S 2460 — Every Prescription Conveyed Securely Act

(a) Dissemination of information (1) General information (A) Application of MA information A PDP sponsor shall disclose, in a clear, accurate, and standardized form to each enrollee with a prescription drug plan offered by the sponsor under this part at the time of enrollment and at least annually thereafter, the information described in section 1395w–22(c)(1) of this title relating to such plan, insofar as the Secretary determines appropriate with respect to benefits provided under this part, and, subject to subparagraph (C), including the information described in subparagraph (B). (B) Drug specific information The information described in this subparagraph is information concerning the following: (i) Access to specific covered part D drugs, including access through pharmacy networks. (ii) How any formulary (including any tiered formulary structure) used by the sponsor functions, including a description of how a part D eligible individual may obtain information on the formulary consistent with paragraph (3). (iii) Beneficiary cost-sharing requirements and how a part D eligible individual may obtain information on such requirements, including tiered or other copayment level applicable to each drug (or class of drugs), consistent with paragraph (3). (iv) The medication therapy management program required under subsection (c). (v) The drug management program for at-risk beneficiaries under subsection (c)(5). (vi) For plan year 2021 and each subsequent plan year, subject to subparagraph (C), with respect to the treatment of pain— (I) the risks associated with prolonged opioid use; and (II) coverage of nonpharmacological therapies, devices, and nonopioid medications— (aa) in the case of an MA–PD plan under part C, under such plan; and (bb) in the case of a prescription drug plan, under such plan and under parts A and B. (C) Targeted provision of information A PDP sponsor of a prescription drug plan may, in lieu of disclosing the information described in subparagraph (B)(vi) to each enrollee under the plan, disclose such information through mail or electronic communications to a subset of enrollees under the plan, such as enrollees who have been prescribed an opioid in the previous 2-year period. (2) Disclosure upon request of general coverage, utilization, and grievance information Upon request of a part D eligible individual who is eligible to enroll in a prescription drug plan, the PDP sponsor offering such plan shall provide information similar (as determined by the Secretary) to the information described in subparagraphs (A), (B), and (C) of section 1395w–22(c)(2) of this title to such individual. (3) Provision of specific information (A) Response to beneficiary questions Each PDP sponsor offering a prescription drug plan shall have a mechanism for providing specific information on a timely basis to enrollees upon request. Such mechanism shall include access to information through the use of a toll-free telephone number and, upon request, the provision of such information in writing. (B) Availability of information on changes in formulary through the Internet A PDP sponsor offering a prescription drug plan shall make available on a timely basis through an Internet website information on specific changes in the formulary under the plan (including changes to tiered or preferred status of covered part D drugs). (4) Claims information A PDP sponsor offering a prescription drug plan must furnish to each enrollee in a form easily understandable to such enrollees— (A) an explanation of benefits (in accordance with section 1395b–7(a) of this title or in a comparable manner); and (B) when prescription drug benefits are provided under this part, a notice of the benefits in relation to— (i) for a year preceding 2025, the initial coverage limit for the current year; and (ii) the annual out-of-pocket threshold for the current year. Notices under subparagraph (B) need not be provided more often than as specified by the Secretary and noti...