Medicare Drug Formulary Protection Act

MMM (Regulatory Issues) Ongoing implementation issues for the Medicare Advantage and Medicare Part D prescription drug programs, including risk adjustment methodology and data issues, bidding and payment (including Part D reinsurance and low income subsidies), benefit design rules, SSA and CMS premium withhold processing issues, systems issues affecting enrollment and disenrollment processing, enrollment rules, marketing materials review and approval, measurement and oversight of plan performance, grievance and appeals processes, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education program; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval, systems issues affecting enrollment and disenrollment processing, payment and other operational issues; Medicare demonstration program on performance-based payments for physician groups; Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, grievance and appeals processes, beneficiary information requirements, and other issues affecting Medicaid health plan operations; Medicaid prescription drug cost/rebate issues affecting Medicaid health plans; health plan-related State Children’s Health Insurance Program (SCHIP) issues, including eligibility and outreach issues; and implementation of Medicaid changes made in Deficit Reduction Act of 2005, including documentation of citizenship requirements, state benefit flexibility options, and Medicaid managed care organization provider tax issues; standards for electronic prescribing; and CMS RFI concerning health information technology. H.R. 4297: “Tax Relief Extension Reconciliation Act” (Thomas); H.R. 4719: Medicare Advantage Funding (Dingell); H.R. 5166: “Independent Pharmacy Protection Act” (Wicker); H.R. 5399: “Medicare Drug Benefit Enrollment Fairness Act" (Johnson); H.R. 4939: “Emergency Supplemental Appropriations Act” (Lewis); H.R. 5647: Labor-HHS-Education Appropriations Act (Regula); H.R. 5866 "Medicare Physician Payment Reform and Quality Improvement Act" (Burgess); H.R. 6077: SCHIP Funding (Norwood); H.R. 6098 "Keep Children Covered Act" (Barrow); H.R. 6111: Medicare and Medicaid Provisions; H.R. 6164: SCHIP Funding (Barton); H.Con.Res. 376: Budget Resolution (Nussle); S. 124: Repeal of the Medicare Advantage Stabilization Fund (Feingold); S. 1356: “Medicare Value Purchasing Act” (Grassley-Baucus); S. 1778: QI-1 Extension/Ban on Coverage of ED Drugs (Grassley); S. 1932: Budget Reconciliation Bill (Gregg); S. 2255: “Medicare Drug Formulary Protection Act” (Feinstein-Collins); S. 2260: Medicare Advantage Funding (Clinton); S. 2354: “Medicare Prescription Drug Gap Reduction Act” (Nelson-Collins); S. 2409: “Home and Community Services Copayment Equity Act” (Smith-Bingaman); S. 2563: “Pharmacist Access and Recognition in Medicare Act” (Cochran); S. 2664: “Pharmacy Access Improvement Act” (Baucus); S. 2665: “Medicare Prescription Drug Simplification Act” (Baucus); S. 2810: “Medicare Late Enrollment Assistance Act” (Grassley-Baucus); S. 3647: "Prescription For Fairness Act" (Dorgan); S. 3897: "Medicare Data Access and Research Act" (Grassley); S. 3900: "Medicare Quality Enhancement Act" (Gregg); S. 3193: "Keep Children Covered Act" (Rockefeller); S. 3972: "Fair-SCHIP Act" (Grassley); S.Con.Res. 83: Budget Resolution (Gregg). MMM (Legislative Issues): H.R. 3617: “Medicare Value-Based Purchasing for Physicians' Services Act” (Johnson); H.R. 4241: Budget Reconciliation Bill (Nussle) (continued)

Client expense: $3,700,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of

H.R.752.IH, Medicare Prescription Drug Savings and Choice Act of 2005 H.R.918.IH, Medicare Prescription Drug Cost Containment Act of 2005 H.R.2685.IH, Medicare Presciption Drug Price Negotiation Act S.18.IS, Meeting our Responsibility to Medicare Beneficiaries Act of 2005 S.40.IS, Geriatric and Chronic Care Management Act of 2005 S.222.IS, Keep the Promise of Medicare Act of 2005 S.345, Medicare Prescription Drug Savings and Choice Act of 2005 (Introduced in the Senate) S.345.IS, Medicare Prescription Drug Savings and Choice Act of 2005 S.445, Medicare Prescription Drug Price Reduction Act of 2005 (Introduced in the Senate) S.581.IS, Medicare Prescription Drug Cost Containment Act of 2005 S.873.PCS, Medicare Prescription Drug Savings and Choice Act of 2005 S.1356.IS, Medicare Value Purchasing Act of 2005 S.1403, Medicare Cost Contract Extension and Refinement Act of 2005 (Introduced in the Senate) S.1841, The Medicare Informed Choice Act of 2005 (Introduced in the Senate) S.1589, Affordability in Medicare Premiums Act of 2005 (Introduced in the Senate) S.1589,IS, Affordability in Medicare Premiums Act of 2005 S.2240, Medicare Part D Reform Act of 2006 S.2255-7, Medicare Drug Formulary Protection Act S.2354, Medicare Prescription Drug Gap Reduction Act of 2006 (Introduced in the Senate) S.2563, Pharmacist Access and Recognition in Medicare (PhARM) Act of 2006 (Introduced in the Senate) S.2665, Medicare Prescription Drug Simplification Act of 2006 S.2723, Pharmacists Medicare Relief Act of 2006 S.2759, Medicare Part D Outreach and Enrollment Enhancement Act of 2006 (Introduced in the Senate) S.3697, Medicare Health Savings Accounts Act of 2006 (Introduced in the Senate) See attached list.

Client expense: $440,000 · Firm income: Not reported

Medicare Payment and operational issues. HR 1, S.1, HR2427, S.1225, PL108-173, HR4337, S.2413, HR4304, S.2343, S.2339/HR4195, S.2810, S.2354, HR5156, S.2255, HR3617, S.2664, S.2665, S.2300, S.2357, S.2234, S.2130, S.2053, S.2076, S.1995, HR3767, HR3711, S.2563, HJ Resolution 107, S.1356, HR1932

Client expense: $1,323,170 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Treasury, Dept of

* "Pharmacy Access Improvement Act" - S 2664 A bill to amend Title XVIII of the Social Security Act to improve access to pharmacies under part D, issues relating to health plans. Sponsor: Senator Max Baucus "Bipartisan Commission on the Medicaid Act of 2005" - S 338 To provide for the establishment of a Bipartisan commission on Medicaid, issues relating to health plans. Sponsor: Senator Gordon Smith "Medicare Value Purchasing Act of 2005" - S 1356 To amend Title XVIII of the Social Security Act to provide incentives for the provision of high quality care under the Medicare program, issues relating to health plans. Sponsor: Senator Charles Grassley "Bipartisan Commission on Medicaid Act of 2005" - HR 985 To provide for the establishment of a Bipartisan Commission on Medicaid, issues relating to health plans. Sponsor: Congresswoman Heather Wilson "Medicare Cost Contract Extension and Refinement Act of 2005" - HR 4050 To amend title XVIII of the Social Security Act to extend reasonable cost contracts under Medicare, issues relating to health plan. Sponsor: Senator Ron Wyden "No Title – an amendment to the Deficit Reduction Act of 2005" - S 3590 To amend title XIX of the Social Security Act to delay the effective date of the amendments made by the Deficit Reduction Act of 2005 requiring documentation evidencing citizenship or nationality "Medicare Prescription Drug Simplification Act of 2006" - S 2665 A bill to amend Title XVIII of the Social Security Act to simplify and improve the Medicare prescription drug program, issues relating to health plans. Sponsor: Senator Max Baucus "Medicare Drug Benefit Enrollment Fairness Act of 2006" - HR 5399 To amend title XVIII of the Social Security Act to eliminate the Medicare prescription drug late enrollment penalty for months during 2006, and for other purposes, issues relating to health plans. Sponsor: Rep. Nancy Johnson for State Health Insurance Counseling Programs and area Agencies on Aging, and for other purposes, issues related to health plans. Sponsor(s) Sens. Charles Grassley and Max Baucus “Medicare Late Enrollment Assistance Act of 2006” – S 2810 To amend title XVIII of the Social Security Act to eliminate months in 2006 from the calculation of any late enrollment penalty under the Medicare Part D prescription drug program and to provide for additional funding as a condition for receipt of medical assistance under the Medicaid program, issues relating to health plans. Sponsor: Senator Daniel Akaka "Medicare Drug Formulary Protection Act of 2006" - S 2255 A bill to amend Title XVIII of the Social Security Act to prohibit removal of covered part D drugs from a prescription drug plan formulary during the plan year once an individual has enrolled in the plan, issues relating to health plans. Sponsor: Senator Diane Feinstein and organizations, and congressional support agencies, issues relating to health plans. Sponsor: Senator Ron Grassley “Federal Family Health Information Technology Act of 2006” – HR 4859 To establish electronic health records for federal workers, retirees, and their dependents, issues relating to health plans. Sponsor: Rep. Jon Porter "Medicare Data Access and Research Act" - S 3897 A bill to amend Titles XI and XVIII of the Social Security Act to provide for the sharing of certain data collected by the Centers for Medicare & Medicaid Services with certain agencies, research centers 1 2 3 4 5 6 7 8 9 10 11

HR 3617, Medicare Value-Based Purchasing for Physicians' Services Act of 2005; HR 4078, Maintaining Medicare Access Act of 2005; HR 5916, Patients' Access to Physicians Act of 2006; HR 4388, Tax Revision Act of 2005; HR 6408, Tax Relief and Health Care Act of 2006; HR 6111, Tax Relief and Health Care Act of 2006; S 1081, Preserving Patient Access to Physicians Act of 2005; S 1356, Medicare Value Purchasing Act of 2005. HR 4241, Budget Reconciliation Bill; HR 4297, Tax Relief Extension Reconciliation Act; HR 4719, Medicare Advantage Funding; HR 5166, Independent Pharmacy Protection Act; HR 5399, Medicare Drug Benefit Enrollment Fairness Act; HR 4939, Emergency Supplemental Appropriations Act; HR 5647, Labor-HHS-Education Appropriations Act; HR 5866, Medicare Physician Payment Reform and Quality Improvement Act; HR 6077, SCHIP Funding; HR 6098, Keep Children Covered Act; HR 6164, SCHIP Funding; H Con Res 376, Budget Resolution; S 124 Repeal of the Medicare Advantage Stabilization Act; S 1778, QI-1 Extension/Ban on Coverage of ED Drugs; S 1932, Budget Reconciliation Act; S 2255, Medicare Drug Formulary Protection Act; S 2260, Medicare Advantage Funding; S 2354, Medicare Prescription Drug Gap Reduction Act; S 2409, Home and Community Services Copayment Equity Act; S 2563, Pharmacist Access and Recognition in Medicare Act; S 2664, Pharmacy Access Improvement Act; S 2665, Medicare Prescription Drug Simplification Act; S 2810 Medicare Late Enrollment Assistance Act; S 3647, Prescription for Fairness Act; S 3897, Medicare Data Access and Research Act; S 3900, Medicare Quality Enhancement Act; S 3913, Keep Children Covered Act; S 3972, FAIR-SCHIP Act; S Con Res 83, Budget Resolution Implementation of Medicare Part C (Medicare Advantage) - Executive action concerning this issue. Medicare Part D - Executive action concerning this issue. Medicare update for physicians, stabilization fund - HR 2356, Preserving Patient Access to Physicians Act of 2005;

S.1356 – Medicare Value Purchasing Act S.1589 – Affordability in Medicare Premiums Act of 2005 S.18 – Meeting Our Responsibility to Medicare Beneficiaries Act of 2005 S.2072 – Medicare Early Access Act of 2005 S.2255 – Medicare Drug Formulary Protection Act S.2260 – Medicare Advantage Funding S.2354 – Medicare Prescription Drug Gap Reduction Act S.2409 – Home and Community Services Copayment Equity Act S.2563 – Pharmacist Access and Recognition in Medicare Act S.2664 – Pharmacy Access Improvement Act S.2665 – Medicare Prescription Drug Simplification Act S.2810 – Medicare Late Enrollment Assistance Act S.334 – Pharmaceutical Market Access and Drug Safety Act S.345 – Medicare Prescription Drug Savings and Choice Act of 2005 S.445 – Medicare Prescription Drug Price Reductions Act of 2005 S.566 – Medicare Dual Eligible Prescription Drug Coverage Act of 2005 S.581 – Medicare Prescription Drug Cost Containment Act of 2005 S.873 – Medicare Prescription Drug Savings and Choice Act of 2005 HR.3617 – Medicare Value-Based Purchasing for Physicians’ Services Act of 2005 HR.4557 – Medicare Prescription Drug Affordability Act of 2005 HR.5399 – Medicare Drug Benefit Enrollment Fairness Act S.124 – Repeal of the Medicare Advantage Stabilization Fund

Client expense: Not reported · Firm income: $80,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.2354 – Medicare Prescription Drug Gap Reduction Act S.2409 – Home and Community Services Copayment Equity Act S.2563 – Pharmacist Access and Recognition in Medicare Act S.2664 – Pharmacy Access Improvement Act S.2665 – Medicare Prescription Drug Simplification Act S.2810 – Medicare Late Enrollment Assistance Act S.334 – Pharmaceutical Market Access and Drug Safety Act HR.5399 – Medicare Drug Benefit Enrollment Fairness Act S.2072 – Medicare Early Access Act of 2005 S.2255 – Medicare Drug Formulary Protection Act S.2260 – Medicare Advantage Funding

Client expense: Not reported · Firm income: $75,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.18 – Meeting Our Responsibility to Medicare Beneficiaries Act of 2005 S.2255 – Medicare Drug Formulary Protection Act S.2260 – Medicare Advantage Funding S.2354 – Medicare Prescription Drug Gap Reduction Act S.2409 – Home and Community Services Copayment Equity Act S.2563 – Pharmacist Access and Recognition in Medicare Act S.2664 – Pharmacy Access Improvement Act S.2665 – Medicare Prescription Drug Simplification Act S.2810 – Medicare Late Enrollment Assistance Act S.345 – Medicare Prescription Drug Savings and Choice Act of 2005 S.445 – Medicare Prescription Drug Price Reductions Act of 2005 S.566 – Medicare Dual Eligible Prescription Drug Coverage Act of 2005 S.581 – Medicare Prescription Drug Cost Containment Act of 2005 S.873 – Medicare Prescription Drug Savings and Choice Act of 2005 HR.4557 – Medicare Prescription Drug Affordability Act of 2005 HR.5399 – Medicare Drug Benefit Enrollment Fairness Act S.1356 – Medicare Value Purchasing Act S.1589 – Affordability in Medicare Premiums Act of 2005

Client expense: Not reported · Firm income: $90,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.2260 – Medicare Advantage Funding S.2354 – Medicare Prescription Drug Gap Reduction Act S.2409 – Home and Community Services Copayment Equity Act S.2563 – Pharmacist Access and Recognition in Medicare Act S.2664 – Pharmacy Access Improvement Act S.2665 – Medicare Prescription Drug Simplification Act S.2810 – Medicare Late Enrollment Assistance Act HR.5399 – Medicare Drug Benefit Enrollment Fairness Act S.124 – Repeal of the Medicare Advantage Stabilization Fund S.1356 – Medicare Value Purchasing Act S.2255 – Medicare Drug Formulary Protection Act

Client expense: Not reported · Firm income: $105,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.2260 – Medicare Advantage Funding S.2354 – Medicare Prescription Drug Gap Reduction Act S.2409 – Home and Community Services Copayment Equity Act S.2563 – Pharmacist Access and Recognition in Medicare Act S.2664 – Pharmacy Access Improvement Act S.2665 – Medicare Prescription Drug Simplification Act S.2810 – Medicare Late Enrollment Assistance Act HR.5399 – Medicare Drug Benefit Enrollment Fairness Act S.124 – Repeal of the Medicare Advantage Stabilization Fund S.1356 – Medicare Value Purchasing Act S.2255 – Medicare Drug Formulary Protection Act

Client expense: Not reported · Firm income: $150,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.2255 – Medicare Drug Formulary Protection Act S.2260 – Medicare Advantage Funding S.2354 – Medicare Prescription Drug Gap Reduction Act S.2409 – Home and Community Services Copayment Equity Act S.2563 – Pharmacist Access and Recognition in Medicare Act S.2664 – Pharmacy Access Improvement Act S.2665 – Medicare Prescription Drug Simplification Act S.2810 – Medicare Late Enrollment Assistance Act HR.3617 – Medicare Value-Based Purchasing for Physicians’ Services Act of 2005 HR.5399 – Medicare Drug Benefit Enrollment Fairness Act S.124 – Repeal of the Medicare Advantage Stabilization Fund S.1356 – Medicare Value Purchasing Act

Client expense: Not reported · Firm income: $150,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE