Sec. 50354. PROVIDING PRESCRIPTION DRUG PLANS WITH PARTS A AND B CLAIMS DATA TO PROMOTE THE APPROPRIATE USE OF MEDICATIONS AND IMPROVE HEALTH OUTCOMES

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## SEC. 50354 PROVIDING PRESCRIPTION DRUG PLANS WITH PARTS A AND B CLAIMS DATA TO PROMOTE THE APPROPRIATE USE OF MEDICATIONS AND IMPROVE HEALTH OUTCOMES Section 1860D–4(c) of the Social Security Act (42 U.S.C. 1395w–104(c)) is amended by adding at the end the following new paragraph: > > #### “(6) Providing prescription drug plans with parts a and b claims data to promote the appropriate use of medications and improve health outcomes > > > ##### “(A) Process > > Subject to subparagraph (B), the Secretary shall establish a process under which a PDP sponsor of a prescription drug plan may submit a request for the Secretary to provide the sponsor, on a periodic basis and in an electronic format, beginning in plan year 2020, data described in subparagraph

(D)with respect to enrollees in such plan. Such data shall be provided without regard to whether such enrollees are described in clause

(ii)of paragraph (2)(A). > > > ##### “(B) Purposes > > A PDP sponsor may use the data provided to the sponsor pursuant to subparagraph

(A)for any of the following purposes: > > > ###### “(i) > > To optimize therapeutic outcomes through improved medication use, as such phrase is used in clause

(i)of paragraph (2)(A). > > > ###### “(ii) > > To improving care coordination so as to prevent adverse health outcomes, such as preventable emergency department visits and hospital readmissions. > > > ###### “(iii) > > For any other purpose determined appropriate by the Secretary. > > > ##### “(C) Limitations on data use > > A PDP sponsor shall not use data provided to the sponsor pursuant to subparagraph

(A)for any of the following purposes: > > > ###### “(i) > > To inform coverage determinations under this part. > > > ###### “(ii) > > To conduct retroactive reviews of medically accepted indications determinations. > > > ###### “(iii) > > To facilitate enrollment changes to a different prescription drug plan or an MA–PD plan offered by the same parent organization. > > > ###### “(iv) > > To inform marketing of benefits. > > > ###### “(v) > > For any other purpose that the Secretary determines is necessary to include in order to protect the identity of individuals entitled to, or enrolled for, benefits under this title and to protect the security of personal health information. > > > ##### “(D) Data described > > The data described in this clause are standardized extracts (as determined by the Secretary) of claims data under parts A and B for items and services furnished under such parts for time periods specified by the Secretary. Such data shall include data as current as practicable.” > . # TITLE IV PART B IMPROVEMENT ACT AND OTHER PART B ENHANCEMENTS ## Subtitle A Medicare Part B Improvement Act

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42 USC 1395w–104(c)

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Sec. 50354

PROVIDING PRESCRIPTION DRUG PLANS WITH PARTS A AND B CLAIMS DATA TO PROMOTE THE APPROPRIATE USE OF MEDICATIONS AND IMPROVE HEALTH OUTCOMES

Cite42 USC 1395w–104(c)

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