[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 470 Introduced in House (IH)]
110th CONGRESS
1st Session
H. R. 470
To amend titles XVIII and XIX of the Social Security Act to provide for
continuity of Medicare prescription drug coverage for full-benefit dual
eligible individuals, for Medicare prescription drug coverage of
benzodiazepines and off-label uses of certain prescription drugs and
biological products, for optional Medicaid coverage of Medicare
prescription drug cost-sharing for full-benefit dual eligible
individuals, and for authorization to the Secretary of Health and Human
Services to waive certain determinations denying Medicare prescription
drug coverage.
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IN THE HOUSE OF REPRESENTATIVES
January 12, 2007
Mrs. Wilson of New Mexico 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 titles XVIII and XIX of the Social Security Act to provide for
continuity of Medicare prescription drug coverage for full-benefit dual
eligible individuals, for Medicare prescription drug coverage of
benzodiazepines and off-label uses of certain prescription drugs and
biological products, for optional Medicaid coverage of Medicare
prescription drug cost-sharing for full-benefit dual eligible
individuals, and for authorization to the Secretary of Health and Human
Services to waive certain determinations denying Medicare prescription
drug coverage.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. CONTINUITY OF MEDICARE PRESCRIPTION DRUG COVERAGE FOR FULL-
BENEFIT DUAL ELIGIBLE INDIVIDUALS.
(a) In General.--Section 1860D-2(a) of the Social Security Act (42
U.S.C. 1395w-102(a)) is amended--
(1) in paragraph (1), by inserting ``subject to paragraph
(6),'' after ``part C''; and
(2) by adding at the end the following new paragraph:
``(6) Continuation of medicare coverage for certain
prescriptions for full-benefit dual eligible individuals.--In
the case of an individual who, as of the date the individual is
first enrolled under a prescription drug plan under this part
(or an MA-PD plan under part C), is a full-benefit dual
eligible individual and is being provided medical assistance
for a covered part D drug under title XIX, qualified
prescription drug coverage must include coverage for such drug
unless a prescribing physician certifies that the coverage of
such drug is not medically necessary, regardless of whether the
individual subsequently remains a full-benefit dual eligible
individual.''.
(b) Effective Date.--The amendments made by subsection (a) shall be
effective as if included in the enactment of Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173).
SEC. 2. MEDICARE PRESCRIPTION DRUG COVERAGE OF BENZODIAZEPINES.
(a) In General.--Section 1860D-2(e)(2)(A) of the Social Security
Act (42 U.S.C. 1395w-112(e)(2)(A)) is amended by inserting after
``agents)'' the following: ``and other than subparagraph (J) of such
section (relating to benzodiazepines)''.
(b) Effective Date.--The amendment made by subsection (a) shall be
effective as if included in the enactment of Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173).
SEC. 3. PERMITTING STATE MEDICAID PROGRAMS TO COVER MEDICARE
PRESCRIPTION DRUG COPAYMENTS FOR FULL-BENEFIT DUAL
ELIGIBLE INDIVIDUALS.
(a) In General.--Section 1935(d) of the Social Security Act (42
U.S.C. 1396u-5(d)) is amended by adding at the end the following new
paragraph:
``(3) Optional coverage of medicare prescription drug cost-
sharing.--Notwithstanding paragraph (1), a State may, at its
option, provide medical assistance under the plan under this
title for the deductible and cost-sharing imposed under a
prescription drug plan (or an MA-PD plan) for full-benefit dual
eligible individuals and payment shall be available under
section 1903(a) with respect to such assistance provided.''.
(b) Effective Date.--The amendment made by subsection (a) shall be
effective as if included in the enactment of Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173).
SEC. 4. MEDICARE COVERAGE OF OFF-LABEL USES OF PRESCRIPTION DRUGS AND
BIOLOGICALS.
(a) In General.--Section 1860D-2(e) of the Social Security Act (42
U.S.C. 1395w-102(e)) is amended at the end by adding the following new
paragraph:
``(4) Rule of Construction.--Nothing in this subsection shall be
construed as excluding from the definition of the term `covered part D
drug'--
``(A) a drug described in paragraph (1)(A) on the sole
basis that such drug is prescribed by a physician for a use
other than a use included in the labeling of such drug pursuant
to the approval of the safety and effectiveness of such drug as
a prescription drug under section 505 or 507 of the Federal
Food, Drug, and Cosmetic Act or approval of such drug under
section 505(j) of such Act; or
``(B) a biological product described in paragraph (1)(B) on
the sole basis that such product is prescribed by a physician
for a use other than a use included in the labeling of such
product pursuant to the licensure of such product under section
351 of the Public Health Service Act;
even if the unlabeled use of the drug or product is not included in a
standard clinical reference compendia used by clinicians for purposes
of providing guidance to such clinicians with respect to unlabeled uses
of such a drug or product.''.
(b) Effective Date.--The amendment made by subsection (a) shall be
effective as if included in the enactment of Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173).
SEC. 5. AUTHORIZATION FOR SECRETARY OF HEALTH AND HUMAN SERVICES TO
WAIVE DENIAL OF PRESCRIPTION DRUG COVERAGE.
(a) In General.--Section 1860D-4(h) of the Social Security Act (42
U.S.C. 1395w-104(h)) is amended at the end by adding the following new
paragraph:
``(4) Authorization for Secretary To Waive Denial of Prescription
Drug Coverage.--After a part D eligible individual has exhausted all
rights of such individual under this subsection and subsection (g),
with respect to a determination made under this subsection or
subsection (g) for a prescription drug plan not to provide for coverage
of a covered part D drug (or a determination related to the application
of tiered cost-sharing described in subsection (g)(2)), the individual
may apply to the Secretary for a waiver that requires the prescription
drug plan to provide for such coverage (or provide for an exception to
the structure of such tiered cost-sharing). Upon receipt of such
application, the Secretary may grant such waiver if the prescribing
physician certifies that the coverage of such prescription drug is
medically necessary with respect to the individual.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to determinations made on or after the date of the enactment of
this Act.
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