Sec. 802. Reporting requirements for PDP sponsors regarding point-of-sale rejections under Medicare part D

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Section 1860D–4(g) of the Social Security Act ( 42 U.S.C. 1395w–104(g) ) is amended by adding at the end the following new paragraph: With respect to a plan year beginning on or after January 1, 2020, a PDP sponsor offering a prescription drug plan shall submit to the Secretary, in a form and manner specified by the Secretary, information on point-of-sale rejections made during a period of time occurring in such plan year (as specified by the Secretary), including each of the following:

The reason for each point-of-sale rejection. Identifying information for each drug with respect to which a point-of-sale rejection was made. With respect to applicable types of point-of-sale rejections (as specified by the Secretary), each of the following: Whether such a rejection was consistent with the formulary of the plan (as approved by the Secretary). Whether a coverage determination or appeal of a coverage determination was requested for the drug with respect to which such a rejection was made.

The outcome of any such coverage determination or appeal of a coverage determination. The length of time between when such a rejection was made and when the drug with respect to which such rejection was made is dispensed, as applicable. The Secretary shall make publicly available on the public website of the Centers for Medicare & Medicaid Services information submitted under subparagraph (A). The Secretary may use information submitted under subparagraph (A), as determined appropriate, in developing measures for the 5-star rating system under section 1853(o)(4).

Notwithstanding any other provision of law, the Secretary may implement this paragraph through program instruction or otherwise. The are authorized to be appropriated to the Secretary from the Federal Supplementary Medical Insurance Trust Fund under section 1841 such sums as may be necessary to implement this paragraph. .

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42 USC 1395w–104(g)

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Sec. 802

Reporting requirements for PDP sponsors regarding point-of-sale rejections under Medicare part D

Cite42 USC 1395w–104(g)

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