Section 1 Short title
This Act may be cited as the “Part D Beneficiary Appeals Fairness Act”.
Part D Beneficiary Appeals Fairness Act
A BILL
To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D.
Sec. 2 Fair exceptions process for drug in tiers under Medicare part D
in the first sentence—
by striking “for tiered cost-sharing for drugs included within a formulary and” and inserting “for any tiered cost-sharing structure within a formulary (including a structure that”; and
by inserting “, or provides for different co-payment or coinsurance amounts for drugs in different tiers included within the formulary)” before “, a part D eligible individual”;
in the second sentence, by inserting “in any plan formulary” before “could be covered”; and
by inserting the following before the last sentence: “In no case may the Secretary allow a PDP sponsor to make any formulary tier of the tiered cost-sharing structure (including a formulary tier used for very high cost or unique items) ineligible for lower-cost sharing through an exception under this paragraph.”.