[Congressional Record Volume 155, Number 84 (Monday, June 8, 2009)]
[Senate]
[Page S6265]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Begich, and Ms. Stabenow):
  S. 1201. A bill to amend title XVIII of the Social Security Act to 
include costs incurred by the Indian Health Service, a Federally 
qualified health center, an AIDS drug assistance program, certain 
hospitals, or a pharmaceutical manufacturer patient assistance program 
in providing prescription drugs toward the annual out of pocket 
threshold under part D of the Medicare program; to the Committee on 
Finance.
  Mr. BINGAMAN. Mr. President, I rise along with Senators Begich and 
Stabenow today to introduce important legislation that will ensure that 
low-income seniors have full access to the benefits available to them 
under the Medicare Drug Benefit. Helping Fill the Medicare Rx Gap Act 
of 2009 will ensure that low-income seniors and other low-income 
beneficiaries do not get caught in the Medicare Part D coverage gap, or 
``doughnut hole,'' simply because of where they choose to purchase 
their Part D pharmaceuticals.
  Under current regulation and guidance, individuals who are in the 
doughnut hole and receive Part D drugs from commercial pharmacies are 
permitted to count waivers or reductions in Part D cost-sharing to 
count towards their true out of pocket expenses, TrOOP. However, low-
income individuals who may receive Part D drugs from safety-net 
pharmacies and other safety-net providers are not permitted to count 
similar waivers or reductions in Part D cost-sharing by safety-net 
providers towards their TrOOP. Thus, current law penalizes low-income 
individuals and makes it easier for them to get stuck in the doughnut 
hole--never accessing the catastrophic coverage to which they are 
entitled.
  My legislation would undo this inequity and permit waivers and 
reductions for beneficiaries receiving care from safety-net providers 
to count towards beneficiaries' TrOOP. Specifically, the legislation 
will count waivers and reductions by certain safety-net hospitals and 
pharmacies, Federally Qualified Health Centers, AIDS Drug Assistance 
Programs, Pharmacy Assistance Programs and the Indian Health Service 
toward TrOOP.
  I would like to express my gratitude for the assistance of several 
key senior citizen advocates in crafting this legislation, including: 
Howard Bedlin from the National Council on Aging, Lena O'Rourke and 
Marc Steinberg from Families USA, Patricia Nemore and Vicki Gottlich 
from the Center for Medicare Advocacy and Paul Precht and Rachel 
Shiffrin, from the Medicare Rights Center.
  I urge my colleagues to join me in supporting this important piece of 
legislation, which will ensure that life saving pharmaceuticals are 
available to low-income Americans.
  Mr. President, 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. 1201

       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 ``Helping Fill the Medicare Rx 
     Gap Act of 2009''.

     SEC. 2. INCLUDING COSTS INCURRED BY THE INDIAN HEALTH 
                   SERVICE, A FEDERALLY QUALIFIED HEALTH CENTER, 
                   AN AIDS DRUG ASSISTANCE PROGRAM, CERTAIN 
                   HOSPITALS, OR A PHARMACEUTICAL MANUFACTURER 
                   PATIENT ASSISTANCE PROGRAM IN PROVIDING 
                   PRESCRIPTION DRUGS TOWARD THE ANNUAL OUT OF 
                   POCKET THRESHOLD UNDER PART D.

       (a) In General.--Section 1860D-2(b)(4)(C) of the Social 
     Security Act (42 U.S.C. 1395w-102(b)(4)(C)) is amended--
       (1) in clause (i), by striking ``and'' at the end;
       (2) in clause (ii)--
       (A) by striking ``such costs shall be treated as incurred 
     only if'' and inserting ``subject to clause (iii), such costs 
     shall be treated as incurred if'';
       (B) by striking ``, under section 1860D-14, or under a 
     State Pharmaceutical Assistance Program'';
       (C) by striking ``(other than under such section or such a 
     Program)''; and
       (D) by striking the period at the end and inserting ``; 
     and''; and
       (3) by inserting after clause (ii) the following new 
     clause:
       ``(iii) such costs shall be treated as incurred and shall 
     not be considered to be reimbursed under clause (ii) if such 
     costs are borne or paid--

       ``(I) under section 1860D-14;
       ``(II) under a State Pharmaceutical Assistance Program;
       ``(III) by the Indian Health Service, an Indian tribe or 
     tribal organization, or an urban Indian organization (as 
     defined in section 4 of the Indian Health Care Improvement 
     Act);
       ``(IV) by a Federally qualified health center (as defined 
     in section 1861(aa)(4));
       ``(V) under an AIDS Drug Assistance Program under part B of 
     title XXVI of the Public Health Service Act;
       ``(VI) by a subsection (d) hospital (as defined in section 
     1886(d)(1)(B)) that meets the requirements of clauses (i) and 
     (ii) of section 340B(a)(4)(L) of the Public Health Service 
     Act; or
       ``(VII) by a pharmaceutical manufacturer patient assistance 
     program, either directly or through the distribution or 
     donation of covered part D drugs, which shall be valued at 
     the negotiated price of such covered part D drug under the 
     enrollee's prescription drug plan or MA-PD plan as of the 
     date that the drug was distributed or donated.''.

       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to costs incurred on or after January 1, 2010.
                                 ______