,,ii ,calendar ,no4 #chi #aagth         
,,congress  #b;d ,session  ,h4 ,r4 #fhcc
  ,,in ,,the ,,senate ,,of ,,the        
,,united ,,states  ,april #d            
7legislative day1 ,march #ca71          
#bjbb,received  ,may #bd1 #bjbb ,read   
the first time  ,may #be1 #bjbb,read the
 second time and placed on the calendar 
,,an ,,act  ,to amend title ,,xxvii of  
the ,public ,health ,service ,act1 the  
,internal ,revenue ,code of #aihf1 and  
the ,employee ,retirement ,income       
,security ,act of #aigd to establish    
requirements with respect to            
cost-sharing for certain insulin        
products1 and for other purposes4  #a4  
,short title ,this ,act may be cited as 
the ,affordable ,insulin ,now ,act4  #b4
 ,requirements with respect to          
cost-sharing for insulin products  7a7  
,,phsa ,part ,d of title ,,xxvii of the 
,public ,health ,service ,act 7#db      
,u4,s4,c4 #cjj;gg-#aaa et seq47 is      
amended by adding at the end the        
following new section3  #bgii;,a-#aa4   

,requirements with respect to           
cost-sharing for certain insulin        
products  7a7 ,in general ,for plan     
years beginning on or after ,january #a1
 #bjbc1 a group health plan or health   
insurance issuer offering group or      
individual health insurance coverage    
shall provide coverage of selected      
insulin products and1 with respect to   
such products1 shall not-- 7#a7 apply   
any deductible2 or  7#b7 impose any     
cost-sharing in excess of the lesser of1
 per #cj-;day supply-- 7,a7 #ce2 or     
7,b7 the amount equal to #be percent of 
the negotiated price of the selected    
insulin product net of all price        
concessions received by or on behalf of 
the plan or coverage1 including price   
concessions received by or on behalf of 
third-party entities providing services 
to the plan or coverage1 such as        
pharmacy benefit management services4   
7b7 ,definitions ,in this section3 7#a7 
,selected insulin products ,the term    
selected insulin products means at least

 one of each dosage form 7such as vial1 
pump1 or inhaler dosage forms7 of each  
different type 7such as rapid-acting1   
short-acting1 intermediate-acting1      
long-acting1 ultra long-acting1 and     
premixed7 of insulin 7as defined below71
 when available1 as selected by the     
group health plan or health insurance   
issuer4  7#b7 ,insulin defined ,the term
 insulin means insulin that is licensed 
under subsection 7a7 or 7k7 of section  
#cea and continues to be marketed under 
such section1 including any insulin     
product that has been deemed to be      
licensed under section #cea7;a7 pursuant
 to section #gjjb7;e77#d7 of the        
,biologics ,price ,competition and      
,innovation ,act of #bjji and continues 
to be marketed pursuant to such         
licensure4  7c7 ,out-of-,network        
providers ,nothing in this section      
requires a plan or issuer that has a    
network of providers to provide benefits
 for selected insulin products described
 in this section that are delivered by  

an out-of-network provider1 or precludes
 a plan or issuer that has a network of 
providers from imposing higher          
cost-sharing than the levels specified  
in subsection 7a7 for selected insulin  
products described in this section that 
are delivered by an out-of-network      
provider4  7d7 ,rule of construction    
,subsection 7a7 shall not be construed  
to require coverage of1 or prevent a    
group health plan or health insurance   
coverage from imposing cost-sharing     
other than the levels specified in      
subsection 7a7 on1 insulin products that
 are not selected insulin products1 to  
the extent that such coverage is not    
otherwise required and such cost-sharing
 is otherwise permitted under ,federal  
and applicable ,state law4  7e7         
,application of cost-,sharing towards   
deductibles and out-of-,pocket maximums 
,any cost-sharing payments made pursuant
 to subsection 7a77#b7 shall be counted 
toward any deductible or out-of-pocket  
maximum that applies under the plan or  

coverage4  4  7b7 ,,irc  7#a7 ,in       
general ,subchapter ,b of chapter #ajj  
of the ,internal ,revenue ,code of #aihf
 is amended by adding at the end the    
following new section3  #ihbf4          
,requirements with respect to           
cost-sharing for certain insulin        
products  7a7 ,in general ,for plan     
years beginning on or after ,january #a1
 #bjbc1 a group health plan shall       
provide coverage of selected insulin    
products and1 with respect to such      
products1 shall not-- 7#a7 apply any    
deductible2 or  7#b7 impose any         
cost-sharing in excess of the lesser of1
 per #cj-;day supply-- 7,a7 #ce2 or     
7,b7 the amount equal to #be percent of 
the negotiated price of the selected    
insulin product net of all price        
concessions received by or on behalf of 
the plan1 including price concessions   
received by or on behalf of third-party 
entities providing services to the plan1
 such as pharmacy benefit management    
services4  7b7 ,definitions ,in this    

section3 7#a7 ,selected insulin products
 ,the term selected insulin products    
means at least one of each dosage form  
7such as vial1 pump1 or inhaler dosage  
forms7 of each different type 7such as  
rapid-acting1 short-acting1             
intermediate-acting1 long-acting1 ultra 
long-acting1 and premixed7 of insulin   
7as defined below71 when available1 as  
selected by the group health plan4  7#b7
 ,insulin defined ,the term insulin     
means insulin that is licensed under    
subsection 7a7 or 7k7 of section #cea of
 the ,public ,health ,service ,act and  
continues to be marketed under such     
section1 including any insulin product  
that has been deemed to be licensed     
under section #cea7;a7 of such ,act     
pursuant to section #gjjb7;e77#d7 of the
 ,biologics ,price ,competition and     
,innovation ,act of #bjji and continues 
to be marketed pursuant to such         
licensure4  7c7 ,out-of-,network        
providers ,nothing in this section      
requires a plan that has a network of   

providers to provide benefits for       
selected insulin products described in  
this section that are delivered by an   
out-of-network provider1 or precludes a 
plan that has a network of providers    
from imposing higher cost-sharing than  
the levels specified in subsection 7a7  
for selected insulin products described 
in this section that are delivered by an
 out-of-network provider4  7d7 ,rule of 
construction ,subsection 7a7 shall not  
be construed to require coverage of1 or 
prevent a group health plan from        
imposing cost-sharing other than the    
levels specified in subsection 7a7 on1  
insulin products that are not selected  
insulin products1 to the extent that    
such coverage is not otherwise required 
and such cost-sharing is otherwise      
permitted under ,federal and applicable 
,state law4  7e7 ,application of        
cost-,sharing towards deductibles and   
out-of-,pocket maximums ,any            
cost-sharing payments made pursuant to  
subsection 7a77#b7 shall be counted     

toward any deductible or out-of-pocket  
maximum that applies under the plan4  4 
7#b7 ,clerical amendment ,the table of  
sections for subchapter ,b of chapter   
#ajj of the ,internal ,revenue ,code of 
#aihf is amended by adding at the end   
the following new item3  ,sec4 #ihbf4   
,requirements with respect to           
cost-sharing for certain insulin        
products4  4  7c7 ,,erisa  7#a7 ,in     
general ,subpart ,b of part #g of       
subtitle ,b of title ,i 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        
following3  #gbf4 ,requirements with    
respect to cost-sharing for certain     
insulin products  7a7 ,in general ,for  
plan years beginning on or after        
,january #a1 #bjbc1 a group health plan 
or health insurance issuer offering     
group health insurance coverage shall   
provide coverage of selected insulin    
products and1 with respect to such      
products1 shall not-- 7#a7 apply any    

deductible2 or  7#b7 impose any         
cost-sharing in excess of the lesser of1
 per #cj-;day supply-- 7,a7 #ce2 or     
7,b7 the amount equal to #be percent of 
the negotiated price of the selected    
insulin product net of all price        
concessions received by or on behalf of 
the plan or coverage1 including price   
concessions received by or on behalf of 
third-party entities providing services 
to the plan or coverage1 such as        
pharmacy benefit management services4   
7b7 ,definitions ,in this section3 7#a7 
,selected insulin products ,the term    
selected insulin products means at least
 one of each dosage form 7such as vial1 
pump1 or inhaler dosage forms7 of each  
different type 7such as rapid-acting1   
short-acting1 intermediate-acting1      
long-acting1 ultra long-acting1 and     
premixed7 of insulin 7as defined below71
 when available1 as selected by the     
group health plan or health insurance   
issuer4  7#b7 ,insulin defined ,the term
 insulin means insulin that is licensed 

under subsection 7a7 or 7k7 of section  
#cea of the ,public ,health ,service    
,act and continues to be marketed under 
such section1 including any insulin     
product that has been deemed to be      
licensed under section #cea7;a7 of such 
,act pursuant to section #gjjb7;e77#d7  
of the ,biologics ,price ,competition   
and ,innovation ,act of #bjji and       
continues to be marketed pursuant to    
such licensure4  7c7 ,out-of-,network   
providers ,nothing in this section      
requires a plan or issuer that has a    
network of providers to provide benefits
 for selected insulin products described
 in this section that are delivered by  
an out-of-network provider1 or precludes
 a plan or issuer that has a network of 
providers from imposing higher          
cost-sharing than the levels specified  
in subsection 7a7 for selected insulin  
products described in this section that 
are delivered by an out-of-network      
provider4  7d7 ,rule of construction    
,subsection 7a7 shall not be construed  

to require coverage of1 or prevent a    
group health plan or health insurance   
coverage from imposing cost-sharing     
other than the levels specified in      
subsection 7a7 on1 insulin products that
 are not selected insulin products1 to  
the extent that such coverage is not    
otherwise required and such cost-sharing
 is otherwise permitted under ,federal  
and applicable ,state law4  7e7         
,application of cost-,sharing towards   
deductibles and out-of-,pocket maximums 
,any cost-sharing payments made pursuant
 to subsection 7a77#b7 shall be counted 
toward any deductible or out-of-pocket  
maximum that applies under the plan or  
coverage4  4  7#b7 ,clerical amendment  
,the table of contents in section #a of 
the ,employee ,retirement ,income       
,security ,act of #aigd 7#bi ,u4,s4,c4  
#ajja et seq47 is amended by inserting  
after the item relating to section #gbe 
the following3  ,sec4 #gbf4             
,requirements with respect to           
cost-sharing for certain insulin        

products4  4  7d7 ,no effect on other   
cost-,sharing ,section #acjb7;d77#b7 of 
the ,patient ,protection and ,affordable
 ,care ,act 7#db ,u4,s4,c4              
#ahjbb7;d77#b77 is amended by adding at 
the end the following new subparagraph3 
7,d7 ,special rule relating to insulin  
coverage ,the exemption of coverage of  
selected insulin products 7as defined in
 section #bgii;,a-#aa7;b7 of the ,public
 ,health ,service ,act7 from the        
application of any deductible pursuant  
to section #bgii;,a-#aa7;a77#a7 of such 
,act1 section #gbf7;a77#a7 of the       
,employee ,retirement ,income ,security 
,act of #aigd1 or section #ihbf7;a77#a7 
of the ,internal ,revenue ,code of #aihf
 shall not be considered when           
determining the actuarial value of a    
qualified health plan under this        
subsection4  4  7e7 ,coverage of certain
 insulin products under catastrophic    
plans ,section #acjb7;e7 of the ,patient
 ,protection and ,affordable ,care ,act 
7#db ,u4,s4,c4 #ahjbb7;e77 is amended by

 adding at the end the following3  7#d7 
,coverage of certain insulin products   
7,a7 ,in general ,notwithstanding       
paragraph 7#a77;,b77i71 a health plan   
described in paragraph 7#a7 shall       
provide coverage of selected insulin    
products1 in accordance with section    
#bgii;,a-#aa of the ,public ,health     
,service ,act1 before an enrolled       
individual has incurred1 during a plan  
year1 cost-sharing expenses in an amount
 equal to the annual limitation in      
effect under subsection 7c77#a7 for the 
plan year4  7,b7 ,terminology ,for      
purposes of subparagraph 7,a7-- 7i7 the 
term selected insulin products has the  
meaning given such term in section      
#bgii;,a-#aa7;b7 of the ,public ,health 
,service ,act2 and  7ii7 the            
requirements of section #bgii;,a-#aa of 
such ,act shall be applied by deeming   
each reference in such section to       
individual health insurance coverage to 
be a reference to a plan described in   
paragraph 7#a74  4  7f7 ,implementation 

,the ,secretary of ,health and ,human   
,services1 the ,secretary of ,labor1 and
 the ,secretary of the ,treasury may    
implement the provisions of1 including  
the amendments made by1 this section    
through sub-regulatory guidance1 program
 instruction1 or otherwise4  #c4        
,appropriate cost-sharing for certain   
insulin products under ,medicare part ,d
  7a7 ,in general ,section #ahfj;,d-#b  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #aciew-#ajb7 is amended-- 7#a7
 in subsection 7b7-- 7,a7 in paragraph  
7#a77;,a71 by striking ,the coverage and
 inserting ,subject to paragraph 7#h71  
the coverage2  7,b7 in paragraph 7#b7-- 
7i7 in subparagraph 7,a71 by striking   
and 7,d7 and inserting and 7,d7 and     
paragraph 7#h72  7ii7 in subparagraph   
7,b71 by striking and 7,d7 and inserting
 and 7,d7 and paragraph 7#h72  7iii7 in 
subparagraph 7,c77i71 by striking       
paragraph 7#d7 and inserting paragraphs 
7#d7 and 7#h72 and  7iv7 in subparagraph
 7,d77i71 by striking paragraph 7#d7 and

 inserting paragraphs 7#d7 and 7#h72    
7,c7 in paragraph 7#c77;,a71 by striking
 and 7#d7 and inserting 7#d71 and 7#h72 
7,d7 in paragraph 7#d77;,a77i71 by      
striking ,the coverage and inserting    
,subject to paragraph 7#h71 the         
coverage2 and  7,e7 by adding at the end
 the following new paragraph3  7#h7     
,treatment of cost-sharing for certain  
insulin products  7,a7 ,in general ,for 
plan years beginning on or after        
,january #a1 #bjbc1 with respect to an  
individual1 the following shall apply   
with respect to any insulin product 7as 
defined in subparagraph 7,b77 that is   
covered under the prescription drug plan
 or ,,ma-,,pd plan in which the         
individual is enrolled3 7i7 ,no         
application of deductible ,the          
deductible under paragraph 7#a7 shall   
not apply with respect to such insulin  
product4  7ii7 ,application of          
cost-sharing  7,i7 ,in general ,the     
coverage provides benefits for such     
insulin product1 regardless of whether  

an individual has reached the initial   
coverage limit under paragraph 7#c7 or  
the out-of-pocket threshold under       
paragraph 7#d71 with cost-sharing for a 
one-month supply that is equal to the   
applicable copayment amount4  7,,ii7    
,applicable copayment amount ,for       
purposes of this clause1 the term       
applicable copayment amount means1 with 
respect to an insulin product under a   
prescription drug plan or an ,,ma-,,pd  
plan1 an amount that is not more than   
#ce4  7,b7 ,insulin product ,for        
purposes of this paragraph1 the term    
insulin product means a covered part ,d 
drug that is an insulin product that is 
approved under section #eje of the      
,federal ,food1 ,drug1 and ,cosmetic    
,act or licensed under section #cea of  
the ,public ,health ,service ,act and   
marketed pursuant to such approval or   
licensure1 including any insulin product
 that has been deemed to be licensed    
under section #cea of the ,public       
,health ,service ,act pursuant to       

section #gjjb7;e77#d7 of the ,biologics 
,price ,competition and ,innovation ,act
 of #bjji and marketed pursuant to such 
section4  2 and  7#b7 in subsection 7c71
 by adding at the end the following new 
paragraph3  7#d7 ,treatment of          
cost-sharing for insulin products ,the  
coverage is provided in accordance with 
subsection 7b77#h74  4  7b7 ,conforming 
amendments to cost-,sharing for         
low-,income individuals ,section        
#ahfj;,d-#ad7;a7 of the ,social         
,security ,act 7#db ,u4,s4,c4           
#aciew-#aad7;a77 is amended-- 7#a7 in   
paragraph 7#a7-- 7,a7 in subparagraph   
7,d77iii71 by adding at the end the     
following new sentence3 ,for plan year  
#bjbc and subsequent plan years1 the    
copayment amount applicable under the   
preceding sentence for a one-month      
supply of an insulin product 7as defined
 in subparagraph 7,b7 of section        
#ahfj;,d-#b7;b77#h77 dispensed to the   
individual may not exceed the applicable
 copayment amount 7as defined in        

subparagraph 7,a77ii77,,ii7 of such     
section7 for the product under the      
prescription drug plan or ,,ma-,,pd plan
 in which the individual is enrolled42  
and  7,b7 in subparagraph 7,e71 by      
inserting the following before the      
period at the end or under section      
#ahfj;,d-#b7;b77#h7 in the case of an   
insulin product 7as defined in          
subparagraph 7,b7 of such section72 and 
7#b7 in paragraph 7#b7-- 7,a7 in        
subparagraph 7,b71 by adding at the end 
the following new sentence3 ,for plan   
year #bjbc and subsequent plan years1   
the annual deductible applicable under  
such section1 including as reduced under
 the preceding sentence1 shall not apply
 with respect to an insulin product 7as 
defined in subparagraph 7,b7 of section 
#ahfj;,d-#b7;b77#h77 dispensed to the   
individual42  7,b7 in subparagraph 7,d71
 by adding at the end the following new 
sentence3 ,for plan year #bjbc and      
subsequent plan years1 the amount of the
 coinsurance applicable under the       

preceding sentence for a one-month      
supply of an insulin product 7as defined
 in subparagraph 7,b7 of section        
#ahfj;,d-#b7;b77#h77 dispensed to the   
individual may not exceed the applicable
 copayment amount 7as defined in        
subparagraph 7,a77ii77,,ii7 of such     
section7 for the product under the      
prescription drug plan or ,,ma-,,pd plan
 in which the individual is enrolled42  
and  7,c7 in subparagraph 7,e71 by      
adding at the end the following new     
sentence3 ,for plan year #bjbc and      
subsequent plan years1 the amount of the
 copayment or coinsurance applicable    
under the preceding sentence for a      
one-month supply of an insulin product  
7as defined in subparagraph 7,b7 of     
section #ahfj;,d-#b7;b77#h77 dispensed  
to the individual may not exceed the    
applicable copayment amount 7as defined 
in subparagraph 7,a77ii77,,ii7 of such  
section7 for the product under the      
prescription drug plan or ,,ma-,,pd plan
 in which the individual is enrolled4   

7c7 ,implementation ,notwithstanding any
 other provision of law1 the ,secretary 
of ,health and ,human ,services shall   
implement this section for plan years   
#bjbc and #bjbd by program instruction  
or otherwise4  #d4 ,one year-extension  
on moratorium on implementation of rule 
relating to eliminating the             
anti-kickback statute safe harbor       
protection for prescription drug rebates
 ,section #ijjjf of the ,infrastructure 
,investment and ,jobs ,act 7,p4,l4      
#aag-eh7 is amended by striking ,january
 #a1 #bjbf and inserting ,january #a1   
#bjbg4  #e4 ,medicare ,improvement ,fund
 ,section #ahih7;b77#a7 of the ,social  
,security ,act 7#db ,u4,s4,c4           
#acie;iii7b77#a771 as amended by section
 #cac of division ,p of the             
,consolidated ,appropriations ,act1     
#bjbb1 is amended by striking #e1jjj1jjj
 and inserting #i1jdf1ejj1jjj4  ,passed 
the ,house of ,representatives ,march   
#ca1 #bjbb4;,cheryl ,l4 ,johnson1,clerk4
  ,may #be1 #bjbb,read the second time  

and placed on the calendar