To express the sense of the Senate regarding the Medicare part D prescription drug program.

SA 2731. Mr. GRASSLEY proposed an amendment to amendment SA 2707
proposed by Mr. Frist (for Mr. Grassley (for himself and Mr. Baucus))
to the bill H.R. 4297, to provide for reconciliation pursuant to
section 201(b) of the concurrent resolution on the budget for fiscal
year 2006; as follows:

At the appropriate place, insert the following:

SEC. __. SENSE OF THE SENATE REGARDING THE MEDICARE PART D
PRESCRIPTION DRUG PROGRAM.

(a) Findings.--The Senate finds the following:
(1) It is not acceptable that startup issues under the new
Medicare prescription drug program have resulted in some of
our Nation's most vulnerable citizens having difficulties
getting their prescription drugs covered under the program,
and these issues must be addressed and resolved.
(2) The Department of Health and Human Services and the
Centers for Medicare &

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Medicaid Services are working tirelessly to address these
startup issues and have taken numerous steps to smooth the
transition process.
(3) All prescription drug plans under part D of title XVIII
of the Social Security Act and MA-PD plans under part C of
such title (in this section referred to as ``Medicare
prescription drug plans'') already have a ``first fill''
policy in place that provides a new enrollee with coverage
for prescription drugs during at least the first 30 days of
enrollment regardless of whether the particular prescription
drug is on the plan's formulary, and the Centers for Medicare
& Medicaid Services is enforcing this requirement.
(4) Under current law, full-benefit dual eligible
individuals (as defined in section 1935(c)(6) of the Social
Security Act (42 U.S.C. 1395u-5(c)(6)) are already
automatically enrolled into Medicare prescription drug
coverage so no change in law is necessary.
(5) Medicare prescription drug plans are already
responsible for covering the cost of covered prescriptions
filled for enrollees, including short term transition
prescriptions.
(6) Medicare prescription drug plans are already
responsible for reimbursing any enrollee, including full-
benefit dual eligible individuals, for any out-of-pocket
costs incurred by the enrollee that should have been covered
by the plan.
(7) The Centers for Medicare & Medicaid Services is already
reimbursing States for the reasonable administrative costs
incurred by States that have temporarily covered some claims
for prescription drug coverage during the transition period.
(8) Enrollment is exceeding projections, with at least
24,000,000 Medicare beneficiaries who now have drug coverage
and another 90,000 are enrolling each day in the Medicare
prescription drug program;
(9) In addition, the Secretary of Health and Human Services
has taken many other actions to smooth the implementation of
the Medicare prescription drug program, including the
following:
(A) Establishing processes to ensure that full-benefit dual
eligible individuals are not overcharged for their
prescriptions and to require Medicare prescription drug plans
to refund overcharges to such individuals.
(B) Establishing a reconciliation process to ensure that
Medicare prescription drug plans reimburse pharmacies for
costs incurred by pharmacies that are payable by such plans.
(C) Conducting extensive and continuing outreach to
pharmacies and pharmacy associations on the implementation of
the Medicare prescription drug benefit, particularly with
respect to full-benefit dual eligible individuals, as well as
establishing a special pharmacy telephone help line.
(D) Requiring Medicare prescription drug plans to have
comprehensive formularies and procedures for enrollees to
rapidly secure an exception to the limitation of coverage of
a prescription drug when medical necessity is demonstrated.
(E) Permitting full-benefit dual eligible individuals to
switch Medicare prescription drug plan under the Medicare
prescription drug benefit at any time, for any reason, and
improving data flows and communication with plans to ensure
that plan switches by such individuals become fully effective
as quickly as possible.
(F) Partnering with national, State, and local groups that
work with full-benefit dual eligible individuals to educate
such individuals about the Medicare prescription drug
program, and assisting in their transition to, and enrollment
under, such program.
(b) Sense of the Senate.--It is the sense of the Senate
that--
(1) the Secretary of Health and Human Services is making
significant progress in smoothing the implementation of the
new Medicare prescription drug program, legislation changing
the program is not needed at this time, and legislation at
this time would also likely complicate implementation of the
program and confuse beneficiaries;
(2) each of the implementation problems identified under
the Medicare prescription drug program will be resolved more
quickly through administrative actions, which the Secretary
of Health and Human Services already has the authority to
take under current law, rather than through Congressional
action followed by administrative action;
(3) the Senate fully supports the efforts of the Secretary
of Health and Human Services, Medicare prescription drug
plans, pharmacists, and others to implement the Medicare
prescription drug program and to resolve problems that have
occurred during the implementation of the program; and
(4) the pace of enrollment in the Medicare prescription
drug benefit indicates that extending the six-month
enrollment period is not warranted at this time, and, by
contrast, such an action could exacerbate implementation
issues under the program.
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