Independent Pharmacy Protection Act of 2006 - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to require each prescription drug plan contract entered into with a plan sponsor to provide for: (1) the availability of direct deposit payments; (2) an increased dispensing fee for generic drugs; and (3) payments within 10 days for certain pharmacies.
Requires the dispensing fee paid to a participating pharmacy for a generic covered part D drug therapeutically equivalent and bioequivalent to a brand name covered part D drug dispensed through the pharmacy to be at least 50% greater than the dispensing fee for the brand name drug.
Limits to $10 the dispensing fee paid to a participating pharmacy for a generic covered part D drug.
Prohibits a prescription drug plan, subject to exception by the Secretary of Health and Human Services, from decreasing the dispensing fee paid to a participating pharmacy for a brand name drug to an amount less than the dispensing fee paid for it on the date of enactment of this Act.
Applies this Act to contracts with a Medicare Advantage organization in the same manner as they apply to those with a prescription drug plan sponsor.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5166 Introduced in House (IH)]
109th CONGRESS
2d Session
H. R. 5166
To amend title XVIII of the Social Security Act to improve payments
made by prescription drug plans and MA-PD plans to pharmacies for
covered part D drugs dispensed through such pharmacies.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 6, 2006
Mr. Wicker (for himself, Mr. LoBiondo, Mr. Pickering, Mr. Bonner, Mr.
Brown of Ohio, Mr. Peterson of Pennsylvania, Mrs. Cubin, Mr. Everett,
Mr. Bachus, Mr. Davis of Kentucky, Mr. Boustany, Mr. Sodrel, Mr.
Conaway, Mr. Fortenberry, Ms. Harris, Mr. Whitfield, Mr. Bilirakis,
Mrs. Emerson, Ms. Pryce of Ohio, Mr. Schwarz of Michigan, Mr. Foley,
Mr. Leach, Mr. Gerlach, Mr. Walden of Oregon, Mrs. Jo Ann Davis of
Virginia, Mr. Sherwood, Mr. Boozman, Mr. Osborne, Mr. Doolittle, Mr.
Tiahrt, Mr. Burgess, Mr. Akin, Mr. Aderholt, Mr. Blunt, Mr. McHenry,
Ms. Foxx, Mr. Pence, Mr. Bishop of Utah, Mr. Garrett of New Jersey, Mr.
Hoekstra, Mr. Fitzpatrick of Pennsylvania, Ms. Kaptur, Mr. Gutknecht,
Ms. Wasserman Schultz, and Mr. Van Hollen) introduced the following
bill; which was referred to the Committee on Ways and Means, and in
addition to the Committee on Energy and Commerce, 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 improve payments
made by prescription drug plans and MA-PD plans to pharmacies for
covered part D drugs dispensed through such pharmacies.
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 ``Independent Pharmacy Protection Act
of 2006''.
SEC. 2. IMPROVING MEDICARE PRESCRIPTION DRUG PLAN PAYMENTS TO
PHARMACIES.
(a) In General.--Section 1860D-12(b) of the Social Security Act (42
U.S.C. 1395w-112(b)) is amended by adding at the end the following new
paragraph:
``(4) Payments to pharmacies.--
``(A) In general.--Each contract entered into with
a PDP sponsor under this section with respect to a
prescription drug plan offered by such sponsor shall
provide for the following:
``(i) Availability of direct deposit
payments.--The option for any participating
pharmacy to elect for the plan to make payments
by direct deposits to the pharmacy for covered
part D drugs dispensed through the pharmacy.
``(ii) Increased dispensing fee for generic
drugs.--The payment of dispensing fees by the
plan to each participating pharmacy for covered
part D drugs dispensed through the
participating pharmacy, in accordance with
subparagraph (B).
``(iii) Payments within 10 days for certain
pharmacies.--In the case of a participating
pharmacy that is not part of a chain of
pharmacies that consists of more than three
pharmacies at different locations, payment with
respect to any non-disputed claim (as defined
in subparagraph (C)) for a covered part D drug
dispensed through the pharmacy to be made by
the plan to the pharmacy in full by a date that
is not more than 10 days after the date on
which the claim is received by the plan.
``(B) Payment of dispensing fees to encourage use
of generic drugs.--
``(i) In general.--For purposes of
subparagraph (A)(ii) and subject to clauses
(ii) and (iii), with respect to a generic
covered part D drug that is therapeutically
equivalent and bioequivalent to a brand name
drug that is a covered part D drug dispensed
through a participating pharmacy, the amount of
the dispensing fee paid to the pharmacy for the
generic covered part D drug shall be an amount
that is at least 50 percent greater than the
amount of the dispensing fee for the brand name
drug.
``(ii) Cap on amount of dispensing fees for
generic drugs.--For purposes of subclause (i),
the amount of the dispensing fee paid to a
participating pharmacy for a generic covered
part D drug shall not be more than $10.
``(iii) Safe harbor for brand name drug
dispensing fee amounts.--
``(I) In general.--For purposes of
clause (i) and subject to subclause
(II), a prescription drug plan under
this section shall not decrease the
amount of the dispensing fee paid by
the plan to a participating pharmacy
for a brand name drug described in such
clause to an amount that is less than
the amount of the dispensing fee paid
by such plan to such pharmacy for such
drug on the date of the enactment of
the `Independent Pharmacy Protection
Act of 2006'.
``(II) Exception.--The Secretary
may waive the prohibition under
subclause (I) with respect to a
dispensing fee paid by a prescription
drug plan for a brand name drug, as the
Secretary determines appropriate.
``(C) Non-disputed claim defined.--For purposes of
subparagraph (A)(iii), a `non-disputed claim' means a
claim that has no defect or impropriety or particular
circumstance requiring special treatment that prevents
timely payment from being made under this part.''.
(b) Application to MA-PD Plans.--Section 1857(e) of such Act (42
U.S.C. 1395w-27(e)) is amended by adding at the end the following new
paragraph:
``(4) Incorporation of prescription drug plan contract
requirements for pharmacy payments.--The provisions of section
1860D-12(b)(4) shall apply to contracts with a Medicare
Advantage organization in the same manner as they apply to
contracts with a PDP sponsor offering a prescription drug plan
under part D.''.
(c) Effective Date.--The amendments made by this Act shall apply to
plan years beginning on or after the date of the enactment of this Act.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
Referred to the Subcommittee on Health, for a period to be subsequently determined by the Chairman .
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