Bill Summary
The Seniors Prescription Drug Relief Act of 2019 is a bill that seeks to amend the Social Security Act to provide relief for enrollees of Medicare Part D prescription drug plans who incur significant costs towards the annual out-of-pocket threshold in a single month. This bill would establish a process for these enrollees to pay their out-of-pocket costs in equal installments over the remaining months of the plan year, with the total amount not exceeding the annual out-of-pocket threshold. This would apply to both standard and alternative prescription drug coverage plans, with the monthly out-of-pocket cost sharing maximum being required. The bill also allows for the Secretary to define the term "significant percentage" and regulate this process.
Possible Impacts
1. Improved Access to Medication: The Seniors Prescription Drug Relief Act of 2019 could potentially improve access to medication for seniors by limiting their out-of-pocket costs for prescription drugs. This could make it more affordable for them to obtain necessary medications and improve their overall health and well-being.
2. Financial Relief for Low-Income Individuals: The monthly out-of-pocket cost sharing maximum established by this legislation could provide financial relief for low-income individuals who struggle to afford their prescription medications. This could ultimately help to reduce health disparities and improve health outcomes for this population.
3. Impact on Insurance Providers: This legislation could also have an impact on insurance providers, as they will be required to cover the cost of prescription drugs for enrollees who have reached the monthly out-of-pocket cost sharing maximum. This could potentially result in an increase in premiums for all enrollees or changes in coverage and benefits offered by insurance plans.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2911 Introduced in Senate (IS)]
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116th CONGRESS
1st Session
S. 2911
To amend title XVIII of the Social Security Act to provide a monthly
out-of-pocket cost sharing maximum for enrollees who incur a
significant portion of costs for covered part D drugs towards the
annual out-of-pocket threshold during a month.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
November 20, 2019
Mr. Cassidy (for himself and Mr. Menendez) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide a monthly
out-of-pocket cost sharing maximum for enrollees who incur a
significant portion of costs for covered part D drugs towards the
annual out-of-pocket threshold during a month.
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 ``Seniors Prescription Drug Relief Act
of 2019''.
SEC. 2. MONTHLY OUT-OF-POCKET COST SHARING MAXIMUM FOR ENROLLEES WHO
INCUR A SIGNIFICANT PORTION OF COSTS TOWARDS ANNUAL OUT-
OF-POCKET THRESHOLD.
(a) Standard Prescription Drug Coverage.--Section 1860D-2(b)(2) of
the Social Security Act (42 U.S.C. 1395w-102(b)(2)) is amended--
(1) in subparagraph (A), by striking ``and (D)'' and
inserting ``, (D), and (E)'';
(2) in each of subparagraphs (C)(i) and (D)(i), by striking
``paragraph (4)'' and inserting ``paragraph (4), and subject to
subparagraph (E)''; and
(3) by adding at the end the following new subparagraph:
``(E) Monthly out-of-pocket cost sharing maximum.--
``(i) In general.--For plan years beginning
on or after January 1, 2022, the Secretary
shall through regulation establish a process to
allow an enrollee in a prescription drug plan
who incurs costs (as described in paragraph
(4)(C)) equal to or greater than a significant
percentage of the annual out-of-pocket
threshold specified in paragraph (4)(B) within
a one month time period to choose to pay the
total amount of such costs owed, in equal
installments in the remaining months of the
plan year up to the total amount of such annual
out-of-pocket threshold.
``(ii) Definition of significant percent.--
For purposes of the process described in clause
(i), the Secretary shall through regulation
provide for a definition of the term
`significant percentage' with respect to a
percentage of the annual out-of-pocket
threshold specified in paragraph (4)(B) but in
no case shall the `significant percentage' be
less than 50 percent or more than 100 percent
of the annual out-of-pocket threshold.''.
(b) Alternative Prescription Drug Coverage.--Section 1860D-2(c) of
the Social Security Act (42 U.S.C. 1395w-102(c)) is amended by adding
at the end the following new paragraph:
``(4) Same monthly out-of-pocket cost sharing maximum.--For
plan years beginning on or after January 1, 2022, the coverage
provides the monthly out-of-pocket cost sharing maximum
required under subsection (b)(2)(E).''.
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