,i #aaf? ,,congress #b;d ,session ,h4 ,r4 #hdfg ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,septemb] #cj1 #bjbj,mr4 ,?ompson ( ,cali=nia 7= himself & ,mr4 ,kelly ( ,p5nsylvania7 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 titles ,,xviii & ,,xix ( ! ,social ,security ,act & title ,,xxvii ( ! ,public ,heal? ,s]vice ,act to provide = cov]age ( c]ta9 drugs us$ 9 ! treatm5t or managem5t ( a r>e disease or condition1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,access to ,r>e ,indications ,act ( #bjbj4 #b4 ,cov]age ( c]ta9 drugs us$ 9 treatm5t or managem5t ( r>e disease or condition 7a7 ,m$ic>e 7#a7 ,9 g5]al ,section #ahfa7t77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7t77#b77 is am5d$-- 7,a7 9 subp>agraph 7,a71 by ins]t+ aft] regim5 ! foll[+3 1 or 9 ! treatm5t or managem5t ( a disease or condition affect+ #bjj1jjj or few] individuals 9 ! ,unit$ ,/ates12 & 7,b7 9 subp>agraph 7,b77ii7-- 7i7 9 subclause 7,i71 by /rik+ 1 or at ! end & ins]t+ a semicolon2 7ii7 9 subclause 7,,ii71 by /rik+ ! p]iod at ! end & ins]t+ 2 or2 & 7iii7 by add+ at ! end ! foll[+ new subclause3 7,,iii7 9 ! case t ! drug is us$ 9 ! treatm5t or managem5t ( a disease or condition affect+ #bjj1jjj or few] individuals 9 ! ,unit$ ,/ates1 su* use is support$ by pe]-review$ lit]ature1 cl9ical guidel9es1 or exp]t op9ion )9 ! ,national ,in/itutes ( ,heal? ,r>e ,diseases ,cl9ical ,rese>* ,network consortia or its p>ticipat+ cl9ical c5t]s4 4 7#b7 ,prohibition ( cov]age exclusions = =mul>ies "u ,m$ic>e "p ,d ,section #ahfj;,d-#d7;b77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;b77#c77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,i7 ,prohibition ( c]ta9 cov]age exclusions 7i7 ,9 g5]al ,if ! ,,pdp sponsor ( a prescription drug plan uses a =mul>y1 su* sponsor may n impose a limitation or exclusion ( b5efits ) respect to cov]age ( a r>e disease cov]$ "p ,d drug 7z def9$ 9 clause 7ii77 includ$ 9 su* =mul>y4 7ii7 ,r>e disease cov]$ "p ,d drug ,= purposes ( ?is subp>agraph1 ! t]m r>e disease cov]$ "p ,d drug means a cov]$ "p ,d drug-- 7,i7 us$ 9 ! treatm5t or managem5t ( a disease or condition affect+ #bjj1jjj or few] individuals 9 ! ,unit$ ,/ates2 & 7,,ii7 ! use ( :i* is support$ by pe]-review$ lit]ature1 cl9ical guidel9es1 or exp]t op9ion )9 ! ,national ,in/itutes ( ,heal? ,r>e ,diseases ,cl9ical ,rese>* ,network consortia or its p>ticipat+ cl9ical c5t]s4 4 7#c7 ,effective date ,! am5dm5ts made by ?is subsection apply ) respect to items & s]vices furni%$ on or aft] ! date t is #cj days aft] ! date ( ! enactm5t ( ?is ,act4 7b7 ,m$icaid 7#a7 ,9 g5]al ,section #aibg7k77#f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7k77#f77 is am5d$-- 7,a7 by /rik+ 1 or & ins]t+ a comma2 & 7,b7 by ins]t+ be=e ! p]iod ! foll[+3 1 or ! use ( :i* is relat$ to ! treatm5t or managem5t ( a disease or condition affect+ #bjj1jjj or few] individuals 9 ! ,unit$ ,/ates & is support$ by pe]-review$ lit]ature1 cl9ical guidel9es1 or exp]t op9ion )9 ! ,national ,in/itutes ( ,heal? ,r>e ,diseases ,cl9ical ,rese>* ,network consortia or its p>ticipat+ cl9ical c5t]s4 7#b7 ,prohibition ( cov]age exclusions = =mul>ies ,section #aibg7;d77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;d77#d77 is am5d$-- 7,a7 9 subp>agraph 7,c71 by /rik+ ,a cov]$ outpati5t drug & ins]t+ ,subject to subp>agraph 7,e71 a cov]$ outpati5t drug2 7,b7 by r$esignat+ subp>agraph 7,e7 z subp>agraph 7,f72 & 7,c7 by ins]t+ aft] subp>agraph 7,d7 ! foll[+ new subp>agraph3 7,e7 ,not)/&+ subp>agraph 7,c71 ! ,/ate may n impose a limitation or exclusion ( b5efits ) respect to cov]age ( a cov]$ outpati5t drug t is-- 7i7 us$ 9 ! treatm5t or managem5t ( a disease or condition affect+ #bjj1jjj or few] individuals 9 ! ,unit$ ,/ates2 & 7ii7 ! use ( :i* is support$ by pe]-review$ lit]ature1 cl9ical guidel9es1 or exp]t op9ion )9 ! ,national ,in/itutes ( ,heal? ,r>e ,diseases ,cl9ical ,rese>* ,network consortia or its p>ticipat+ cl9ical c5t]s4 4 7#c7 ,effective date ,! am5dm5ts made by ?is subsection apply ) respect to cov]$ outpati5t drugs furni%$ on or aft] ! date t is #cj days aft] ! date ( ! enactm5t ( ?is ,act4 7c7 ,private heal? insurance 7#a7 ,9 g5]al ,subp>t ,,ii ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #bgcj4 ,cov]age ( c]ta9 drugs us$ 9 treatm5t or managem5t ( r>e disease or condition 7a7 ,9 g5]al ,a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all provide cov]age = a drug-- 7#a7 approv$ by ! ,food & ,drug ,adm9i/ration2 7#b7 us$ 9 ! treatm5t or managem5t ( a disease or condition affect+ #bjj1jjj or few] individuals 9 ! ,unit$ ,/ates2 & 7#c7 ! use ( :i* is support$ by pe]-review$ lit]ature1 cl9ical guidel9es1 or exp]t op9ion )9 ! ,national ,in/itutes ( ,heal? ,r>e ,diseases ,cl9ical ,rese>* ,network consortia or its p>ticipat+ cl9ical c5t]s4 7b7 ,prohibition ( c]ta9 cov]age exclusions ,a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age may n impose a limitation or exclusion ( b5efits ) respect to cov]age ( a drug describ$ 9 subsection 7a7 o!r ?an a limitation or exclusion ( b5efits ) respect to a use ( su* drug id5tifi$ z contra9dicat$ by ! ,food & ,drug ,adm9i/ration4 4 7#b7 ,effective date ,! am5dm5t made by ?is subsection applies ) respect to plan ye>s beg9n+ on or aft] ! date t is #cj days aft] ! date ( ! enactm5t ( ?is ,act4