text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Secondary Payer Advancement, 
  Rationalization, and Clarification Act'' or the ``SPARC Act''.
  
  SEC. 2. CLARIFICATION AND RATIONALIZATION OF MEDICARE PRESCRIPTION DRUG 
                SECONDARY CLAIMS RESPONSIBILITY.
  
      (a) In General.--Section 1860D-2(a)(4) of the Social Security Act 
  (42 U.S.C. 1395w-102(a)(4)) is amended to read as follows:
              ``(4) Secondary payor and recovery rights.--
                      ``(A) In general.--
                              ``(i) Application of secondary payor.--A 
                          prescription drug plan shall be secondary payor 
                          to any valid and collectible payment from a 
                          primary drug plan (as defined in clause (iv)) 
                          until such time as such primary drug plan pays 
                          a final settlement, judgment, or award to an 
                          individual enrolled under the prescription drug 
                          plan with regard to an injury or illness 
                          involved or otherwise terminates its ongoing 
                          responsibility for medical payments with 
                          respect to the individual.
                              ``(ii) Limitation on parties making 
                          prescription drug plans primary.--A primary 
                          drug plan (as defined in clause (iv), other 
                          than a group health plan or multiemployer or 
                          multiple employer plan of, or contributed to 
                          by, an employer that has 20 or fewer employees 
                          for each working day in each of 20 or more 
                          calendar weeks in the calendar year involved or 
                          the preceding calendar year), a self-insured 
                          plan, a service benefit plan, a managed care 
                          organization, a pharmacy benefit manager, or 
                          other party that, by statute, contract, or 
                          agreement, is legally responsible for payment 
                          of a claim for a covered outpatient drug, in 
                          enrolling an individual or in making any 
                          payments for benefits to the individual or on 
                          the individual's behalf, may not take into 
                          account that the individual is enrolled under a 
                          prescription drug plan under this part or is 
                          eligible for or is provided coverage for 
                          covered part D drugs under this part.
                              ``(iii) Limitation on secretarial claims 
                          through subrogation.--The Secretary shall not 
                          assert any claim on behalf or against a 
                          prescription drug plan, other than through the 
                          recovery from such a plan of amounts paid 
                          related to a covered part D drug event that has 
                          been repaid to the plan through a subrogation 
                          action or otherwise.
                              ``(iv) Primary drug plan defined.--In this 
                          paragraph, the term `primary drug plan' means, 
                          with respect to benefits for covered part D 
                          drugs, a group health plan or large group 
                          health plan (other than a group health plan or 
                          multiemployer or multiple employer plan of, or 
                          contributed to by, an employer that has 20 or 
                          fewer employees for each working day in each of 
                          20 or more calendar weeks in the calendar year 
                          involved or the preceding calendar year), a 
                          workers' compensation law or plan, an 
                          automobile or liability insurance policy or 
                          plan (including a self-insured plan) or no-
                          fault insurance insofar as such a plan, law, 
                          policy, or insurance provides such benefits, 
                          insofar as, under the provisions of section 
                          1862(b)(2), such coverage would be treated as a 
                          primary plan if benefits for covered part D 
                          drugs were treated as benefits under parts A 
                          and B. For purposes of this clause, an entity 
                          that engages in a business, trade, or 
                          profession shall be deemed to have a self-
                          insured plan if it carries its own risk 
                          (whether by a failure to obtain insurance, or 
                          otherwise) in whole or in part.
                      ``(B) Waiver.--A prescription drug plan may waive 
                  (in whole or in part) the provisions of this paragraph 
                  in the case of an individual claim if the plan 
                  determines that the waiver is in the best interests of 
                  the program established under this part.
                      ``(C) Recovery.--A prescription drug plan shall be 
                  subrogated (to the extent of payment made under this 
                  part by the plan for any covered part D drug before the 
                  date the plan received notice pursuant to subparagraph 
                  (D)) to any right of an individual or any other entity 
                  to payment, with respect to such covered part D drug, 
                  under a primary drug plan. A subrogation claim may not 
                  be asserted pursuant to this subparagraph by a 
                  prescription drug plan with respect to a payment for a 
                  covered part D drug after the date that is 3 years 
                  after the date such plan receives notice of a payment, 
                  with respect to such covered part D drug, pursuant to 
                  subparagraph (D). Any such subrogation claim shall be 
                  the exclusive legal remedy of the PDP sponsor of the 
                  plan and shall be reduced to take into account the cost 
                  of procuring the judgment or settlement with respect to 
                  such claim if an individual's liability, workers' 
                  compensation, or no-fault claim is disputed. Any costs 
                  or expense incurred by a prescription drug plan related 
                  to recoveries pursuant to this subparagraph shall not 
                  be considered an administrative cost or expense, as 
                  those terms are used in this part.
                      ``(D) Coordination of benefits information.--Not 
                  later than 15 days after the date the Secretary 
                  receives information under paragraph (7) or (8) of 
                  section 1862(b) relating to an individual enrolled in a 
                  prescription drug plan during an applicable time, the 
                  Secretary shall provide such information to such 
                  prescription drug plan in a format convenient and 
                  accessible to such plans. The Secretary shall waive any 
                  requirements under this part that a prescription drug 
                  plan establish procedures for determining whether costs 
                  for part D eligible individuals are being reimbursed 
                  through insurance or otherwise or identify payers that 
                  are primary to the program under subparagraph (A)(ii) 
                  other than as required under this paragraph.
                      ``(E) Coordination of benefits.--A prescription 
                  drug plan shall, in the case of receipt of a notice 
                  pursuant to subparagraph (D) related to an enrollee for 
                  whom a primary drug plan has reported on ongoing 
                  responsibility for medical costs pursuant to paragraph 
                  (7) or (8) of section 1862(b), authorize the provider 
                  of such covered part D drug to charge, in accordance 
                  with the charges allowed under the prescription drug 
                  plan, such primary drug plan for such covered part D 
                  drug related to or arising out of the treatment 
                  accident or injury subject to such notice (other than 
                  payments subject to a claim under subparagraph (B) or 
                  (F)) for the period in which the enrollee remains 
                  enrolled in such plan through the date upon which such 
                  primary drug plan has terminated such ongoing 
                  responsibility for medical payments.
                      ``(F) Use of web site to determine final 
                  reimbursement amount.--
                              ``(i) Notification of plans.--Not later 
                          than 10 days after the date the Secretary 
                          receives a notice under section 
                          1862(b)(2)(B)(vii)(I) relating to an individual 
                          during the period the individual is enrolled in 
                          a prescription drug plan, the Secretary shall 
                          provide such notice to the plan.
                              ``(ii) Statement by plan.--
                                      ``(I) In general.--Not later than 
                                  30 days after the date a plan receives 
                                  a notice under clause (i), the plan may 
                                  provide the Secretary with a statement 
                                  of any covered part D drug for which 
                                  the plan seeks reimbursement, including 
                                  the amount of such reimbursement.
                                      ``(II) Failure to provide 
                                  statement.--The prescription drug plan 
                                  shall be deemed to have waived its 
                                  rights under subparagraph (B)--
                                              ``(aa) in the case that the 
                                          prescription drug plan does not 
                                          provide such statement by such 
                                          date, with respect to any 
                                          covered part D drug provided to 
                                          such individual with respect to 
                                          such notice; and
                                              ``(bb) in the case that the 
                                          prescription drug plan provides 
                                          such statement by such date, 
                                          with respect to any covered 
                                          part D drug provided to such 
                                          individual which was not 
                                          identified in the notice.
                              ``(iii) Inclusion of information on web 
                          site.--The Secretary shall include any covered 
                          part D drug identified by a prescription drug 
                          plan pursuant to clause (ii) within the 
                          Secretary's statement of reimbursement amount 
                          on the Web site as described in section 
                          1862(b)(2)(B)(vii).
                              ``(iv) Collection.--The Secretary may 
                          collect (on behalf of a prescription drug plan) 
                          the reimbursement amount for covered part D 
                          drugs, as identified pursuant to clause (ii), 
                          from the individual involved or the primary 
                          drug plan pursuant to the procedures set forth 
                          under section 1862(b)(2)(B)(vii). Any such 
                          amounts collected by the Secretary for covered 
                          part D drugs directly paid by the plan shall be 
                          remitted directly by the Secretary to the 
                          appropriate prescription drug plan that 
                          enrolled the individual related to the notice 
                          during the applicable time period for which 
                          such individual was enrolled, and the Secretary 
                          shall retain such amounts as were paid to the 
                          plan in subsidy for such drugs.''.
      (b) Effective Date.--The amendment made by subsection (a) shall 
  apply to drugs dispensed in years beginning more than 6 months after 
  the date of the enactment of this Act.
target: Secondary Payer Advancement, Rationalization, and Clarification Act or the SPARC Act This bill specifies&nbsp;recovery rules and timelines with respect to secondary claims responsibility under the Medicare prescription drug benefit. Current law specifies only that&nbsp;secondary payor provisions apply under the benefit in the same manner as they apply with respect to Medicare Advantage plans.
feat_title: Secondary Payer Advancement, Rationalization, and Clarification Act