[Congressional Record Volume 152, Number 11 (Thursday, February 2, 2006)]
[Senate]
[Pages S512-S513]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
by Mr. LEVIN (for himself and Ms. Stabenow):
S. 2240. A bill to amend title XVIII to reform the Medicare
prescription drug program; to the Committee on Finance.
Mr. LEVIN. Mr. President, today I am introducing ``The Medicare Part
D Reform Act of 2006.'' This bill is necessary to address some of the
major problems in the Medicare prescription drug benefit that took
effect on January 1 of this year. As we all know, the reaction of our
seniors has been widespread disappointment, mass confusion and
downright anger.
Let me describe some of the problems that I am hearing from people in
Michigan about this new Medicare prescription drug benefit.
First, many drug companies have previously issued discount cards and
are currently providing drugs to low-income people and seniors at a
nominal or no cost. These are individuals usually at 200 percent of the
Federal poverty level, which is 19,600 for a single person or $26,400
for a couple, while to qualify for the Medicare low-income subsidy,
their income must be $14,700 for a single person or $19,800 for a
couple. Many of these programs are being discontinued, and seniors are
losing a vital method of obtaining low cost prescription drugs.
Second, prescription drug plans can drop a drug from its list of
covered drugs with 60 days notice at any time during the calendar year.
This is particularly egregious for a senior who relied on a particular
medication being available and covered when the senior chose that
particular plan.
Third, the situation of so-called ``dual eligibles'' is clearly worse
now than before enactment of the prescription drug benefit. These are
former Medicaid beneficiaries who are being forced into Medicare
prescription drug coverage, often putting them in plans with more
restrictive formularies and higher co-payments, in other words leaving
them worse off.
Fourth, many Michigan residents are retirees from good paying jobs
and currently have a good prescription drug plan. This has changed for
the worse with the creation of the new Medicare prescription drug
benefit because many companies have decided to scale back or eliminate
that retiree coverage. As a result, many of those retirees are worse
off than they were before the bill became law.
Fifth, Medicare is specifically barred from negotiating lower drug
prices for all of its beneficiaries.
Finally, the coverage gap from $2,250-$3,600 in prescription drug
expenses per year, commonly referred to as the ``doughnut hole,'' is
unconscionable. Many seniors do not yet understand that this huge
coverage gap is looming in their future and that during this gap, they
are still expected to pay their monthly premiums, although they are
getting no prescription drug coverage assistance.
To address many of these concerns I, along with my colleague Senator
Stabenow, today am introducing the Medicare Part D Reform Act of 2006,
and I hope the Senate will immediately consider these positive reforms.
My legislation has four goals and I will briefly outline them.
First, this legislation would prohibit prescription drug plans from
removing drugs from the plan's list of covered drugs until January 1 of
the following year. This will give seniors the opportunity to make an
informed decision during open enrollment at the end of each year if one
plan decides to remove a particular drug from the plan.
Second, my legislation clearly states that the discount cards that
pharmaceutical companies are providing to our lower income seniors are
permissible and that seniors should be allowed to participate in these
programs. There has been some confusion as to whether companies can
legally continue these programs and, if companies do continue their
assistance, questions have arisen as to whether that assistance will
count towards the ``true-out-of-pocket'' costs for that beneficiary,
which plunges them into the ``doughnut hole'' when they reach $2,250.
My legislation mandates that there will be no negative consequences for
pharmaceutical companies continuing to provide discount cards to our
low-income seniors.
Third, my legislation would allow former Medicaid beneficiaries now
receiving their medications under Medicare to continue to receive their
prescription drugs even if they cannot meet the worsened co-payment
requirements.
Lastly, the legislation would specifically give the Federal
Government the authority to negotiate lower prescription drug prices
for our seniors. Current Medicare law prohibits the Department of
Health and Human Services from negotiating lower prices, as we do for
veterans in our VA health programs. As a result, Medicare beneficiaries
do not have the benefit of the bargaining power of Medicare.
All of us are hearing from our constituents that we need to improve
Medicare Part D. Congress needs to fulfill the promise it made that
Medicare Part D would lower prescription drug prices, not increase
them. This bill will help us begin to keep that promise.
I ask unanimous consent that the text of the bill be printed in the
Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 2240
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 Part D Reform Act
of 2006''.
SEC. 2. REMOVAL OF COVERED PART D DRUGS FROM THE PRESCRIPTION
DRUG PLAN FORMULARY.
Section 1860D-4(b)(3)(E) of the Social Security Act (42
U.S.C. 1395w-104(b)(3)(E)) is amended to read as follows:
``(E) Removing drug from formulary or changing preferred or
tier status of drug.--
``(i) Limitation on removal or change.--Beginning with
2006, the PDP sponsor of a prescription drug plan may not
remove a covered part D drug from the plan formulary or
change the preferred or tiered cost-sharing status of such a
drug other than during the period beginning on September 1
and ending on October 31. Subject to clause (ii), such
removal or change shall only be effective beginning on
January 1 of the immediately succeeding calendar year.
``(ii) Notice.--Any removal or change under this
subparagraph shall not take effect unless appropriate notice
is made available (such as under subsection (a)(3)) to the
Secretary, affected enrollees, physicians, pharmacies, and
pharmacists. Such notice shall ensure that such information
is made available prior to the annual, coordinated open
election period described in section 1851(e)(3)(B)(iii), as
applied under section 1860D-1(b)(1)(B)(iii).''.
SEC. 3. PHARMACEUTICAL PATIENT ASSISTANCE PROGRAMS.
(a) Providing a Safe Harbor for Pharmaceutical Patient
Assistance Programs.--Section 1128B(b)(3) of the Social
Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--
(1) in subparagraph (G)--
(A) by inserting ``or under a patient assistance program
(including a pharmaceutical
[[Page S513]]
manufacturer patient assistance program)'' after ``Indian
organizations)''; and
(B) by striking ``and'' at the end;
(2) in subparagraph (H), as added by section 237(d) of the
Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 (Public Law 108-173; 117 Stat. 2213)--
(A) by moving such subparagraph 2 ems to the left; and
(B) by striking the period at the end and inserting ``;
and''; and
(3) by redesignating subparagraph (H), as added by section
431(a) of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173; 117 Stat.
2287), as subparagraph (I) and moving such subparagraph 2 ems
to the left.
(b) Exclusion of Expenditures Under Certain Pharmacy
Assistance Programs From TROOP.--Section 1860D-2(b)(4)(C)(ii)
of such Act (42 U.S.C. 1395w-102(b)(4)(C)(ii)) is amended by
inserting ``under a pharmaceutical manufacturer patient
assistance program,'' after ``a group health plan,''.
(c) Effective Date.--The amendments made by this section
shall take effect on the date of enactment of this Act.
SEC. 4. PROTECTION AGAINST COST-SHARING FOR FULL-BENEFIT DUAL
ELIGIBLE INDIVIDUALS.
(a) In General.--Section 1860D-14(a)(1)(D)(ii) of the
Social Security Act (42 U.S.C. 1395w-114(a)(1)(D)(ii)) is
amended--
(1) in the heading, by striking ``Lowest income'';
(2) by striking ``and whose income does not exceed 100
percent of the poverty line applicable to a family of the
size involved''; and
(3) by adding at the end the following new sentence: ``In
the case of an individual who is unable to pay the copayment
applicable under the preceding sentence, such copayment shall
be waived.''
(b) Effective Date.--The amendments made by this section
shall apply to drugs dispensed on or after the date of
enactment of this Act.
SEC. 5. NEGOTIATING FAIR PRICES FOR MEDICARE PRESCRIPTION
DRUGS.
(a) In General.--Section 1860D-11 of the Social Security
Act (42 U.S.C. 1395w-111) is amended by striking subsection
(i) (relating to noninterference) and by inserting the
following new subsection:
``(i) Authority To Negotiate Prices With Manufacturers.--In
order to ensure that beneficiaries enrolled under
prescription drug plans and MA-PD plans pay the lowest
possible price, the Secretary shall have authority similar to
that of other Federal entities that purchase prescription
drugs in bulk to negotiate contracts with manufacturers of
covered part D drugs, consistent with the requirements and in
furtherance of the goals of providing quality care and
containing costs under this part.''.
(b) Effective Date.--The amendment made by this section
shall take effect on the date of enactment of this Act.
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