,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #dfj  ,,in ,,the ,,house ,,of   
,,representatives  ,february #d1 #bjac  
,mr4 ,mc,kinley 7for himself1 ,mrs4     
,capps1 ,mrs4 ,capito1 ,mr4 ,young of   
,florida1 ,mr4 ,moran1 ,mr4 ,wolf1 ,mr4 
,tonko1 ,mr4 ,runyan1 ,mr4 ,conyers1    
,ms4 ,bonamici1 ,mr4 ,cicilline1 ,mr4   
,de,fazio1 ,mr4 ,michaud1 ,mr4 ,farr1   
,ms4 ,pingree of ,maine1 ,mr4 ,rangel1  
and ,mr4 ,crenshaw7 introduced the      
following bill2 which was referred to   
the ,committee on ,energy and ,commerce 
,a ,,bill  ,to amend title ,,xxvii of   
the ,public ,health ,service ,act to    
limit co-payment1 coinsurance1 or other 
cost-sharing requirements applicable to 
prescription drugs in a specialty drug  
tier to the dollar amount 7or its       
equivalent7 of such requirements        
applicable to prescription drugs in a   
non-preferred brand drug tier1 and for  
other purposes4  #a4 ,short title ,this 
,act may be cited as the ,patients'     
,access to ,treatments ,act of #bjac4   

#b4 ,cost-sharing requirements          
applicable to prescription drugs in a   
specialty drug tier  7a7 ,in general    
,subpart ,,ii of part ,a of title       
,,xxvii of the ,public ,health ,service 
,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is 
amended by adding at the end the        
following3  #bgai;,b4 ,cost-sharing     
requirements applicable to prescription 
drugs in a specialty drug tier  7a7     
,requirement ,a group health plan1 or a 
health insurance issuer offering group  
or individual health insurance1 that    
provides coverage for prescription drugs
 and uses a formulary or other tiered   
cost-sharing structure shall not impose 
cost-sharing requirements applicable to 
prescription drugs in a specialty drug  
tier that exceed the dollar amount 7or  
its equivalent7 of cost-sharing         
requirements applicable to prescription 
drugs in a non-preferred brand drug tier
 7or prescription drugs in a brand drug 
tier if there is no non-preferred brand 
drug tier74  7b7 ,special rule ,if a    

formulary used by a group health plan or
 a health insurance issuer offering     
group or individual health insurance    
contains more than one non-preferred    
brand drug tier1 then the requirements  
of subsection 7a7 shall be applied with 
respect to the non-preferred brand drug 
tier for which beneficiary cost-sharing 
is lowest4  7c7 ,definitions ,in this   
section3  7#a7 ,the term cost-sharing   
includes co-payment and coinsurance4    
7#b7 ,the term drug tier means1 with    
respect to a group health plan or health
 insurance issuer offering group or     
individual health insurance coverage    
that uses a formulary or other          
cost-sharing structure1 a category of   
drugs--  7,a7 within such formulary or  
structure for which the total dollar    
amount of cost-sharing requirements for 
any drug does not vary by more than ten 
percent from the total dollar amount of 
cost-sharing requirements for any other 
drug2 and  7,b7 that are prescription   
drugs4  7#c7 ,the term non-preferred    

brand drug tier means1 with respect to a
 group health plan or health insurance  
issuer offering group or individual     
health insurance coverage that uses a   
formulary or other tiered cost-sharing  
structure1 a category of drugs--  7,a7  
within a drug tier in such formulary or 
structure for which beneficiary         
cost-sharing is greater than drug tiers 
for generic drugs or preferred brand    
drugs in the formulary or structure2    
7,b7 that are prescription drugs2 and   
7,c7 that are not included within a     
specialty drug tier4  7#d7 ,the term    
prescription drug means--  7,a7 a drug  
subject to section #ejc7;b77#a7 of the  
,federal ,food1 ,drug1 or ,cosmetic     
,act2 and  7,b7 includes a drug         
described in subparagraph 7,a7 that is a
 biological product 7as defined in      
section #cea7;i7 of this ,act74  7#e7   
,the term specialty drug tier means1    
with respect to a group health plan or  
health insurance issuer offering group  
or individual health insurance coverage 

that uses a formulary or other tiered   
cost-sharing structure1 a category of   
drugs--  7,a7 within a drug tier in such
 formulary or structure for which       
beneficiary cost-sharing is greater than
 drug tiers for generic drugs1 preferred
 brand drugs1 or non-preferred drugs in 
the plan's formulary2 and  7,b7 that are
 prescription drugs4  4  7b7 ,effective 
date ,section #bgai;,b of the ,public   
,health ,service ,act1 as added by      
subsection 7a71 applies to plan years   
beginning on or after the date of the   
enactment of this ,act4