay, 
     at the election of the Secretary, one or more of the 
     following:
       ``(A) An annual enrollment fee in an amount determined 
     appropriate by the Secretary.
       ``(B) A copayment for each 30-day supply of such 
     medications in an amount determined appropriate by the 
     Secretary.
       ``(C) An amount equal to the cost to the Secretary of such 
     medications, as determined by the Secretary.
       ``(2)(A) In determining the amounts to be paid by a veteran 
     under paragraph (1), and the basis of payment under one or 
     more subparagraphs of that paragraph, the Secretary shall 
     ensure that the total amount paid by veterans for medications 
     under that paragraph in a year is not less than the costs of 
     the Department in furnishing medications to veterans under 
     section 1710C(b) of this title during that year, including 
     the cost of purchasing and furnishing medications, and other 
     costs of administering that section.
       ``(B) The Secretary shall take appropriate actions to 
     ensure, to the maximum extent practicable, that amounts paid 
     by veterans under paragraph (1) in a year are equal to the 
     costs of the Department referred to in subparagraph (A) in 
     that year.
       ``(3) In determining amounts under paragraph (1), the 
     Secretary may take into account the following:
       ``(A) Whether or not the medications furnished are generic 
     medications or brand name medications.
       ``(B) Whether or not the medications are furnished by mail.
       ``(C) Whether or not the medications furnished are listed 
     on the National Prescription Drug Formulary of the 
     Department.
       ``(D) Any other matters the Secretary considers 
     appropriate.
       ``(4) The Secretary may from time to time adjust any amount 
     determined by the Secretary under paragraph (1), as 
     previously adjusted under this paragraph, in order to meet 
     the purpose specified in paragraph (2).''; and
       (D) in subsection (d), as so redesignated--
       (i) by striking ``subsection (a)'' and inserting 
     ``subsections (a) and (b)''; and
       (ii) by striking ``subsection (b)'' and inserting 
     ``subsection (c)''.
       (2) Deposit of collections in medical care collections 
     fund.--Paragraph (4) of section 1729A(b) of such title is 
     amended to read as follows:
       ``(4) Subsection (a) or (b) of section 1722A of this 
     title.''.
       (c) Conforming Amendments.--(1) Section 1707 of such title 
     is amended by adding at the end the following new subsection:
       ``(c) Notwithstanding any other provision of law, a veteran 
     who makes an election authorized by section 1710C(b) of this 
     title (other than a veteran covered by paragraph (4)(B) of 
     that section) shall not, for the period of such election, be 
     eligible for care and services under this chapter, except as 
     provided in that section.''.
       (2) Section 1712 of such title is amended by striking 
     subsections (d) and (e).
       (d) Clerical Amendments.--(1) The heading for section 1712 
     of such title is amended to read as follows:

     ``Sec. 1712. Dental care''.

       (2) The table of sections at the beginning of chapter 17 of 
     such title is amended--
       (A) by inserting after the item relating to section 1710B 
     the following new item:

``1710C. Drugs and medications; vaccines.''; and
       (B) by striking the item relating to section 1712 and 
     inserting the following new item:

``1712. Dental care.''.

  Mr. BOND. Mr. President, I rise today to express my strong support 
for the Veterans Prescription Drugs Assistance Act of 2003. As an 
original co-sponsor, I am pleased to join my colleague, the Chairman of 
the Veterans Affairs Committee, Senator Specter in introducing this 
important legislation that addresses the medical care needs of 
Medicare-eligible veterans. I applaud Senator Specter for his 
leadership on this important issue.
  For several years, many veterans have not been able to receive timely 
health care from the Department of Veterans Affairs due to the long 
waiting lines created by the huge demand for prescription drugs. Under 
current policy, veterans are required to see a VA doctor before 
receiving their medication even when they have already

[[Page S7149]]

had a prescription written by a privately licensed physician. This 
policy has not only contributed to the long waiting lines, but it has 
denied care to service-connected and lower income veterans. It is a 
moral imperative that we correct this problem and I believe that this 
legislation is a step in the right direction.
  As Chair of the VA-HUD and Independent Agencies Appropriations 
Subcommittee, my top priority is ensuring that the VA has adequate 
funding to provide accessible and quality care for our Nation's 
veterans. Unfortunately, despite record funding increases over the past 
few years, veterans must still wait for several months to see a VA 
doctor.
  This past January, VA Secretary Principi had to take the unfortunate 
but necessary step of closing new enrollments to middle and higher 
income veterans who do not have service-connected disabilities. Many of 
these so-called Priority 8 veterans have Medicare insurance but do not 
have a prescription drug benefit. I recognize that the Congress and the 
President are trying to address the prescription drug issue for all 
American seniors and I will continue to fight to ensure that a Medicare 
prescription drug bill is enacted. Nevertheless, I believe that we need 
to raise awareness of the tragedy that many veterans suffer today to 
ensure that no matter what occurs during this session of Congress, they 
are not left behind.
  This bill contains a number of important provisions but I highlight 
one particular measure. As I mentioned earlier, current policy requires 
veterans to see a VA doctor before having their prescription filled, 
even if they have had already seen a private doctor. This legislation 
allows eligible veterans to fill their prescriptions at the VA without 
having to see a VA doctor. This not only greatly streamlines the 
process and time for veterans to receive much-needed medications, but 
it also provides relief to the waiting lines so that our higher 
priority veterans can receive timely care. In other words, this 
legislation is a win-win for all veterans.
  This legislation may not be perfect but it is important to begin a 
dialogue on the prescription drug needs of our nation's veterans. I 
welcome my colleagues' comments and comments from the Administration. I 
believe that we can resolve this matter this year. I thank my 
colleagues for their attention to this matter and I look forward to 
working with all of you over the next several weeks.
                                 ______