H.R.4199 - Patient Health and Real Medication Access Cost Savings Act of 2009111th Congress (2009-2010)
Summary: H.R.4199 — 111th Congress (2009-2010)
Introduced in House (12/03/2009)
Patient Health and Real Medication Access Cost Savings Act of 2009 or the PHARMACY Bill - Declares that a consumer shall have the right to choose to purchase prescription drugs from any domestic pharmacy that meets all applicable federal and state license and permit requirements.
Directs the Secretary of Health and Human Services (HHS) to issue regulations that: (1) prohibit a pharmacy benefit manager (PBM) from providing incentives to, encouraging, or requiring pharmacy benefit plan enrollees to use certain pharmacies or from excluding an eligible pharmacy from a plan's pharmacy network; (2) require a PBM to ensure that pharmacy benefit plan enrollees pay a specified copayment for brand name drugs; (3) require a PBM to reimburse a pharmacy in the network of a pharmacy benefit plan that is federally funded, at specified rates, for brand-name drugs, generic drugs, and additional professional services; (4) require a PBM to be reimbursed by a pharmacy benefit plan sponsor for adjudicating and processing claims; (5) limit the amount that a PBM charges a pharmacy benefit plan sponsor for a drug that is dispensed to enrollees to the amount the PBM paid the pharmacy for such drug; (6) require a manufacturer of prescription drugs to pay all rebates directly to the pharmacy benefit plan sponsor and not to a PBM; and (7) require a pharmacy benefit plan sponsor to provide a list of the wholesale acquisition costs of the top 500 most frequently prescribed drugs to physicians in a plan any insurance-related charge of which is underwritten by a federal, state, or local government.
Amends title XVIII (Medicare) of the Social Security Act to include pharmacist services as "medical and other health services" under Medicare.
Directs the Secretary, by January 1, 2011, to establish a pharmaceutical access program to provide affordable prescription drugs to individuals who receive drug benefits under federal programs (except Medicaid). Requires: (1) a pharmacy that dispenses prescription drugs in the United States to remit to the Secretary 50 cents for each brand name prescription and $1.00 for generic drug prescription dispensed; and (2) the sponsor of a pharmacy benefit plan that is not federally funded to increase the professional dispensing fee paid to pharmacies by the same amounts. Requires the use of funds generated from such fees to provide affordable access to prescription drugs to low-income individuals who have enrolled in the program.