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H.R. 4169: Protecting Seniors Access to Proper Care Act of 2017

The text of the bill below is as of Oct 31, 2017 (Introduced).



1st Session

H. R. 4169


October 31, 2017

(for himself, Mr. Smith of Missouri, Mr. Simpson, and Mr. Ferguson) 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


To amend title XVIII of the Social Security Act to remove the enrollment restriction on certain physicians and practitioners prescribing covered outpatient drugs under the Medicare prescription drug program.


Short title

This Act may be cited as the Protecting Seniors Access to Proper Care Act of 2017.


Permitting certain non-enrolled physicians or practitioners to prescribe covered outpatient drugs under medicare part d


In general

Section 1860D–4 of the Social Security Act (42 U.S.C. 1395w–103) is amended by adding at the end the following new subsection:


Removal of enrollment restriction


In general

Nothing in this title or section 6405(c) of the Patient Protection and Affordable Care Act shall be construed as authorizing the Secretary to require, as a condition of payment by a PDP sponsor for a covered part D drug that is prescribed by an applicable physician or practitioner who is authorized under State law to prescribe such drug, that such applicable physician or practitioner be enrolled under section 1866(j).


Applicable physician or practitioner defined

For purposes of paragraph (1), the term applicable physician or practitioner means an eligible professional described in section 1848(k)(3)(B) (other than a physician described in section 1861(r)(1))—




is not excluded under this title or title XI;


is not barred from participating in the program under this title for a period of time following a revocation under section 424.535(c) of title 42, Code of Federal Regulations (or any successor regulation); or


meets other criteria similar to clauses (i) and (ii) that may be specified by the Secretary; and


who prescribes a low volume (as determined by the Secretary) of such drugs to individuals enrolled in plans under this part.

In determining low volume under subparagraph (B), the Secretary may determine low volume differently based on the specialty of the applicable physician or practitioner.



Effective date and enforcement delay


Effective date

The amendment made by subsection (a) shall apply to covered part D drugs prescribed on or after January 1, 2019.


Delay in enforcement of enrollment requirement until low volume exemption is implemented

The Secretary shall continue not to enforce the enrollment requirement under clauses (ii) through (v) of section 423.120(c)(6) of title 42, Code of Federal Regulations, until section 1860D–4(m), as added by subsection (a), takes effect.