2296 112th CONGRESS
H. R. 2296
To establish an America Rx program to establish
fairer pricing for prescription drugs for individuals without access to prescription
drugs at discounted prices.IN THE HOUSE OF REPRESENTATIVES
Mr. MICHAUD (for himself, Mr. HINCHEY, Ms. PINGREE of
Maine, and Mr. JACKSON of Illinois) introduced the following bill; which was referred
to the Committee on Energy and Commerce
establish an America Rx program to establish fairer pricing for prescription drugs
for individuals without access to prescription drugs at discounted prices.
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
1. SHORT TITLE; PURPOSE.
(a) Short Title- This Act may be cited
as the `America Rx Act of 2011'.
(b) Purpose- The purpose of this
Act is to establish an America Rx program that utilizes manufacturer rebates and
pharmacy discounts to reduce prescription drug prices to those residents who are
without access to discounted prices for outpatient prescription drugs.
2. AMERICA RX PROGRAM.
(1) IN GENERAL- Not later than 1 year after the date of the enactment of this
Act, the Secretary of Health and Human Services shall establish a program (in
this section referred to as the `America Rx program') consistent with the provisions
of this section to provide qualified residents with access to discounted prices
for outpatient prescription drugs through rebate agreements that the Secretary
has negotiated with prescription drug manufacturers.
(2) OUTREACH- The Secretary shall provide for--
outreach efforts to build public awareness of the program and maximize enrollment
of qualified residents; and
(B) simplified eligibility
procedures and uniform eligibility standards for qualified residents.
(3) SUSPENSION; TERMINATION- If the Secretary determines that American Health
Benefit Exchanges are operational under subtitle D of title I of the Patient Protection
and Affordable Care Act (Public Law 111-148) and the America Rx program is no
longer needed to ensure that qualified residents have access to outpatient prescription
drugs at affordable prices, the Secretary may suspend or terminate the program.
(b) Rebate Agreements With Manufacturers-
(1) IN GENERAL-
Under the America Rx program the Secretary shall negotiate with manufacturers
of outpatient prescription drugs rebate agreements with respect to drugs offered
under the program to qualified residents.
AMOUNT OF REBATES- In negotiating the amount of such a rebate under paragraph
(1), the Secretary shall take into consideration the amount of the rebate calculated
under the Medicaid program, the average manufacturer price of prescription drugs,
and other information on prescription drug prices and price discounts. The Secretary
shall negotiate the amount of such rebates in a manner so that the rebates on
average are comparable to the average percentage rebate obtained in outpatient
prescription drugs provided under section 1927(c) of the Social Security Act (42
(3) DISCOUNTED PRICES- The Secretary
shall specify the method for computing and applying such discounts, including
a method for computing and applying discounts on a uniform, average percentage
(4) PAYMENT- Rebates under such agreements shall
be payable to the Secretary according to a schedule (not less often than quarterly)
negotiated with manufacturers and shall be paid, directly or through States, to
participating pharmacies that provide discounts to qualified residents.
(5) INCENTIVE- In order to induce manufacturers of outpatient prescription drugs
to enter into such rebate agreements to carry out the purpose described in section
1(b), the Secretary shall provide, in the case of a manufacturer that has not
entered into such an agreement, for a denial of a deduction under chapter 1 of
the Internal Revenue Code of 1986 for the amount of expenses of the manufacturer
for advertising and marketing of drugs of the manufacturer, other than expenses
for free samples of drugs subject to section 503(b)(1) of the Federal Food, Drug,
and Cosmetic Act intended to be distributed to patients.
(6) APPLICATION OF REBATES- Amounts received by the Secretary as rebates under
this subsection shall be placed into an appropriate account in the Treasury and
shall be available in advance of appropriations to the Secretary for the payment
of discounts and other costs of participating pharmacies in carrying out the America
Rx program and for the payment of administrative costs in carrying out the program.
Under the America Rx program, participating pharmacies shall be ensured reasonable
and timely payment of discounts they provide to qualified residents under the
(c) Role of States in Administering Program-
(1) IN GENERAL- Under the America Rx program the Secretary may enter into appropriate
arrangements with States under which States provide for the administration of
the program in return for payment of the reasonable administrative expenses associated
with such administration.
(2) ADMINISTRATIVE FUNCTIONS-
Such administration functions may include--
of eligibility of qualified residents;
with participating pharmacies; and
other functions as the Secretary determines appropriate.
(3) CONTRACTUAL AUTHORITY- In carrying out responsibilities under this section,
the Secretary and States may enter into agreements with pharmacy benefit managers
and other third parties.
(1) QUALIFIED RESIDENT DEFINED- For purposes of this section, the term `qualified
resident' means an individual who--
(A) is a citizen
or national of the United States or is lawfully present in the United States (as
determined in accordance with section 1411 of the Patient Protection and Affordable
Care Act); and
(B) as determined under regulations
of the Secretary, is not covered under any public or private program that provides
substantial benefits (which may be discounted prices) towards the purchase of
outpatient prescription drugs.
(A) FOR OTHER GOVERNMENTAL PROGRAMS- Individuals who apply for benefits under
the America Rx program shall be screened for eligibility under the Medicaid program
and other applicable Governmental health care programs and, if found eligible,
shall be enrolled in such program or programs.
(B) SCREENING BY HEALTH INSURANCE EXCHANGES- In the case of individuals enrolling
in a qualified health plan through a Health Insurance Exchange under title I of
the Patient Protection and Affordable Care Act, the Exchange shall provide (at
the time of enrollment) for a screening of the individual to determine if the
individual is a qualified resident for purposes of the America Rx program.
(3) RELATION TO OTHER COVERAGE- In order not to discourage employers and health
insurance issuers from providing comprehensive prescription drug coverage through
a group health plan or health insurance coverage, no such employer or issuer may
participate in a Health Insurance Exchange if the Secretary determines that the
prescription drug benefits under the plan or coverage have been reduced as a result
of the America Rx program.
(4) PROTECTION OF THE LOW
INCOME- Nothing in this section shall be construed as reducing the prescription
drug benefits available to low-income individuals, as well as senior citizens
and the disabled, under the Medicare or Medicaid programs as a result of the implementation
of the America Rx program.
(e) Arrangements With Participating
(1) IN GENERAL- Under the America Rx program arrangements
are made with pharmacies for the provision of prescription drugs at discounted
prices to qualified residents in a reasonably accessible manner. Such arrangements
shall provide that--
(A) each participating pharmacy
(i) provide discounts on prices
for outpatient prescription drugs for qualified residents in return for prompt
reimbursement of the amount of such discounts and a reasonable dispensing fee;
(ii) not charge qualified residents more (before such discounts) for outpatient
prescription drugs than the amount that individuals who are not qualified residents
are charged for such drugs; and
report to the Secretary (or the Secretary's designee) information regarding the
discounts provided and fees incurred; and
(i) ensure the reasonable
and timely payment to a participating retail pharmacy on a prompt basis (no less
promptly than as provided under the Medicare program) for discounted prices provided
to qualified residents under the program and for reasonable dispensing fees; and
(ii) not impose any additional fees on such pharmacies in connection with participation
in the program.
(2) DISCOUNTED PRICES- The
amount of the discount provided to enrolled qualifying residents shall reflect
the amount of rebates obtained, reduced by expenses relating to administrative
costs of the Federal and State governments and of participating pharmacies.
(f) Definitions- For purposes of this section:
(1) The term
`Health Insurance Exchange' means such an Exchange as established and operated
under part 3 of subtitle D of title I of the Patient Protection and Affordable
(2) The term `manufacturer' has the meaning
given such term in section 1927(k)(5) of the Social Security Act (42 U.S.C. 1396r-8(k)(5)).
(3) The term `Medicaid program' means a State program under title XIX of the Social
Security Act, including such a program operating under a Statewide waiver under
section 1115 of such Act.
(4) The term `outpatient prescription
drug' has the meaning given the term `covered outpatient drug' in section 1927(k)(2)
of the Social Security Act (42 U.S.C. 1396r-8(k)(2)).
(5) The term `Secretary' means the Secretary of Health and Human Services.
(6) The term `State' has the meaning given such term for purposes of title XIX
of the Social Security Act.