US Codex
Bill
Notes

To amend title XIX of the Social Security Act to add standards for drug compendia for physician use for purposes of Medicaid payment for certain drugs, and for other purposes.

S. 2981 · 114th Congress · May 25, 2016 · Lineage

A BILL

Section 1 Adding standards for drug compendia for physician use for purposes of payment under Medicaid for certain drugs

(a)
In general— Section 1927(g)(1)(B)(i) of the Social Security Act (42 U.S.C. 1396r–8(g)(1)(B)(i)) is amended—
(1)
in subclause (I), by striking the semicolon at the end and inserting a period;
(2)
in subclause (II), by striking “); and” at the end and inserting “).”;
(3)
in subclause (III)—
(A)
by striking “the DRUGDEX” and inserting “The DRUGDEX”; and
(B)
by striking “; and” at the end and inserting a period; and
(4)
by adding at the end the following:

“(IV) Other compendia that, as determined by the Secretary—

“(aa) are utilized nationwide by the private health insurance industry;

“(bb) are used by health care providers, such as long-term care facilities or academic health centers;

“(cc) have a publicly available policy on the disclosure of conflicts of interest that may exist between such a health care provider and drug manufacturers;

“(dd) use an international, widely recognized standard to systematically evaluate the clinical evidence for inclusion in the compendia; and

“(ee) are accepted as professional drug compendia by at least one State board of pharmacy (or an equivalent State licensing body).”

(b)
Technical amendments— Section 1927(g)(1)(B) of the Social Security Act (42 U.S.C. 1396r–8(g)(1)(B)) is amended—
(1)
in clause (i), by striking “compendia” and inserting “Compendia”; and
(2)
in clause (ii), by striking “the peer-reviewed” and inserting “The peer-reviewed”.

Sec. 2 Revising definition of medically accepted indication for Medicare Part D drugs

Section 1860D–2(e)(4) of the Social Security Act (42 U.S.C. 1395w–102(e)(4)) is amended—
(1)
in subparagraph (A)(i)(II), by striking “section 1927(g)(1)(B)(i)(III)” and inserting “subclauses (III) and (IV) of section 1927(g)(1)(B)(i)”; and
(2)
in subparagraph (B), by striking “subparagraph (A)(i)(II)” and all that follows through “1927(g)(1)(B)(i)(III)” and inserting “a compendium described in subclause (III) or (IV) of section 1927(g)(1)(B)(i) shall not be included in the list of compendia described in section 1861(t)(2)(B)(ii)(I) unless such compendium”.