To amend the Public Health Service Act to include State high risk pool insurance programs in the list of covered entities that receive reductions in the prices charged for prescription drugs under the prescription drug pricing agreements under section 340B of that Act.

March 13, 2003

Mr. UDALL of Colorado introduced the following bill; which was referred to the Committee on Energy and Commerce

To amend the Public Health Service Act to include State high risk pool insurance programs in the list of covered entities that receive reductions in the prices charged for prescription drugs under the prescription drug pricing agreements under section 340B of that Act.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `State High Risk Pool Drug Assistance Program Act of 2003'.

SEC. 2. INCLUSION OF STATE HIGH RISK POOL INSURANCE PROGRAMS AS A 340B COVERED ENTITY.

Section 340B(a)(4) of the Public Health Service Act (42 U.S.C. 256b(a)(4)) is amended by adding at the end the following:

`(M) A State-operated qualified high risk pool that provides for premium rates and covered benefits for such coverage consistent with standards included in the National Association of Insurance Commissioners Model Health Plan for Uninsurable Individuals, subject to such conditions as the Secretary may establish by regulation, which shall include the following:

`(i) The pool establishes criteria for individuals eligible to obtain benefits through the pool.

`(ii) Eligible individuals are given a card identifying them as high risk pool members.

`(iii) Pharmacies that fill prescriptions for eligible individuals may bill the administrator or pharmacy benefit manager of the pool.

`(iv) The pool has a direct relationship to the eligible individual that includes--

`(I) maintaining records of the individual's health care claims; and

`(II) the receipt by the individuals of health care services from contracted network providers.

`(v) The pool serves at least individuals who would be eligible under the provisions of any of subparagraphs (A) through (L) but for level of income.

In the case of such a pool, nothing in clause (v) shall be construed as limiting the application of the agreement under this section to individuals described in such clause.'.

END