S. 648 — Introduced in Senate

II 114th CONGRESS 1st Session S. 648 IN THE SENATE OF THE UNITED STATES March 4, 2015Mr. Grassley (for himself and Mr. Brown) 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 improve formulary requirements for prescription drug plans and MA–PD plans with respect to certain categories or classes of drugs. 1. Short title This Act may be cited as the Medicare Formulary Improvement Act of 2015. 2. Improving formulary requirements for prescription drug plans and MA–PD plans with respect to certain categories or classes of drugs (a) In general Section 1860D–4(b)(3)(G) of the Social Security Act (42 U.S.C. 1395w–104(b)(3)(G)) is amended to read as follows: (G) Required inclusion of drugs in certain categories and classes (i) Formulary requirements (I) In general Subject to subclause (II), a PDP sponsor offering a prescription drug plan shall be required to include all covered part D drugs in the categories and classes described in clause (iii). (II) Exceptions Subject to clause (ii), the Secretary may establish exceptions that permit a PDP sponsor offering a prescription drug plan to exclude from its formulary a particular covered part D drug in a category or class that is otherwise required to be included in the formulary under subclause (I) (or to otherwise limit access to such a drug, including through prior authorization or utilization management). (ii) Implementation The Secretary shall establish any exceptions under clause (i)(II) through the promulgation of a regulation which includes a public notice and comment period. (iii) Requirement for certain categories and classes The following categories and classes of drugs are described in this clause: (I) Anticonvulsants. (II) Antidepressants. (III) Antineoplastics. (IV) Antipsychotics. (V) Antiretrovirals. (VI) Immunosuppressants for the treatment of transplant rejection. . (b) Effective date The amendment made by subsection (a) shall apply to plan year 2015 and subsequent plan years.