,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #aabb  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,febru>y #af1         
#bjag,mr4 ,murphy ( ,p5nsylvania 7=     
himself & ,mr4 ,k9d7 introduc$ ! foll[+ 
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce1 & 9 addition to !    
,committee on ,ways & ,means1 = a p]iod 
to be subsequ5tly det]m9$ by ! ,speak]1 
9 ea* case = consid]ation ( su*         
provisions z fall )9 ! jurisdiction ( ! 
committee conc]n$  ,a ,,bill  ,to am5d  
title ,,xviii ( ! ,social ,security ,act
 to provide = cl>ification &            
rationalization ( ,m$ic>e prescription  
drug plan recov]y rules = c]ta9 claims4 
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,second>y ,pay] ,advancem5t1          
,rationalization1 & ,cl>ification ,act  
or ! ,,sp>c ,act4  #b4 ,cl>ification &  
rationalization ( ,m$ic>e prescription  
drug second>y claims responsibility  7a7
 ,9 g5]al ,section #ahfj;,d-#b7;a77#d7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciew-#ajb7;a77#d77 is am5d$ to read z

 foll[s3  7#d7 ,second>y payor & recov]y
 rights  7,a7 ,9 g5]al  7i7 ,application
 ( second>y payor ,a prescription drug  
plan %all be second>y payor to any valid
 & collectible paym5t f a prim>y drug   
plan 7z def9$ 9 clause 7iv77 until su*  
"t z su* prim>y drug plan pays a f9al   
settlem5t1 judgm5t1 or aw>d to an       
individual enroll$ "u ! prescription    
drug plan ) reg>d to an injury or       
illness involv$ or o!rwise t]m9ates its 
ongo+ responsibility = m$ical paym5ts ) 
respect to ! individual4  7ii7          
,limitation on p>ties mak+ prescription 
drug plans prim>y ,a prim>y drug plan 7z
 def9$ 9 clause 7iv71 o!r ?an a gr\p    
heal? plan or multiemploy] or multiple  
employ] plan (1 or contribut$ to by1 an 
employ] t has #bj or few] employees =   
ea* work+ day 9 ea* ( #bj or m cal5d>   
weeks 9 ! cal5d> ye> involv$ or ! prec$+
 cal5d> ye>71 a self-insur$ plan1 a     
s]vice b5efit plan1 a manag$ c>e        
organization1 a ph>macy b5efit manag]1  
or o!r p>ty t1 by /atute1 contract1 or  

agreem5t1 is legally responsible =      
paym5t ( a claim = a cov]$ outpati5t    
drug1 9 enroll+ an individual or 9 mak+ 
any paym5ts = b5efits to ! individual or
 on ! individual's behalf1 may n take   
into acc\nt t ! individual is enroll$ "u
 a prescription drug plan "u ?is "p or  
is eligible = or is provid$ cov]age =   
cov]$ "p ,d drugs "u ?is "p4  7iii7     
,limitation on secret>ial claims ?r\gh  
subrogation ,! ,secret>y %all n ass]t   
any claim on behalf or aga9/ a          
prescription drug plan1 o!r ?an ?r\gh ! 
recov]y f su* a plan ( am\nts paid      
relat$ to a cov]$ "p ,d drug ev5t t has 
be5 repaid to ! plan ?r\gh a subrogation
 action or o!rwise4  7iv7 ,prim>y drug  
plan def9$ ,9 ?is p>agraph1 ! t]m prim>y
 drug plan means1 ) respect to b5efits =
 cov]$ "p ,d drugs1 a gr\p heal? plan or
 l>ge gr\p heal? plan 7o!r ?an a gr\p   
heal? plan or multiemploy] or multiple  
employ] plan (1 or contribut$ to by1 an 
employ] t has #bj or few] employees =   
ea* work+ day 9 ea* ( #bj or m cal5d>   

weeks 9 ! cal5d> ye> involv$ or ! prec$+
 cal5d> ye>71 a work]s' comp5sation law 
or plan1 an automobile or liability     
insurance policy or plan 7includ+ a     
self-insur$ plan7 or no-fault insurance 
ins(> z su* a plan1 law1 policy1 or     
insurance provides su* b5efits1 ins(> z1
 "u ! provisions ( section              
#ahfb7;b77#b71 su* cov]age w\ld be      
treat$ z a prim>y plan if b5efits =     
cov]$ "p ,d drugs 7 treat$ z b5efits "u 
p>ts ,a & ,b4 ,= purposes ( ?is clause1 
an entity t engages 9 a bus9ess1 trade1 
or pr(ession %all be deem$ to h a       
self-insur$ plan if x c>ries its own    
risk 7:e!r by a failure to obta9        
insurance1 or o!rwise7 9 :ole or 9 "p4  
7,b7 ,waiv] ,a prescription drug plan   
may waive 79 :ole or 9 "p7 ! provisions 
( ?is p>agraph 9 ! case ( an individual 
claim if ! plan det]m9es t ! waiv] is 9 
! be/ int]e/s ( ! program e/abli%$ "u   
?is "p4  7,c7 ,recov]y ,a prescription  
drug plan %all be subrogat$ 7to ! ext5t 
( paym5t made "u ?is "p by ! plan = any 

cov]$ "p ,d drug be=e ! date ! plan     
receiv$ notice pursuant to subp>agraph  
7,d77 to any "r ( an individual or any  
o!r entity to paym5t1 ) respect to su*  
cov]$ "p ,d drug1 "u a prim>y drug plan4
 ,a subrogation claim may n be ass]t$   
pursuant to ?is subp>agraph by a        
prescription drug plan ) respect to a   
paym5t = a cov]$ "p ,d drug aft] ! date 
t is #c ye>s aft] ! date su* plan       
receives notice ( a paym5t1 ) respect to
 su* cov]$ "p ,d drug1 pursuant to      
subp>agraph 7,d74 ,any su* subrogation  
claim %all be ! exclusive legal rem$y ( 
! ,,pdp sponsor ( ! plan & %all be r$uc$
 to take into acc\nt ! co/ ( procur+ !  
judgm5t or settlem5t ) respect to su*   
claim if an individual's liability1     
work]s' comp5sation1 or no-fault claim  
is disput$4 ,any co/s or exp5se incurr$ 
by a prescription drug plan relat$ to   
recov]ies pursuant to ?is subp>agraph   
%all n be consid]$ an adm9i/rative co/  
or exp5se1 z ^? t]ms are us$ 9 ?is "p4  
7,d7 ,coord9ation ( b5efits in=mation ,n

 lat] ?an #ae days aft] ! date !        
,secret>y receives in=mation "u p>agraph
 7#g7 or 7#h7 ( section #ahfb7;b7 relat+
 to an individual enroll$ 9 a           
prescription drug plan dur+ an          
applicable "t1 ! ,secret>y %all provide 
su* in=mation to su* prescription drug  
plan 9 a =mat conv5i5t & accessible to  
su* plans4 ,! ,secret>y %all waive any  
requirem5ts "u ?is "p t a prescription  
drug plan e/abli% proc$ures = det]m9+   
:e!r co/s = "p ,d eligible individuals  
are be+ reimburs$ ?r\gh insurance or    
o!rwise or id5tify pay]s t are prim>y to
 ! program "u subp>agraph 7,a77ii7 o!r  
?an z requir$ "u ?is p>agraph4  7,e7    
,coord9ation ( b5efits ,a prescription  
drug plan %all1 9 ! case ( receipt ( a  
notice pursuant to subp>agraph 7,d7     
relat$ to an enrollee = :om a prim>y    
drug plan has report$ on ongo+          
responsibility = m$ical co/s pursuant to
 p>agraph 7#g7 or 7#h7 ( section        
#ahfb7;b71 au?orize ! provid] ( su*     
cov]$ "p ,d drug to *>ge1 9 accordance )

 ! *>ges all[$ "u ! prescription drug   
plan1 su* prim>y drug plan = su* cov]$  
"p ,d drug relat$ to or aris+ out ( !   
treatm5t accid5t or injury subject to   
su* notice 7o!r ?an paym5ts subject to a
 claim "u subp>agraph 7,b7 or 7,f77 = ! 
p]iod 9 :i* ! enrollee rema9s enroll$ 9 
su* plan ?r\gh ! date ^u :i* su* prim>y 
drug plan has t]m9at$ su* ongo+         
responsibility = m$ical paym5ts4  7,f7  
,use ( web site to det]m9e f9al         
reimbursem5t am\nt  7i7 ,notification ( 
plans ,n lat] ?an #aj days aft] ! date !
 ,secret>y receives a notice "u section 
#ahfb7;b77#b77;,b77vii77,i7 relat+ to an
 individual dur+ ! p]iod ! individual is
 enroll$ 9 a prescription drug plan1 !  
,secret>y %all provide su* notice to !  
plan4  7ii7 ,/atem5t by plan  7,i7 ,9   
g5]al ,n lat] ?an #cj days aft] ! date a
 plan receives a notice "u clause 7i71 !
 plan may provide ! ,secret>y ) a       
/atem5t ( any cov]$ "p ,d drug = :i* !  
plan seeks reimbursem5t1 includ+ ! am\nt
 ( su* reimbursem5t4  7,,ii7 ,failure to

 provide /atem5t ,! prescription drug   
plan %all be deem$ to h waiv$ its rights
 "u subp>agraph 7,b7-- 7aa7 9 ! case t !
 prescription drug plan does n provide  
su* /atem5t by su* date1 ) respect to   
any cov]$ "p ,d drug provid$ to su*     
individual ) respect to su* notice2 &   
7bb7 9 ! case t ! prescription drug plan
 provides su* /atem5t by su* date1 )    
respect to any cov]$ "p ,d drug provid$ 
to su* individual :i* 0 n id5tifi$ 9 !  
notice4  7iii7 ,inclusion ( in=mation on
 web site ,! ,secret>y %all include any 
cov]$ "p ,d drug id5tifi$ by a          
prescription drug plan pursuant to      
clause 7ii7 )9 ! ,secret>y's /atem5t (  
reimbursem5t am\nt on ! ,web site z     
describ$ 9 section                      
#ahfb7;b77#b77;,b77vii74  7iv7          
,collection ,! ,secret>y may collect 7on
 behalf ( a prescription drug plan7 !   
reimbursem5t am\nt = cov]$ "p ,d drugs1 
z id5tifi$ pursuant to clause 7ii71 f ! 
individual involv$ or ! prim>y drug plan
 pursuant to ! proc$ures set =? "u      

section #ahfb7;b77#b77;,b77vii74 ,any   
su* am\nts collect$ by ! ,secret>y =    
cov]$ "p ,d drugs directly paid by !    
plan %all be remitt$ directly by !      
,secret>y to ! appropriate prescription 
drug plan t enroll$ ! individual relat$ 
to ! notice dur+ ! applicable "t p]iod =
 :i* su* individual 0 enroll$1 & !      
,secret>y %all reta9 su* am\nts z 7 paid
 to ! plan 9 subsidy = su* drugs4  4    
7b7 ,effective date ,! am5dm5t made by  
subsection 7a7 %all apply to drugs      
disp5s$ 9 ye>s beg9n+ m ?an #f mon?s    
aft] ! date ( ! enactm5t ( ?is ,act4