[Congressional Record Volume 151, Number 152 (Wednesday, November 16, 2005)]
[Senate]
[Pages S12958-S12959]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. LAUTENBERG (for himself, Mr. Kerry, Mr. Dorgan, and Mr. 
        Dayton):
  S. 2026. A bill to amend title XVIII of the Social Security Act to 
require that a prescription drug plan or an MA-PD plan that has an 
initial coverage limit obtain a signed certification prior to enrolling 
beneficiaries under the plan under part D of such title; to the 
Committee on Finance.
  Mr. LAUTENBERG. Mr. President, I rise to introduce the Medicare 
Prescription Drug Gap Disclosure Act with my colleagues, Senators 
Kerry, Dorgan and Dayton. This important legislation will require 
Medicare beneficiaries enrolling in a Medicare Prescription Drug Plan, 
PDP, or Medicare Advantage Drug Plan, MA-PD, with a potential coverage 
gap to sign a short, easy to read, statement indicating that they are 
aware of the potential loss of coverage.
  Yesterday, 42 million Medicare beneficiaries became eligible to sign 
up for the new Medicare prescription drug benefit, scheduled to start 
on January 1, 2006. However, too many seniors are understandably 
confused about this complicated change to Medicare, and I fear that 
many may sign up for drug plans without understanding the major 
pitfalls of the program. The biggest pitfall in the drug plan is the 
notorious ``coverage gap'' also known as the ``donut hole.''
  In the coverage gap, beneficiaries pay 100 percent of prescription 
costs after they exceed a certain level of out-of-pocket spending and 
before protection kicks in against catastrophic drug expenses. They 
also continue to pay 100 percent of their monthly premiums.
  We need to make sure that seniors are aware of the threat that the 
coverage gap poses, and it should not be

[[Page S12959]]

hidden in a mountain of paperwork. My legislation would require plan 
providers to have beneficiaries sign the following certification before 
enrollment:

       I understand that the Medicare Prescription Drug Plan or 
     MA-PD Plan that I am signing up for may result in a gap in 
     coverage during a given year. I understand that if subject to 
     this gap in coverage, I will be responsible for paying 100 
     percent of the costs of my prescription drugs and will 
     continue to be responsible for paying the plan's monthly 
     premium while subject to this gap in coverage. For specific 
     information on the potential coverage gap under this plan, I 
     understand that I should contact [prescription drug plan] at 
     [toll free phone number].

  The bottom line is that, after months of trying to explain this new 
drug benefit to Medicare beneficiaries, many do not understand the 
ramifications of the coverage gap. Unfortunately, millions of Medicare 
beneficiaries may learn about the coverage gap the hard way--when the 
pharmacist at the cash register tells them sometime next year that they 
are suddenly required to pay the full cost of their prescriptions.
  Mr. President, a study by the Commonwealth Fund found that 38 percent 
of Medicare enrollees are likely to experience this costly interruption 
in care. Moreover, the benefits must be renewed each year, meaning that 
the coverage gap repeats itself if beneficiaries reach the coverage gap 
again.
  A recent survey by the Kaiser Foundation and the Harvard School of 
Public Health, found that only 35 percent of people 65 and older said 
they understood the new drug benefit. In addition, the numerous media 
stories in recent days contain anecdotal evidence that illustrates the 
confusion around the new drug benefit.
  I therefore urge my colleagues to support this bill. Only with such a 
clear, separate disclaimer will seniors have a fair opportunity to be 
warned of the risks posed by this gap in drug coverage.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2026

       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 ``Medicare Prescription Drug 
     Gap Disclosure Act''.

     SEC. 2. REQUIREMENT OF SIGNED CERTIFICATION PRIOR TO PLAN 
                   ENROLLMENT UNDER PART D.

       (a) In General.--Section 1860D-1(b)(1) of the Social 
     Security Act (42 U.S.C. 1395w-101) is amended by adding at 
     the end the following new subparagraph:
       ``(D) Special rule for plans with an initial coverage 
     limit.--
       ``(i) In general.--The process for enrollment established 
     under subparagraph (A) shall include, in the case of a 
     prescription drug plan or an MA-PD plan that has an initial 
     coverage limit (as described in section 1860D-2(b)(3)), a 
     requirement that, prior to enrolling a part D eligible 
     individual in the plan, the plan must obtain a certification 
     signed by the enrollee or the legal guardian of the enrollee 
     that meets the requirements described in clause (ii) and 
     includes the following text: `I understand that the Medicare 
     Prescription Drug Plan or MA-PD Plan that I am signing up for 
     may result in a gap in coverage during a given year. I 
     understand that if subject to this gap in coverage, I will be 
     responsible for paying 100 percent of the cost of my 
     prescription drugs and will continue to be responsible for 
     paying the plan's monthly premium while subject to this gap 
     in coverage. For specific information on the potential 
     coverage gap under this plan, I understand that I should 
     contact (insert name of the sponsor of the prescription drug 
     plan or the sponsor of the MA-PD plan) at (insert toll free 
     phone number for such sponsor of such plan).'.
       ``(ii) Certification requirements described.--The 
     certification required under clause (i) shall meet the 
     following requirements:

       ``(I) The certification shall be printed in a typeface of 
     not less than 18 points.
       ``(II) The certification shall be printed on a single piece 
     of paper separate from any matter not related to the 
     certification.
       ``(III) The certification shall have a heading printed at 
     the top of the page in all capital letters and bold face type 
     that states the following: `WARNING: POTENTIAL MEDICARE 
     PRESCRIPTION DRUG COVERAGE GAP'.''.

       (b) Effective Date.--The amendment made by this section 
     shall take effect on the date of enactment of this Act.

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