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S. 1999Senate116th Congress (2019-2021)In Committee

Improving Low Income Access to Prescription Drugs Act of 2019

Sponsored by Robert P. Casey Jr.Sen. Robert P. Casey Jr. (D-PA)
Introduced June 27, 2019

AI-Generated Summary

Updated April 14, 2026 at 6:41 AM UTC

The Improving Low Income Access to Prescription Drugs Act of 2019 adds a new program to Medicare Part D for people with low incomes who have just become eligible but have not yet enrolled in a prescription drug plan. Starting no later than Jan. 1, 2021, the program gives these individuals immediate access to covered drugs and, for certain dual‑eligible or SSI recipients, reimburses drug costs retroactively for up to three years before they enroll. The goal is to close the gap in drug coverage for newly eligible low‑income beneficiaries.

Key Provisions

  • Creates a “Limited Income Newly Eligible Transition (LI NET) Program” that provides transitional Part D coverage for low‑income individuals who meet specific income criteria and have not yet enrolled in a drug plan.
  • Defines “transitional coverage” as immediate point‑of‑sale access to all covered Part D drugs from the date eligibility is confirmed until a drug plan takes effect.
  • Provides retroactive reimbursement for full‑benefit dual‑eligible or SSI recipients for drug purchases dating back to the later of their first low‑income subsidy eligibility or 36 months before they enroll in a plan.
  • Requires the program to be administered, if possible, by a single contracted administrator and to offer an open‑formulary drug list through all qualified pharmacies.
  • Allows the Secretary of Health and Human Services to waive certain existing Medicare Part D requirements (such as specific formulary and medication‑therapy‑management rules) to implement the program.

Legislative Activity

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1 earlier action
SenateIntro Referral Latest Action

Read twice and referred to the Committee on Finance.

Finance Committee

June 27, 2019

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SenateIntro Referral

Introduced in Senate

June 27, 2019

SenateIntro Referral

Read twice and referred to the Committee on Finance.

Finance Committee

June 27, 2019

Bill Text

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Introduced in SenateIssued June 27, 2019

II

116th CONGRESS

1st Session

S. 1999

IN THE SENATE OF THE UNITED STATES

June 27, 2019

Mr. Casey (for himself and Mr. Daines) introduced the following bill; which was read twice and referred to the Committee on Finance

A BILL

To amend title XVIII of the Social Security Act to provide transitional coverage and retroactive Medicare part D coverage for certain low-income beneficiaries.

1.

Short title

This Act may be cited as the Improving Low Income Access to Prescription Drugs Act of 2019.

2.

Transitional coverage and retroactive Medicare part D coverage for certain low-income beneficiaries

Section 1860D–14 of the Social Security Act (42 U.S.C. 1395w–114) is amended—

(1)

by redesignating subsection (e) as subsection (f); and

(2)

by adding after subsection (d) the following new subsection:

(e)

Limited income newly eligible transition program

(1)

In general

Beginning not later than January 1, 2021, the Secretary shall carry out a program to provide transitional coverage for covered part D drugs for LI NET eligible individuals in accordance with this subsection.

(2)

LI net eligible individual defined

For purposes of this subsection, the term LI NET eligible individual means a part D eligible individual who—

(A)

meets the requirements of clauses (ii) and (iii) of subsection (a)(3)(A); and

(B)

has not yet enrolled in a prescription drug plan or an MA–PD plan, or, who has so enrolled, but with respect to whom coverage under such plan has not yet taken effect.

(3)

Transitional coverage

For purposes of this subsection, the term transitional coverage means with respect to an LI NET eligible individual—

(A)

immediate access to covered part D drugs at the point of sale during the period that begins on the first day of the month such individual is determined to meet the requirements of clauses (ii) and (iii) of subsection (a)(3)(A) and ends on the date that coverage under a prescription drug plan or MA–PD plan takes effect with respect to such individual; and

(B)

in the case of an LI NET eligible individual who is a full-benefit dual eligible individual (as defined in section 1935(c)(6)) or a recipient of supplemental security income benefits under title XVI, retroactive coverage (in the form of reimbursement of the amounts that would have been paid under this part had such individual been enrolled in a prescription drug plan or MA–PD plan) of covered part D drugs purchased by such individual during the period that begins on the date that is the later of—

(i)

the date that such individual was first eligible for a low-income subsidy under this part; or

(ii)

the date that is 36 months prior to the date such individual enrolls in a prescription drug plan or MA–PD plan,

and ends on the date that coverage under such plan takes effect.
(4)

Program administration

(A)

Single point of contact

The Secretary shall, to the extent feasible, administer the program under this subsection through a contract with a single program administrator.

(B)

Benefit design

The Secretary shall ensure that the transitional coverage provided to LI NET eligible individuals under this subsection—

(i)

provides access to all covered part D drugs under an open formulary;

(ii)

permits all pharmacies determined by the Secretary to be in good standing to process claims under the program;

(iii)

is consistent with such requirements as the Secretary considers necessary to improve patient safety and ensure appropriate dispensing of medication; and

(iv)

meets such other requirements as the Secretary may establish.

(5)

Relationship to other provisions of this title; waiver authority

(A)

In general

The following provisions shall not apply with respect to the program under this subsection:

(i)

Paragraphs (1) and (3)(B) of section 1860D–4(a) (relating to dissemination of general information; availability of information on changes in formulary through the internet).

(ii)

Subparagraphs (A) and (B) of section 1860D–4(b)(3) (relating to requirements on development and application of formularies; formulary development).

(iii)

Paragraphs (1)(C) and (2) of section 1860D–4(c) (relating to medication therapy management program).

(B)

Waiver authority

The Secretary may waive such other requirements of title XI and this title as may be necessary to carry out the purposes of the program established under this subsection.

.