,i #aaeth ,,congress #ast ,session ,h4 ,r4 #aabb ,,in ,,the ,,house ,,of ,,representatives ,february #af1 #bjag,mr4 ,murphy of ,pennsylvania 7for himself and ,mr4 ,kind7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 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 provide for clarification and rationalization of ,medicare prescription drug plan recovery rules for certain claims4 #a4 ,short title ,this ,act may be cited as the ,secondary ,payer ,advancement1 ,rationalization1 and ,clarification ,act or the ,,sparc ,act4 #b4 ,clarification and rationalization of ,medicare prescription drug secondary claims responsibility 7a7 ,in general ,section #ahfj;,d-#b7;a77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;a77#d77 is amended to read as follows3 7#d7 ,secondary payor and recovery rights 7,a7 ,in general 7i7 ,application of secondary payor ,a prescription drug plan shall be secondary payor to any valid and collectible payment from a primary drug plan 7as defined in clause 7iv77 until such time as such primary drug plan pays a final settlement1 judgment1 or award to an individual enrolled under the prescription drug plan with regard to an injury or illness involved or otherwise terminates its ongoing responsibility for medical payments with respect to the individual4 7ii7 ,limitation on parties making prescription drug plans primary ,a primary drug plan 7as defined in clause 7iv71 other than a group health plan or multiemployer or multiple employer plan of1 or contributed to by1 an employer that has #bj or fewer employees for each working day in each of #bj or more calendar weeks in the calendar year involved or the preceding calendar year71 a self-insured plan1 a service benefit plan1 a managed care organization1 a pharmacy benefit manager1 or other party that1 by statute1 contract1 or agreement1 is legally responsible for payment of a claim for a covered outpatient drug1 in enrolling an individual or in making any payments for benefits to the individual or on the individual's behalf1 may not take into account that the individual is enrolled under a prescription drug plan under this part or is eligible for or is provided coverage for covered part ,d drugs under this part4 7iii7 ,limitation on secretarial claims through subrogation ,the ,secretary shall not assert any claim on behalf or against a prescription drug plan1 other than through the recovery from such a plan of amounts paid related to a covered part ,d drug event that has been repaid to the plan through a subrogation action or otherwise4 7iv7 ,primary drug plan defined ,in this paragraph1 the term primary drug plan means1 with respect to benefits for covered part ,d drugs1 a group health plan or large group health plan 7other than a group health plan or multiemployer or multiple employer plan of1 or contributed to by1 an employer that has #bj or fewer employees for each working day in each of #bj or more calendar weeks in the calendar year involved or the preceding calendar year71 a workers' compensation law or plan1 an automobile or liability insurance policy or plan 7including a self-insured plan7 or no-fault insurance insofar as such a plan1 law1 policy1 or insurance provides such benefits1 insofar as1 under the provisions of section #ahfb7;b77#b71 such coverage would be treated as a primary plan if benefits for covered part ,d drugs were treated as benefits under parts ,a and ,b4 ,for purposes of this clause1 an entity that engages in a business1 trade1 or profession shall be deemed to have a self-insured plan if it carries its own risk 7whether by a failure to obtain insurance1 or otherwise7 in whole or in part4 7,b7 ,waiver ,a prescription drug plan may waive 7in whole or in part7 the provisions of this paragraph in the case of an individual claim if the plan determines that the waiver is in the best interests of the program established under this part4 7,c7 ,recovery ,a prescription drug plan shall be subrogated 7to the extent of payment made under this part by the plan for any covered part ,d drug before the date the plan received notice pursuant to subparagraph 7,d77 to any right of an individual or any other entity to payment1 with respect to such covered part ,d drug1 under a primary drug plan4 ,a subrogation claim may not be asserted pursuant to this subparagraph by a prescription drug plan with respect to a payment for a covered part ,d drug after the date that is #c years after the date such plan receives notice of a payment1 with respect to such covered part ,d drug1 pursuant to subparagraph 7,d74 ,any such subrogation claim shall be the exclusive legal remedy of the ,,pdp sponsor of the plan and shall be reduced to take into account the cost of procuring the judgment or settlement with respect to such claim if an individual's liability1 workers' compensation1 or no-fault claim is disputed4 ,any costs or expense incurred by a prescription drug plan related to recoveries pursuant to this subparagraph shall not be considered an administrative cost or expense1 as those terms are used in this part4 7,d7 ,coordination of benefits information ,not later than #ae days after the date the ,secretary receives information under paragraph 7#g7 or 7#h7 of section #ahfb7;b7 relating to an individual enrolled in a prescription drug plan during an applicable time1 the ,secretary shall provide such information to such prescription drug plan in a format convenient and accessible to such plans4 ,the ,secretary shall waive any requirements under this part that a prescription drug plan establish procedures for determining whether costs for part ,d eligible individuals are being reimbursed through insurance or otherwise or identify payers that are primary to the program under subparagraph 7,a77ii7 other than as required under this paragraph4 7,e7 ,coordination of benefits ,a prescription drug plan shall1 in the case of receipt of a notice pursuant to subparagraph 7,d7 related to an enrollee for whom a primary drug plan has reported on ongoing responsibility for medical costs pursuant to paragraph 7#g7 or 7#h7 of section #ahfb7;b71 authorize the provider of such covered part ,d drug to charge1 in accordance with the charges allowed under the prescription drug plan1 such primary drug plan for such covered part ,d drug related to or arising out of the treatment accident or injury subject to such notice 7other than payments subject to a claim under subparagraph 7,b7 or 7,f77 for the period in which the enrollee remains enrolled in such plan through the date upon which such primary drug plan has terminated such ongoing responsibility for medical payments4 7,f7 ,use of web site to determine final reimbursement amount 7i7 ,notification of plans ,not later than #aj days after the date the ,secretary receives a notice under section #ahfb7;b77#b77;,b77vii77,i7 relating to an individual during the period the individual is enrolled in a prescription drug plan1 the ,secretary shall provide such notice to the plan4 7ii7 ,statement by plan 7,i7 ,in general ,not later than #cj days after the date a plan receives a notice under clause 7i71 the plan may provide the ,secretary with a statement of any covered part ,d drug for which the plan seeks reimbursement1 including the amount of such reimbursement4 7,,ii7 ,failure to provide statement ,the prescription drug plan shall be deemed to have waived its rights under subparagraph 7,b7-- 7aa7 in the case that the prescription drug plan does not provide such statement by such date1 with respect to any covered part ,d drug provided to such individual with respect to such notice2 and 7bb7 in the case that the prescription drug plan provides such statement by such date1 with respect to any covered part ,d drug provided to such individual which was not identified in the notice4 7iii7 ,inclusion of information on web site ,the ,secretary shall include any covered part ,d drug identified by a prescription drug plan pursuant to clause 7ii7 within the ,secretary's statement of reimbursement amount on the ,web site as described in section #ahfb7;b77#b77;,b77vii74 7iv7 ,collection ,the ,secretary may collect 7on behalf of a prescription drug plan7 the reimbursement amount for covered part ,d drugs1 as identified pursuant to clause 7ii71 from the individual involved or the primary drug plan pursuant to the procedures set forth under section #ahfb7;b77#b77;,b77vii74 ,any such amounts collected by the ,secretary for covered part ,d drugs directly paid by the plan shall be remitted directly by the ,secretary to the appropriate prescription drug plan that enrolled the individual related to the notice during the applicable time period for which such individual was enrolled1 and the ,secretary shall retain such amounts as were paid to the plan in subsidy for such drugs4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to drugs dispensed in years beginning more than #f months after the date of the enactment of this ,act4