[Congressional Record Volume 169, Number 125 (Thursday, July 20, 2023)]
[Senate]
[Pages S3461-S3462]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mr. THUNE (for himself, Mr. Brown, Mr. Barrasso, and Ms.
Stabenow):
S. 2405. A bill to amend title XVIII of the Social Security Act to
assure pharmacy access and choice for Medicare beneficiaries; to the
Committee on Finance.
Mr. THUNE. Madam 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.2405
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.
[[Page S3462]]
``(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 subclause (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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