,i  #aagth ,,congress  #ast ,session    
,h4 ,r4 #dhac  ,,in ,,the ,,house ,,of  
,,representatives  ,july #bi1 #bjba,mr4 
,fortenberry 7for himself and ,ms4      
,craig7 introduced the following bill2  
which was referred to the ,committee on 
,energy and ,commerce1 and in addition  
to the ,committee on ,education and     
,labor1 for a period to be subsequently 
determined by the ,speaker1 in each case
 for consideration of such provisions as
 fall within the jurisdiction of the    
committee concerned  ,a ,,bill  ,to     
limit the price of insulin drugs        
accessible for participants1            
beneficiaries1 and enrollees enrolled in
 group or individual health insurance   
coverage and group health plans and for 
uninsured individuals who have diabetes1
 and for other purposes4  #a4 ,short    
title ,this ,act may be cited as the    
,matt's ,act4  #b4 ,insulin net price   
protection  7a7 ,publishing of net price
 by manufacturers  7#a7 ,in general ,a  
manufacturer of an insulin drug shall1  

on a quarterly basis1 publish on the    
internet website of such manufacturer   
the average net price of each such      
insulin drug for the preceding calendar 
quarter4  7#b7 ,enforcement ,in the case
 that a manufacturer of an insulin drug 
fails to comply with paragraph 7#a71 a  
,federal agency or program may not make 
payment for such insulin drug of such   
until such manufacturer complies with   
such paragraph4  7b7 ,net price for     
insulin drugs for certain individuals   
7#a7 ,application to ,,phsa plans       
,subpart #a of part ,a of the ,public   
,health ,service ,act 7#db ,u4,s4,c4    
#cjj;gg et seq47 is amended by adding at
 the end the following new section3     
#bgcj4 ,net price for insulin drugs  7a7
 ,availability of net price ,with       
respect to plan years beginning on and  
after ,january #a1 #bjbb1 a health      
insurance issuer offering group or      
individual health insurance coverage    
shall provide a participant1            
beneficiary1 or enrollee who has        

diabetes access to an insulin drug at-- 
7#a7 the lesser of-- 7,a7 the #aj       
percent of the average net price for    
such drug published pursuant to section 
#b7;a7 of ,matt's ,act1 plus the average
 charges for distribution and dispensing
 described in subsection 7c7 for such   
drug2  7,b7 the coinsurance amount for  
an insulin drug under the health        
insurance coverage under which such an  
individual is a participant1            
beneficiary1 or enrollee would otherwise
 be responsible notwithstanding this    
section2 or  7,c7 #bj2 or  7#b7 #j1 in  
the case such a participant1            
beneficiary1 or enrollee is enrolled in 
a high deductible health plan 7as       
defined in section #bbc7;c77#b7 of the  
,internal ,revenue ,code of #aihf74  7b7
 ,waiver of deductible ,in applying     
subsection 7a71 such a participant1     
beneficiary1 or enrollee shall have     
access to an insulin drug without regard
 to a deductible4  7c7 ,charges for     
distributing and dispensing  7#a7 ,in   

general ,for purposes of subsection 7a71
 charges for distribution and dispensing
 described in this subsection-- 7,a7 are
 charges associated with the            
transactions1 with respect to an insulin
 drug1 between wholesalers1             
distributors1 retailers1 and pharmacies2
 and  7,b7 may not exceed #aj percent of
 the average net price of such an       
insulin drug4  7#b7 ,reporting          
requirement for plans ,in the case that 
a health insurance issuer offering group
 or individual health insurance coverage
 charges a participant1 beneficiary1 or 
enrollee for average charges for        
distribution and dispensing pursuant to 
subsection 7a77#a71 the health insurance
 issuer shall submit to the ,inspector  
,general of the ,department of ,health  
and ,human ,services information with   
respect to such charges and the amount  
of the charges4  7#c7 ,report to        
,congress by ,inspector ,general        
,beginning ,january #a1 #bjbc1 and      
annually thereafter1 the ,inspector     

,general shall review the charges       
described in paragraph 7#b7 and submit  
to ,congress a report on such on review4
  7d7 ,definitions ,in this section3    
7#a7 ,insulin  7,a7 ,in general ,the    
term insulin means a prescription drug  
containing insulin that is approved by  
the ,food and ,drug ,administration to  
improve glycemic control in patients    
with diabetes mellitus 7and may include 
any medical supplies included with such 
drug or associated with the injection of
 such drug74  7,b7 ,exclusion ,such term
 does not include any medical supplies  
that provides for the monitoring of     
insulin levels4  7#b7 ,list price ,the  
term list price has the meaning given   
the term wholesale acquisition cost in  
section #ahdg;,a7c77#f77;,b7 of the     
,social ,security ,act4  7#c7 ,net price
 ,the term net price means1 with respect
 to prescription drug coverage under    
group or individual health insurance    
coverage offered by a health insurance  
issuer1 the list price of the drug net  

all rebates1 discounts1 concessions1 and
 other adjustments applied to the cost  
paid by the health insurance issuer1 or 
by any other entity that provides       
pharmacy benefit management services    
under a contract with any such health   
insurance issuer1 regardless of whether 
such adjustments are prospective or     
retrospective4  7#d7 ,prescription drug 
,the term prescription drug mean a drug1
 as defined in section #bja7;g7 of the  
,federal ,food1 ,drug1 and ,cosmetic    
,act1 that is subject to section        
#ejc7;b77#a7 of such ,act4  4  7#b7     
,application to ,,erisa plans ,subpart  
,a of part #g of the ,employee          
,retirement ,income ,security ,act of   
#aigd 7#bi ,u4,s4,c4 #aahe et seq47 is  
amended by adding at the end the        
following new section 7and amending the 
table of contents accordingly73  #gjd4  
,net price for insulin drugs  7a7       
,availability of net price ,with respect
 to plan years beginning on and after   
,january #a1 #bjbb1 a group health plan 

shall provide a participant1            
beneficiary1 or enrollee who has        
diabetes access to an insulin drug at-- 
7#a7 the lesser of-- 7,a7 the #aj       
percent of the average net price for    
such drug published pursuant to section 
#b7;a7 of ,matt's ,act1 plus the average
 charges for distribution and dispensing
 described in subsection 7c7 for such   
drug2  7,b7 the coinsurance amount for  
an insulin drug under the group health  
plan which such an individual is a      
participant1 beneficiary1 or enrollee   
would otherwise be responsible          
notwithstanding this section2 or  7,c7  
#bj2 or  7#b7 #j1 in the case such a    
participant1 beneficiary1 or enrollee is
 enrolled in a high deductible health   
plan 7as defined in section #bbc7;c77#b7
 of the ,internal ,revenue ,code of     
#aihf74  7b7 ,waiver of deductible ,in  
applying subsection 7a71 such a         
participant1 beneficiary1 or enrollee   
shall have access to an insulin drug    
without regard to a deductible4  7c7    

,charges for distributing and dispensing
  7#a7 ,in general ,for purposes of     
subsection 7a71 charges for distribution
 and dispensing described in this       
subsection-- 7,a7 are charges associated
 with the transactions1 with respect to 
an insulin drug1 between wholesalers1   
distributors1 retailers1 and pharmacies2
 and  7,b7 may not exceed #aj percent of
 the average net price of such an       
insulin drug4  7#b7 ,reporting          
requirement for plans ,in the case that 
a group health plan charges a           
participant1 beneficiary1 or enrollee   
for average charges for distribution and
 dispensing pursuant to subsection      
7a77#a71 the group health plan shall    
submit to the ,inspector ,general of the
 ,department of ,health and ,human      
,services information with respect to   
such charges and the amount of the      
charges4  7#c7 ,report to ,congress by  
,inspector ,general ,beginning ,january 
#a1 #bjbc1 and annually thereafter1 the 
,inspector ,general shall review the    

charges described in paragraph 7#b7 and 
submit to ,congress a report on such on 
review4  7d7 ,definitions ,in this      
section3 7#a7 ,insulin  7,a7 ,in general
 ,the term insulin means a prescription 
drug containing insulin that is approved
 by the ,food and ,drug ,administration 
to improve glycemic control in patients 
with diabetes mellitus 7and may include 
any medical supplies included with such 
drug or associated with the injection of
 such drug74  7,b7 ,exclusion ,such term
 does not include any medical supplies  
that provides for the monitoring of     
insulin levels4  7#b7 ,list price ,the  
term list price has the meaning given   
the term wholesale acquisition cost in  
section #ahdg;,a7c77#f77;,b7 of the     
,social ,security ,act4  7#c7 ,net price
 ,the term net price means1 with respect
 to prescription drug coverage under a  
group health plan 1 the list price of   
the drug net all rebates1 discounts1    
concessions1 and other adjustments      
applied to the cost paid by the group   

health plan1 or by any other entity that
 provides pharmacy benefit management   
services under a contract with any such 
group health plan1 regardless of whether
 such adjustments are prospective or    
retrospective4  7#d7 ,prescription drug 
,the term prescription drug mean a drug1
 as defined in section #bja7;g7 of the  
,federal ,food1 ,drug1 and ,cosmetic    
,act1 that is subject to section        
#ejc7;b77#a7 of such ,act4  4  7#c7     
,uninsured individuals  7,a7 ,in general
 ,beginning on and after ,january #a1   
#bjbb1 a pharmacy shall provide to any  
individual who has diabetes and is not  
enrolled in any health plan access to an
 insulin drug at the average net price  
for such drug published pursuant to     
subsection 7a71 plus the average charges
 for the distribution and dispensing    
described in subparagraph 7,c7 for such 
drug4  7,b7 ,review of charges          
,beginning ,january #a1 #bjbc1 and      
annually thereafter1 the ,inspector     
,general of the ,department of ,health  

and ,human ,services shall review the   
amount of charges paid by an individual 
described in subparagraph 7,a7 and      
submit to ,congress a report on such    
review4  7,c7 ,charges for distributing 
and dispensing ,for purposes of         
subparagraph 7,a71 charges for          
distribution and dispensing described in
 this subsection-- 7i7 are charges      
associated with the transactions1 with  
respect to an insulin drug1 between     
wholesalers1 distributors1 retailers1   
and pharmacies2 and  7ii7 may not exceed
 #aj percent of the average net price of
 such an insulin drug4  7,d7            
,definitions ,in this section3 7i7      
,insulin  7,i7 ,in general ,the term    
insulin means a prescription drug       
containing insulin that is approved by  
the ,food and ,drug ,administration to  
improve glycemic control in patients    
with diabetes mellitus 7and may include 
any medical supplies included with such 
drug or associated with the injection of
 such drug74  7,,ii7 ,exclusion ,such   

term does not include any medical       
supplies that provides for the          
monitoring of insulin levels4  7ii7     
,list price ,the term list price has the
 meaning given the term wholesale       
acquisition cost in section             
#ahdg;,a7c77#f77;,b7 of the ,social     
,security ,act 7#db ,u4,s4,c4           
#aciew-#c;a7c77#f77;,b774  7iii7 ,net   
price ,the term net price means1 with   
respect to prescription drug coverage   
under a group health plan 1 the list    
price of the drug net all rebates1      
discounts1 concessions1 and other       
adjustments applied to the cost paid by 
the group health plan1 or by any other  
entity that provides pharmacy benefit   
management services under a contract    
with any such group health plan1        
regardless of whether such adjustments  
are prospective or retrospective4  7iv7 
,prescription drug ,the term            
prescription drug mean a drug1 as       
defined in section #bja7;g7 of the      
,federal ,food1 ,drug1 and ,cosmetic    

,act 7#ba ,u4,s4,c4 #cba7;g771 that is  
subject to section #ejc7;b77#a7 of such 
,act 7#ba ,u4,s4,c4 #cec7;b77#a774