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US HR3415

Real-Time Beneficiary Drug Cost Bill


summary

Introduced
06/21/2019
In Committee
06/24/2019
Crossed Over
Passed
Dead
12/31/2020

Introduced Session

116th Congress

Bill Summary

To amend title XVIII of the Social Security Act to require prescription drug plan sponsors to include real-time benefit information as part of such sponsor's electronic prescription program under the Medicare program. This bill provides statutory authority for certain provisions of the Centers for Medicare & Medicaid Services rule titled "Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses," published on May 23, 2019. The rule requires, in part, Medicare prescription drug plan sponsors to implement an electronic, real-time benefit tool that is capable of integrating with at least one prescriber's electronic prescribing system or electronic health record. The tool must provide prescribers with patient-specific, real-time formulary and benefit information, including information regarding cost-sharing, formulary alternatives, and utilization management requirements. The rule takes effect January 1, 2021.

AI Summary

This bill requires prescription drug plan sponsors under the Medicare program to provide real-time benefit information to prescribing healthcare professionals. This includes information on clinically appropriate drug alternatives, applicable cost-sharing, and any prior authorization or utilization management requirements. The bill provides statutory authority for a Centers for Medicare & Medicaid Services rule that will take effect on January 1, 2021, requiring Medicare prescription drug plans to implement an electronic, real-time benefit tool that can integrate with prescribers' electronic prescribing or electronic health record systems.

Committee Categories

Business and Industry, Health and Social Services

Sponsors (5)

Last Action

Referred to the Subcommittee on Health. (on 06/24/2019)

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