text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Accessing Medicare Therapies Act of 
  2013''.
  
  SEC. 2. COUNTING THE NEGOTIATED PRICE OF DRUGS PROVIDED FREE OR AT 
                NOMINAL CHARGE UNDER COMPASSIONATE TREATMENT PROGRAMS 
                TOWARDS INCURRED OUT-OF-POCKET COSTS.
  
      (a) In General.--Section 1860D-2(b)(4) of the Social Security Act 
  (42 U.S.C. 1395w-102(b)(4)) is amended--
              (1) in subparagraph (C), by striking ``subparagraph (E)'' 
          and inserting ``subparagraphs (E) and (F)''; and
              (2) by adding at the end the following new subparagraph:
                      ``(F) Inclusion of negotiated price of drugs 
                  provided under compassionate treatment programs.--
                              ``(i) In general.--In applying subparagraph 
                          (A) with respect to an individual enrolled in a 
                          prescription drug plan, incurred costs shall 
                          include the negotiated price described in 
                          clause (ii) of a covered part D drug if--
                                      ``(I) the drug is classified, for 
                                  purposes of applying tiered copayments 
                                  consistent with section 1860D-
                                  2(b)(2)(B), in the highest copayment 
                                  tier (such as a tier 4 for specialty 
                                  brand-name drugs);
                                      ``(II) the drug is furnished to the 
                                  individual free or at nominal charge 
                                  under a compassionate treatment program 
                                  (as defined in clause (iii)); and
                                      ``(III) the drug, if furnished 
                                  other than through such program, is 
                                  covered under the formulary of the plan 
                                  or is available through exception or 
                                  appeal.
                              ``(ii) Negotiated price.--The negotiated 
                          price described in this clause, for a covered 
                          part D drug which is dispensed to an enrollee--
                                      ``(I) by a pharmacy, is the 
                                  negotiated price at such pharmacy; or
                                      ``(II) other than by a pharmacy, is 
                                  the average negotiated price for the 
                                  drug in the prescription drug plan in 
                                  the zip code of the enrollee as of the 
                                  date the drug is dispensed.
                              ``(iii) Compassionate treatment program 
                          defined.--In this subparagraph, the term 
                          `compassionate treatment program' means, with 
                          respect to covered part D drugs, a program 
                          that--
                                      ``(I) is administered by an entity 
                                  described in section 501(c)(3) of the 
                                  Internal Revenue Code of 1986 that is 
                                  exempt from tax under section 501(a) of 
                                  such Code;
                                      ``(II) takes title to the drugs and 
                                  distributes the drugs to eligible part 
                                  D individuals free or at nominal charge 
                                  on the basis of the entity's assessment 
                                  of financial need of such individuals;
                                      ``(III) does not distribute the 
                                  drugs to an individual unless the 
                                  individual's household income (as 
                                  determined under section 36B of the 
                                  Internal Revenue Code of 1986) is less 
                                  than the maximum income level for the 
                                  taxpayer in the household to be 
                                  eligible for a refundable credit under 
                                  such section; and
                                      ``(IV) meets such additional 
                                  requirements as the Inspector General 
                                  of the Department of Health and Human 
                                  Services establishes, consistent with 
                                  guidance and advisory opinions issued 
                                  under section 1128D, to prevent fraud 
                                  or abuse in the application of this 
                                  subparagraph.''.
      (b) Effective Date.--The amendments made by subsection (a) shall 
  apply to drugs furnished in plan years beginning on or after January 1, 
  2014.
target: Accessing Medicare Therapies Act of 2013 - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act, with respect to cost-sharing under a prescription drug plan, to require incurred costs to include the negotiated price of a covered part D drug if the drug is: (1) classified in the highest copayment tier; (2) furnished to the individual free or at nominal charge under a compassionate treatment program; and (3) covered under the formulary of the plan, if the drug is furnished other than through such a program, or is available through exception or appeal.
feat_title: Accessing Medicare Therapies Act of 2013