S.Amdt. 3109

SA 3109. Mr. AKAKA submitted an amendment intended to be proposed to
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr.
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal
Revenue Code of 1986 to modify the first-time homebuyers credit in the
case of members of the Armed Forces and certain other Federal
employees, and for other purposes; which was ordered to lie on the
table; as follows:

On page 974, between lines 9 and 10, insert the following:

SEC. 3316. PHARMACY ACCESS FOR CHRONIC CARE TARGETED
INDIVIDUALS.

(a) Purpose.--The purpose of this section is to provide for
the establishment of chronic care pharmacy programs under the
Medicare prescription drug program under part D of title
XVIII of the Social Security Act that utilize available
technologies and efficiencies to improve the safety,
convenience, and affordability of prescription drug coverage
under such part with respect to long-term maintenance
medication refills for enrollees with a chronic disease or
condition.
(b) Establishment and Implementation of Program.--Section
1860D-4 of the Social Security Act (42 U.S.C. 1395w-104) is
amended by adding at the end the following new subsection:
``(m) Pharmacy Access for Targeted Beneficiaries.--
``(1) In general.--
``(A) Establishment and implementation of program.--The PDP
sponsor of a prescription drug plan shall--
``(i) identify (not less frequently than on a quarterly
basis) targeted beneficiaries who are enrolled in the
prescription drug plan; and
``(ii) establish and maintain a chronic care pharmacy
program that meets the requirements of this subsection.
``(B) Definitions.--In this subsection:
``(i) Chronic care pharmacy program.--The term `chronic
care pharmacy program' means the program established and
maintained by a PDP sponsor under subparagraph (A)(ii).
``(ii) Targeted beneficiary.--The term `targeted
beneficiary' means a part D eligible individual who is
identified by the PDP sponsor as taking at least 1 long-term
maintenance medication.
``(iii) Long-term maintenance medication.--The term `long-
term maintenance medication' means a covered part D drug
that--

``(I) has a common indication (obtained from product
labeling) for the treatment of a chronic disease or
condition; and
``(II) is used for the treatment of a chronic disease or
condition when the duration of continuous therapy can
reasonably be expected to exceed 1 year.

``(2) Enrollment.--
``(A) Automatic enrollment.--The PDP sponsor shall
automatically enroll targeted beneficiaries identified under
paragraph (1)(A)(i) in a chronic care pharmacy program.
``(B) Written notice and process to opt out of program.--
``(i) Written notice.--The PDP sponsor shall provide
written notice to targeted beneficiaries automatically
enrolled in the chronic care pharmacy program under
subparagraph (A).
``(ii) Process to decline enrollment and opt out of
program.--The written notice provided under clause (i) shall
include procedures under which the targeted beneficiary may
decline such automatic enrollment and opt-out of the chronic
care pharmacy program.
``(3) Chronic care pharmacy program requirements.--The PDP
sponsor shall establish and maintain procedures to ensure
that each of the following requirements is met by a chronic
care pharmacy program:
``(A) A targeted beneficiary is (not less frequently than
on an annual basis) provided a claims-based comprehensive
written summary of the targeted beneficiary's drug therapy
that includes an analysis of--
``(i) poly-pharmacy and other safety issues, including the
identification of duplicative or excessive drug therapy in
order to reduce

[[Page S12831]]

harmful adverse drug reactions and unnecessary
hospitalizations; and
``(ii) clinically appropriate alternative formulary
treatment options and lower cost alternatives, if any, for
consideration by the treating physician of the targeted
beneficiary.
``(B) Any chronic care pharmacy under the program is
accredited by a private accrediting organization as meeting
standards appropriate for pharmacies that dispense long-term
maintenance medications, including a process for quality and
safety improvement.
``(C) The program makes available, 24 hours a day, 7 days a
week, to a targeted beneficiary confidential pharmacist
counseling, based on the targeted beneficiary's drug therapy.
``(D) The program delivers to the address specified by the
targeted beneficiary an extended supply (such as 90-days) of
long-term maintenance medications where permitted by law and
when indicated to be clinically appropriate.
``(E) The program provides, after filling a prescription
for a targeted beneficiary for 2 consecutive months, only an
extended supply of a long-term maintenance medication, except
that a 1-time 30-day supply of such a medication may be
provided to the targeted beneficiary at a retail pharmacy in
order to transition a targeted beneficiary into the program.
``(4) Access to covered part d drugs.--The requirements of
subsection (b)(1) shall apply to a chronic care pharmacy
program, except that the requirements of subparagraphs (A)
and (D) of such subsection shall apply only in the case of an
individual who opts out of the chronic care pharmacy program
under paragraph (2)(A)(ii).
``(5) Facilitating affordable payment arrangements.--With
respect to an extended supply of part D covered drugs for a
targeted beneficiary under the chronic care pharmacy program,
the PDP sponsor shall offer to the targeted beneficiary an
option to arrange for the payment of any required cost-
sharing by a targeted beneficiary on an alternative basis
(including more affordable payments in installments) over the
period of the extended supply.
``(6) Continuity of election.--In the case where a targeted
beneficiary changes enrollment to a different prescription
drug plan (including a prescription drug plan offered by a
different sponsor)--
``(A) the PDP sponsor of the plan from which the targeted
beneficiary disenrolls shall notify the Secretary (as part of
the disenrollment process)--
``(i) that the individual is a targeted beneficiary to whom
the requirements of this subsection apply; and
``(ii) whether the targeted beneficiary elected to opt out
of the chronic care pharmacy program under paragraph
(2)(A)(ii); and
``(B) the Secretary shall ensure that, in the case where
the targeted beneficiary has not elected to opt out as
described in subparagraph (A)(ii), the continuation of the
enrollment of the targeted beneficiary in the chronic care
pharmacy program of the PDP sponsor offering the prescription
drug plan in which the targeted beneficiary has enrolled.
``(7) Providing information to beneficiaries.--The
Secretary shall include information regarding chronic care
pharmacy programs in the activities required under section
1860D-1(c) (relating to the provision of information to
beneficiaries with respect to informed choice, and other
information), including any consumer satisfaction surveys
under subsection (d).
``(8) Exception for long-term care facilities.--This
subsection shall not apply to a long-term care facility or a
pharmacy located in, or having a contract with, a long-term
care facility.''.
(c) Effective Date.--The amendment made by this section
shall apply for contract years beginning with 2011.
______