,i  #aae? ,,congress  #b;d ,session  ,h4
 ,r4 #gjja  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,septemb] #bh1        
#bjah,mr4 ,o',hall]an introduc$ ! foll[+
 bill2 :i* 0 ref]r$ to ! ,committee on  
,en]gy & ,comm]ce1 & 9 addition to !    
,committee on ,ways & ,means1 = a p]iod 
to be subsequ5tly det]m9$ by ! ,speak]1 
9 ea* case = consid]ation ( su*         
provisions z fall )9 ! jurisdiction ( ! 
committee conc]n$  ,a ,,bill  ,to am5d  
title ,,xviii ( ! ,social ,security ,act
 to provide = a comb9$ ,m$ic>e "p ,b &  
,d drug out-(-pocket co/s limitation4   
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,capp$ ,all[able ,paym5ts f ,s5iors = 
,prescriptions ,act or ! ,,caps =       
,prescriptions ,act4  #b4 ,limit+       
,m$ic>e "p ,b & ,d drug out-(-pocket    
co/s  7a7 ,m$ic>e comb9$ "p ,b & ,d drug
 ,,oop cata/rophic limit & "p ,d        
subsidies ,"p ,d ( title ,,xviii ( !    
,social ,security ,act is am5d$ by      
ins]t+ aft] section #ahfj;,d-#ad;,a 7#db
 ,u4,s4,c4 #aciew-#aad;a7 ! foll[+ new  

section3  #ahfj;,d-#ad;,b4 ,m$ic>e drug 
out-(-pocket limit subsidies  7a7 ,9    
g5]al ,= plan ye> #bjba & ea* subsequ5t 
plan ye>1 9 ! case ( a "p ,d eligible   
individual enroll$ 9 a prescription drug
 plan "u ?is "p = su* ye>--  7#a7 if    
dur+ su* ye> su* individual becomes a   
cata/rophic limit subsidy eligible      
individual1 su* individual is entitl$ to
 ! elim9ation ( any b5efici>y co9surance
 describ$ 9 section #ahfj;,d-#b7;b77#b7 
= cov]$ "p ,d drugs furni%$ to su*      
individual dur+ ! rema9d] ( su* ye>2 &  
7#b7 ! ,secret>y %all provide = paym5t  
to ! ,,pdp sponsor t (f]s su*           
prescription drug plan ( a cata/rophic  
limit cov]age subsidy 7calculat$ "u     
subsection 7b77 9 accordance ) ?is      
section = su* individual & rema9d] ( su*
 ye>4  7b7 ,cata/rophic limit cov]age   
subsidy am\nt ,= purposes ( ?is section1
 a cata/rophic limit cov]age subsidy1 ) 
respect to a cata/rophic limit subsidy  
eligible individual enroll$ = cov]age "u
 ?is "p 9 a prescription drug plan = a  

plan ye>1 %all be calculat$ z an am\nt  
7or am\nts7 equal to any co/-%>+ am\nt  
t--  7#a7 w\ld o!rwise apply )\t        
application ( subsection 7a77#a7 to su* 
individual "u su* cov]age = cov]$ "p ,d 
drugs furni%$ to su* individuals dur+   
su* ye>2 b  7#b7 does n apply to su*    
individual ) application ( subsection   
7a77#a74  ,su* subsidy may be paid 9 su*
 mann] & at su* times z specifi$ by !   
,secret>y4  7c7 ,cata/rophic limit      
subsidy eligible individual ,= purposes 
( ?is section1 ! t]m cata/rophic limit  
subsidy eligible individual means1 )    
respect to a prescription drug plan "u  
?is "p & plan ye>1 a "p ,d eligible     
individual enroll$ 9 su* plan = su* ye> 
:o has incurr$ out-(-pocket co/s        
describ$ 9 subsection 7e7 = eligible    
,m$ic>e drugs furni%$ to su* individual 
dur+ su* ye> above ! ,,oop drug         
cata/rophic limit specifi$ 9 subsection 
7d7 = su* ye>4  7d7 ,,oop drug          
cata/rophic limit ,= purposes ( ?is "p1 
! ,,oop drug cata/rophic limit specifi$ 

9 ?is subsection is-- 7#a7 = plan ye>   
#bjba1 #b1fjj2 &  7#b7 = a subsequ5t    
plan ye>1 ! doll> am\nt appli$ "u ?is   
subsection = ! previ\s plan ye>1        
increas$ by ! annual p]c5tage increase 9
 av]age p] capita aggregate exp5ditures 
= cov]$ "p ,d drugs 9 ! ,unit$ ,/ates = 
"p ,d eligible individuals1 z det]m9$ by
 ! ,secret>y = ! #ab-mon? p]iod end+ 9  
,july ( ! previ\s ye> us+ su* me?ods z !
 ,secret>y %all specify4  7e7           
,out-(-,pocket co/s describ$  7#a7 ,9   
g5]al ,= purposes ( ?is section-- 7,a7  
incurr$ out-(-pocket co/s %all only     
include--  7i7 co/s incurr$ ) respect to
 cov]$ "p ,d drugs = ! annual d$uctible 
describ$ 9 p>agraph 7#a71 = co/-%>+     
describ$ 9 p>agraph 7#b71 & = am\nts =  
:i* b5efits are n provid$ because ( !   
application ( ! initial cov]age limit   
describ$ 9 p>agraph 7#c71 b does n      
include any co/s incurr$ = cov]$ "p ,d  
drugs :i* are n includ$ 7or treat$ z be+
 includ$7 9 ! plan's =mul>y2 &  7ii7    
co/s1 det]m9$ bas$ on submitt$ claims & 

)\t reg>d to any d$uctible "u "p ,b1    
incurr$ = co/-%>+ "u su* "p = "p ,b     
drugs describ$ 9 subsection             
7g77#a77;,b72  7,b7 subject to          
subp>agraph 7,c71 su* co/s %all be      
treat$ z incurr$ only if !y are paid by 
! "p ,d eligible individual 7or by ano!r
 p]son1 su* z a family memb]1 on behalf 
( ! individual7 & ! "p ,d eligible      
individual 7or o!r p]son7 is n reimburs$
 ?r\gh insurance or o!rwise1 a gr\p     
heal? plan1 or o!r ?ird-p>ty paym5t     
arrangem5t 7o!r ?an "u su* section or   
su* a ,program7 = su* co/s2 &  7,c7 su* 
co/s %all be treat$ z incurr$ & %all n  
be consid]$ to be reimburs$ "u          
subp>agraph 7,b7 if su* co/s are borne  
or paid--  7i7 "u section #ahfj;,d-#ad2 
7ii7 "u a ,/ate ,ph>maceutical          
,assi/ance ,program2  7iii7 by ! ,indian
 ,heal? ,s]vice1 an ,indian tribe or    
tribal organization1 or an urban ,indian
 organization 7z def9$ 9 section #d ( ! 
,indian ,heal? ,c>e ,improvem5t ,act72  
or  7iv7 "u an ,,aids ,drug ,assi/ance  

,program "u "p ,b ( title ,,xxvi ( !    
,public ,heal? ,s]vice ,act4  7#b7      
,in=mation ex*ange ,! provisions (      
section #ahfj;,d-#b7;b77#d77;,d7 %all   
apply = purposes ( ?is subsection 9 !   
same mann] z su* provisions apply =     
purposes ( section #ahfj;,d-#b7;b77#d74 
7f7 ,coord9ation ,! ,secret>y %all      
provide = su* proc$ures z is necess>y1  
includ+ by requir+ submission (         
in=mation f ,,pdp sponsors1 to implem5t 
! provisions ( ?is section & apply !    
,,oop drug cata/rophic limit applicable 
to co/s incurr$ = eligible ,m$ic>e drugs
 = purposes ( cov]age ( su* drugs "u "p 
,b & ?is "p4  7g7 ,eligible ,m$ic>e     
drugs  7#a7 ,9 g5]al ,= purposes ( ?is  
section1 ! t]m eligible ,m$ic>e drug    
means any ( ! foll[+3 7,a7 ,a cov]$ "p  
,d drug4  7,b7 ,subject to p>agraph     
7#b71 a drug or biological paid = "u    
section #ahcc7t71 #ahdg1 #ahdg;,a1 or   
#ahdg;,b4  7#b7 ,exception ,a drug or   
biological describ$ 9 p>agraph 7#a77;,b7
 does n include a drug or biological    

furni%$ z "p ( a gr\p+ ( items & s]vices
 & paid = z su* a gr\p+ 9 an ambulatory 
paym5t classification "u section        
#ahcc7t7 7in/ead ( sep>ately payable "u 
su* section74  4  7b7 ,application (    
,,oop drug cata/rophic limit "u "p ,b   
,section #ahcc ( ! ,social ,security    
,act-- 7#a7 9 subsection 7a77#a77,s71 by
 ins]t+ subject to subsection 7bb71 be=e
 ! am\nts paid2  7#b7 by r$esignat+ !   
subsection 7z71 relat+ to m$ical review 
( sp9al subluxation s]vices1 z          
subsection 7aa72 &  7#c7 by add+ at !   
end ! foll[+ new subsection3  7bb7      
,application ( ,,oop drug cata/rophic   
limit ,if an individual cov]$ "u ?is "p 
incurs out-(-pocket co/s describ$ 9     
subsection 7e7 ( section #ahfj;,d-#ad;,b
 = eligible ,m$ic>e drugs 7z def9$ 9    
subsection 7g7 ( su* section7 furni%$ to
 su* individual dur+ a ye> t equals !   
,,oop drug cata/rophic limit specifi$ 9 
subsection 7d7 ( su* section = su* ye>1 
subsection 7a77#a77,s7 %all be appli$ ) 
respect to exp5ses incurr$ = eligible   

,m$ic>e drugs describ$ 9 subsection     
7g77#a77;,b7 ( su* section furni%$ to   
su* individual dur+ ! rema9d] ( ! ye> z 
if ! ref]5ce 9 su* subsection           
7a77#a77,s7 to #hj p]c5t 7 a ref]5ce to 
#ajj p]c5t4  4  7c7 ,premium hold       
h>mless  7#a7 ,9 g5]al ,section         
#ahci7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acier7a77#a77 is am5d$ 
by ins]t+ 1 paym5ts "u section          
#ahfj;,d-#ad;,b1 additional paym5ts by  
reason ( application ( section          
#ahcc7;bb71 aft] section #ahec7l77#c74  
7#b7 ,paym5t ,section #ahdd7;a7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#aciew7a77 is am5d$-- 7,a7 9 p>agraph   
7#c71 by /rik+ ! p]iod at ! end & ins]t+
 2 plus2 &  7,b7 by ins]t+ aft] p>agraph
 7#c7 ! foll[+ new p>agraph3  7#d7 a    
,gov]nm5t contribution equal to ! am\nt 
( cata/rophic limit cov]age subsidies   
payable "u section #ahfj;,d-#ad;,b &    
additional paym5ts by reason (          
application ( section #ahcc7;bb74  4    
7d7 ,con=m+ am5dm5ts ,section           

#ahfj;,d-#b7;b7 ( ! ,social ,security   
,act-- 7#a7 9 p>agraph 7#b77;,a71 by    
ins]t+ & section #ahfj;,d-#ad;,b aft]   
subp>agraphs 7,c7 & 7,d72  7#b7 9       
p>agraph 7#b77;,c77i71 by ins]t+ &      
subject to section #ahfj;,d-#ad;,b aft] 
p>agraph7#d72  7#c7 9 p>agraph          
7#b77;,d77i71 by ins]t+ & subject to    
section #ahfj;,d-#ad;,b aft]            
p>agraph7#d72  7#d7 9 p>agraph          
7#c77;,a71 by /rik+ & 7#d7 & ins]t+ &   
7#d7 & subject to section               
#ahfj;,d-#ad;,b2 &  7#e7 9 p>agraph     
7#d77;,a77i71 by ins]t+ subject to      
section #ahfj;,d-#ad;,b1 aft]           
subp>agraph 7,b714