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Washington, D.C. – U.S. Senator Mike Enzi, R-Wyo., is helping answer the concerns of seniors and pharmacists about how a new Medicare drug benefit would impact the trusted relationship that pharmacists and their senior patients share.

The Senate passed an amendment offered by Enzi today to S. 1, the Prescription Drug and Medicare Improvement Act, by a vote of 95-0. The amendment would help contribute to fair prices for consumers and fair treatment for pharmacies under a proposed Medicare prescription drug benefit.

Enzi's amendment would:

• Require greater accountability to help ensure that rebates, discounts, etc., negotiated from drug manufacturers by the prescription drug plan providers are passed on to beneficiaries.

• Permit the government to audit financial transactions within various plans to ensure compliance and deter fraud and abuse.

• Permit beneficiaries to receive 90-day prescriptions and other benefits and services through community pharmacies, not just through mail order, although beneficiaries would be responsible for any differential in cost.

Enzi was chosen by Senate Majority Leader Bill Frist, R-Tenn., to participate in a Senate Medicare working group. As a member of the leadership group, Enzi helps provide bill managers with a sense of how the legislation might impact rural and frontier areas. He also assists the Majority Leader in addressing questions about access for rural beneficiaries, such as helping to ensure Wyomingites have access to rural pharmacists as well as a full range of health services from their local providers.

The Prescription Drug and Medicare Improvement Act would, among other things, make improvements in the Medicare program and provide prescription drug coverage under Medicare.

Enzi's statement from the Senate floor and the amendment text follows.

Floor Statement on Amendment #932 TO S. 1
Senator Michael B. Enzi
June 19, 2003


Mr. President, I rise today to offer a modified version of Amendment #932, which I offered yesterday on behalf of myself and my distinguished colleague from Rhode Island, Senator Reed. Senators Pryor and Cochran also join us in offering this modified amendment, and I welcome their co-sponsorship and support.

These modifications ensure that the amendment will not add to the cost of this Medicare bill, which is a concern that I share with Chairman Grassley and a great many of my colleagues. I thank the Senator from Iowa for his willingness to work with me to address the concerns of our seniors and pharmacists.

The heart of this amendment remains the provisions that would ensure fair prices for consumers and fair treatment for local pharmacists under a new Medicare prescription drug benefit.

To ensure reasonable drug prices for seniors, the amendment would hold Medicare drug plans and MedicareAdvantage organizations accountable for passing on to consumers a fair portion of the rebates, discounts, and other incentives that the plans may receive from drug manufacturers and other sources.

The amendment would require disclosure of these incentives to the federal government. It would also clarify that the government may audit the records of these plans and organizations to ensure compliance with this disclosure requirement.

The amendment would not, however, make these disclosures part of the public record. That is certainly not our intent. The amendment simply ensures that our corporate partners are held accountable for sharing with our seniors the savings that they generate.

To ensure fair treatment for the pharmacists in our communities, the amendment we are offering would prohibit Medicare drug plans from implementing restrictions that would steer consumers to mail-order pharmacies. It would require Medicare drug plans to allow local community pharmacists to fill long-term prescriptions and offer other services that they are equipped and licensed to provide.

Seniors trust their local pharmacist, and they should be allowed to keep that relationship in place. This drug benefit should not force them to choose a mail-order house when a pharmacist that could provide the same or better service is right down the street.

This amendment would permit a Medicare drug plan or MedicareAdvantage organization to charge a different cost for a mail-order prescription versus a prescription filled by a community pharmacist. This happens today in many health plans.

As an example, one health plan for federal employees charges a 10-dollar co-pay for a 30-day prescription filled at a local pharmacy -- but a 20-dollar co-pay for a 90-day prescription filled through mail order.

Under this amendment, Medicare drug plans could still charge different co-pays, but the plans could not prohibit a local pharmacy from filling 90-day prescriptions.

I know some of my colleagues are concerned that seniors may get confused by all of this, or that they may pay more for their drugs than they should. In response, I would say that the Finance Committee's bill clearly states that seniors cannot be charged more than the negotiated price of a covered drug.

The bill is also very direct in its expectations of Medicare drug plans. The bill would require plans to provide clear information about co-payments and deductibles. This information would have to include details on the differences in cost between mail-order and retail prescriptions.

I think seniors and their families are very smart about drug costs, and they will take things like different co-pays into account when they make their healthcare decisions.

I'm sure that Medicare drug plans will encourage seniors to use mail order, just like health plans encourage us to use mail-order. What this amendment would do is give seniors the option to use their local pharmacists.

The bill already requires health plans to give seniors accurate information on the cost of their options. From that point, I think we should trust seniors and their families to make the decisions that are best for them, without arbitrary limitations on services that steer seniors in one direction or the other.

Again, I thank Senators Reed, Pryor and Cochran for joining me in offering this modified amendment. The sponsors of this bill all appreciate the role that pharmacists play in helping all Americans manage their medications – especially the elderly and the sick, who need the most advice.

As I mentioned yesterday, Senator Reed and I worked last week to pass a bill to address the pharmacist shortage through the Committee on Health, Education, Labor and Pensions. We agreed to work together on that bill to ensure that our aging population has access to the knowledge of pharmacists on how to use a new Medicare drug benefit appropriately and safely.

As highly educated professionals, our pharmacists know how important drug therapy is to helping seniors live longer and better lives, and they want to support this bill. In fact, many pharmacies and pharmacists are supporting and will support the bill, in part because of this amendment.

By ensuring fair prices for seniors and fair treatment for pharmacists, we will ensure that this new Medicare drug benefit does right by seniors, and values the trusted relationship that pharmacists and their senior patients share.

I encourage my colleagues to vote for this amendment.

On page 57, between lines 21 and 22, insert the following:

``(3) DISCLOSURE.--The eligible entity offering a Medicare Prescription Drug plan and the MedicareAdvantage organization offering a MedicareAdvantage plan shall disclose to the Administrator (in a manner specified by the Administrator) the extent to which discounts, direct or indirect subsidies, rebates, or other price concessions or direct or indirect remunerations made available to the entity or organization by a manufacturer are passed through to enrollees through pharmacies and other dispensers or otherwise. The provisions of section 1927(b)(3)(D) shall apply to information disclosed to the Administrator under this paragraph in the same manner as such provisions apply to information disclosed under such section.

``(4) AUDITS AND REPORTS.--To protect against fraud and abuse and to ensure proper disclosures and accounting under this part, in addition to any protections against fraud and abuse provided under section 1860D-7(f)(1), the Administrator may periodically audit the financial statements and records of an eligible entity offering a Medicare Prescription Drug plan and a MedicareAdvantage organization offering a MedicareAdvantage plan with an auditor of the Administrator's choice.

On page 37, between lines 20 and 21, insert the following:

``(C) LEVEL PLAYING FIELD.--An eligible entity offering a Medicare Prescription Drug plan shall permit enrollees to receive benefits (which may include a 90-day supply of drugs or biologicals) through a community pharmacy, rather than through mail order, and may permit a differential amount to be paid by such enrollees.