Summary: H.R.1495 — 106th Congress (1999-2000)All Information (Except Text)

There is one summary for H.R.1495. Bill summaries are authored by CRS.

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Introduced in House (04/20/1999)

Access to Prescription Medications in Medicare Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for coverage of certain covered outpatient prescription drugs (including insulin) and biological products, including those that are also prescribable but are available over-the-counter, under Medicare part B (Supplementary Medical Insurance) for enrolled part B beneficiaries.

(Sec. 3) Establishes and outlines the administrative structure for implementing such new Medicare part B coverage, including requiring the Secretary of Health and Human Services to establish: (1) competitive bidding procedures for contracting with appropriate private sector service providers meeting specified requirements (including requirements to use cost-containment mechanisms such as formularies) to furnish such new Medicare part B benefits, which consist of a basic benefit package and a stop-loss benefit; and (2) a process for providing payments to eligible group health plans on behalf of such enrolled beneficiaries. Imposes certain cost-sharing requirements, with the stop-loss benefit limiting an enrollee's out-of-pocket expenses, and provides for appropriate outreach activities as well as protection of patient confidentiality.

(Sec. 4) Permits the Secretary to make payments, subject to specified requirements, to enrollee group health insurance retiree plans providing drug coverage that is equivalent to or greater than the new Medicare part B coverage provided for by this Act while also permitting such enrollees receiving group coverage to continue to receive such coverage under the plan.

(Sec. 5) Revises Medicare supplemental health insurance (Medigap) policy requirements with regard to this Act's mandated coverage of certain covered outpatient prescription drugs and biological products to require that an appropriate number of Medigap policies provide complementary, non-duplicative coverage in line with such mandated coverage.

(Sec. 6) Amends SSA title XIX (Medicaid) with regard to Medicaid assistance for low-income individuals to modify State Medicaid plan requirements to: (1) increase (from 120 percent to 135 percent of the poverty level) the income eligibility level to qualify for certain Medicare cost-sharing with regard to monthly Medicare part B premiums; and (2) provide for Medicaid prescription drug benefits for qualified Medicare beneficiaries and others as a wrap- around benefit.

(Sec. 7) Directs the Secretary to provide for waiver of the additional portion of the Medicare part B premium attributable to the prescription drug coverage mandate of this Act for certain Medicare beneficiaries already having actuarially equivalent drug coverage. Excludes from such waiver a group health plan enrollee if the plan receives payments for such enrollee under this Act.

(Sec. 8) Amends SSA title XVIII to: (1) eliminate the time limitation on Medicare benefits for immunosuppressive drugs; (2) require Medicare secondary payer provisions with regard to individuals with end stage renal disease be applied without regard to any time limitation with regard to immunosuppressive drugs furnished on or after this Act's enactment; and (3) increase the membership of the Medicare Payment Advisory Commission by two members, with their initial terms staggered, as well as add to the qualifications for membership.

(Sec. 10) Directs the Comptroller General to study and report to Congress with regard to the competitive bidding process for selecting service providers under this Act to furnish certain covered outpatient prescription drugs and biological products, including an analysis of any savings to Medicare as a result of this new Medicare part B benefit.