< Back to H.R. 2827 (113th Congress, 2013–2015)

Text of the Part D Beneficiary Appeals Fairness Act

This bill was introduced on July 25, 2013, in a previous session of Congress, but was not enacted. The text of the bill below is as of Jul 25, 2013 (Introduced).

I

113th CONGRESS

1st Session

H. R. 2827

IN THE HOUSE OF REPRESENTATIVES

July 25, 2013

(for himself, Mr. Jones, Mr. McKinley, and Mr. Braley of Iowa) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D.

1.

Short title

This Act may be cited as the Part D Beneficiary Appeals Fairness Act .

2.

Fair exceptions process for drug in tiers under Medicare part D

Section 1860D–4(g)(2) of the Social Security Act ( 42 U.S.C. 1395w–103(g)(2) ) is amended—

(1)

in the first sentence—

(A)

by striking for tiered cost-sharing for drugs included within a formulary and and inserting for any tiered cost-sharing structure within a formulary (including a structure that; and

(B)

by inserting , or provides for different co-payment or coinsurance amounts for drugs in different tiers included within the formulary) before , a part D eligible individual;

(2)

in the second sentence, by inserting in any plan formulary before could be covered; and

(3)

by inserting the following before the last sentence: In no case may the Secretary allow a PDP sponsor to make any formulary tier of the tiered cost-sharing structure (including a formulary tier used for very high cost or unique items) ineligible for lower-cost sharing through an exception under this paragraph..