,,ii ,cal5d> ,no4 #chi #aag? ,,congress 
#b;d ,session  ,h4 ,r4 #fhcc  ,,9 ,,!   
,,s5ate ,,( ,,! ,,unit$ ,,/ates  ,april 
#d 7legislative day1 ,m>* #ca71         
#bjbb,receiv$  ,may #bd1 #bjbb ,read !  
fir/ "t  ,may #be1 #bjbb,read ! second  
"t & plac$ on ! cal5d>  ,,an ,,act  ,to 
am5d title ,,xxvii ( ! ,public ,heal?   
,s]vice ,act1 ! ,int]nal ,rev5ue ,code (
 #aihf1 & ! ,employee ,retirem5t ,income
 ,security ,act ( #aigd to e/abli%      
requirem5ts ) respect to co/-%>+ = c]ta9
 insul9 products1 & = o!r purposes4  #a4
 ,%ort title ,?is ,act may be cit$ z !  
,af=dable ,insul9 ,n[ ,act4  #b4        
,requirem5ts ) respect to co/-%>+ =     
insul9 products  7a7 ,,phsa ,"p ,d (    
title ,,xxvii ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4 #cjj;gg-#aaa et    
seq47 is am5d$ by add+ at ! end ! foll[+
 new section3  #bgii;,a-#aa4            
,requirem5ts ) respect to co/-%>+ =     
c]ta9 insul9 products  7a7 ,9 g5]al ,=  
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjbc1 a gr\p heal? plan or heal?       

insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age %all provide    
cov]age ( select$ insul9 products &1 )  
respect to su* products1 %all n-- 7#a7  
apply any d$uctible2 or  7#b7 impose any
 co/-%>+ 9 excess ( ! less] (1 p]       
#cj-;day supply-- 7,a7 #ce2 or  7,b7 !  
am\nt equal to #be p]c5t ( ! negotiat$  
price ( ! select$ insul9 product net (  
all price concessions receiv$ by or on  
behalf ( ! plan or cov]age1 includ+     
price concessions receiv$ by or on      
behalf ( ?ird-p>ty entities provid+     
s]vices to ! plan or cov]age1 su* z     
ph>macy b5efit managem5t s]vices4  7b7  
,def9itions ,9 ?is section3 7#a7        
,select$ insul9 products ,! t]m select$ 
insul9 products means at lea/ "o ( ea*  
dosage =m 7su* z vial1 pump1 or inhal]  
dosage =ms7 ( ea* diff]5t type 7su* z   
rapid-act+1 %ort-act+1 int]m$iate-act+1 
long-act+1 ultra long-act+1 & premix$7 (
 insul9 7z def9$ bel[71 :5 available1 z 
select$ by ! gr\p heal? plan or heal?   
insurance issu]4  7#b7 ,insul9 def9$ ,! 

t]m insul9 means insul9 t is lic5s$ "u  
subsection 7a7 or 7k7 ( section #cea &  
cont9ues to be m>ket$ "u su* section1   
includ+ any insul9 product t has be5    
deem$ to be lic5s$ "u section #cea7;a7  
pursuant to section #gjjb7;e77#d7 ( !   
,biologics ,price ,competition &        
,innovation ,act ( #bjji & cont9ues to  
be m>ket$ pursuant to su* lic5sure4  7c7
 ,out-(-,network provid]s ,no?+ 9 ?is   
section requires a plan or issu] t has a
 network ( provid]s to provide b5efits =
 select$ insul9 products describ$ 9 ?is 
section t are deliv]$ by an             
out-(-network provid]1 or precludes a   
plan or issu] t has a network ( provid]s
 f impos+ high] co/-%>+ ?an ! levels    
specifi$ 9 subsection 7a7 = select$     
insul9 products describ$ 9 ?is section t
 are deliv]$ by an out-(-network        
provid]4  7d7 ,rule ( con/ruction       
,subsection 7a7 %all n be con/ru$ to    
require cov]age (1 or prev5t a gr\p     
heal? plan or heal? insurance cov]age f 
impos+ co/-%>+ o!r ?an ! levels specifi$

 9 subsection 7a7 on1 insul9 products t 
are n select$ insul9 products1 to !     
ext5t t su* cov]age is n o!rwise requir$
 & su* co/-%>+ is o!rwise p]mitt$ "u    
,f$]al & applicable ,/ate law4  7e7     
,application ( co/-,%>+ t[>ds d$uctibles
 & out-(-,pocket maximums ,any co/-%>+  
paym5ts made pursuant to subsection     
7a77#b7 %all be c\nt$ t[>d any d$uctible
 or out-(-pocket maximum t applies "u ! 
plan or cov]age4  4  7b7 ,,irc  7#a7 ,9 
g5]al ,sub*apt] ,b ( *apt] #ajj ( !     
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
by add+ at ! end ! foll[+ new section3  
#ihbf4 ,requirem5ts ) respect to co/-%>+
 = c]ta9 insul9 products  7a7 ,9 g5]al  
,= plan ye>s beg9n+ on or aft] ,janu>y  
#a1 #bjbc1 a gr\p heal? plan %all       
provide cov]age ( select$ insul9        
products &1 ) respect to su* products1  
%all n-- 7#a7 apply any d$uctible2 or   
7#b7 impose any co/-%>+ 9 excess ( !    
less] (1 p] #cj-;day supply-- 7,a7 #ce2 
or  7,b7 ! am\nt equal to #be p]c5t ( ! 
negotiat$ price ( ! select$ insul9      

product net ( all price concessions     
receiv$ by or on behalf ( ! plan1       
includ+ price concessions receiv$ by or 
on behalf ( ?ird-p>ty entities provid+  
s]vices to ! plan1 su* z ph>macy b5efit 
managem5t s]vices4  7b7 ,def9itions ,9  
?is section3 7#a7 ,select$ insul9       
products ,! t]m select$ insul9 products 
means at lea/ "o ( ea* dosage =m 7su* z 
vial1 pump1 or inhal] dosage =ms7 ( ea* 
diff]5t type 7su* z rapid-act+1         
%ort-act+1 int]m$iate-act+1 long-act+1  
ultra long-act+1 & premix$7 ( insul9 7z 
def9$ bel[71 :5 available1 z select$ by 
! gr\p heal? plan4  7#b7 ,insul9 def9$  
,! t]m insul9 means insul9 t is lic5s$  
"u subsection 7a7 or 7k7 ( section #cea 
( ! ,public ,heal? ,s]vice ,act &       
cont9ues to be m>ket$ "u su* section1   
includ+ any insul9 product t has be5    
deem$ to be lic5s$ "u section #cea7;a7 (
 su* ,act pursuant to section           
#gjjb7;e77#d7 ( ! ,biologics ,price     
,competition & ,innovation ,act ( #bjji 
& cont9ues to be m>ket$ pursuant to su* 

lic5sure4  7c7 ,out-(-,network provid]s 
,no?+ 9 ?is section requires a plan t   
has a network ( provid]s to provide     
b5efits = select$ insul9 products       
describ$ 9 ?is section t are deliv]$ by 
an out-(-network provid]1 or precludes a
 plan t has a network ( provid]s f      
impos+ high] co/-%>+ ?an ! levels       
specifi$ 9 subsection 7a7 = select$     
insul9 products describ$ 9 ?is section t
 are deliv]$ by an out-(-network        
provid]4  7d7 ,rule ( con/ruction       
,subsection 7a7 %all n be con/ru$ to    
require cov]age (1 or prev5t a gr\p     
heal? plan f impos+ co/-%>+ o!r ?an !   
levels specifi$ 9 subsection 7a7 on1    
insul9 products t are n select$ insul9  
products1 to ! ext5t t su* cov]age is n 
o!rwise requir$ & su* co/-%>+ is o!rwise
 p]mitt$ "u ,f$]al & applicable ,/ate   
law4  7e7 ,application ( co/-,%>+ t[>ds 
d$uctibles & out-(-,pocket maximums ,any
 co/-%>+ paym5ts made pursuant to       
subsection 7a77#b7 %all be c\nt$ t[>d   
any d$uctible or out-(-pocket maximum t 

applies "u ! plan4  4  7#b7 ,cl]ical    
am5dm5t ,! table ( sections = sub*apt]  
,b ( *apt] #ajj ( ! ,int]nal ,rev5ue    
,code ( #aihf is am5d$ by add+ at ! end 
! foll[+ new item3  ,sec4 #ihbf4        
,requirem5ts ) respect to co/-%>+ =     
c]ta9 insul9 products4  4  7c7 ,,erisa  
7#a7 ,9 g5]al ,subp>t ,b ( "p #g (      
subtitle ,b ( title ,i ( ! ,employee    
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aahe et seq47 is  
am5d$ by add+ at ! end ! foll[+3  #gbf4 
,requirem5ts ) respect to co/-%>+ =     
c]ta9 insul9 products  7a7 ,9 g5]al ,=  
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjbc1 a gr\p heal? plan or heal?       
insurance issu] (f]+ gr\p heal?         
insurance cov]age %all provide cov]age (
 select$ insul9 products &1 ) respect to
 su* products1 %all n-- 7#a7 apply any  
d$uctible2 or  7#b7 impose any co/-%>+ 9
 excess ( ! less] (1 p] #cj-;day        
supply-- 7,a7 #ce2 or  7,b7 ! am\nt     
equal to #be p]c5t ( ! negotiat$ price (
 ! select$ insul9 product net ( all     

price concessions receiv$ by or on      
behalf ( ! plan or cov]age1 includ+     
price concessions receiv$ by or on      
behalf ( ?ird-p>ty entities provid+     
s]vices to ! plan or cov]age1 su* z     
ph>macy b5efit managem5t s]vices4  7b7  
,def9itions ,9 ?is section3 7#a7        
,select$ insul9 products ,! t]m select$ 
insul9 products means at lea/ "o ( ea*  
dosage =m 7su* z vial1 pump1 or inhal]  
dosage =ms7 ( ea* diff]5t type 7su* z   
rapid-act+1 %ort-act+1 int]m$iate-act+1 
long-act+1 ultra long-act+1 & premix$7 (
 insul9 7z def9$ bel[71 :5 available1 z 
select$ by ! gr\p heal? plan or heal?   
insurance issu]4  7#b7 ,insul9 def9$ ,! 
t]m insul9 means insul9 t is lic5s$ "u  
subsection 7a7 or 7k7 ( section #cea ( !
 ,public ,heal? ,s]vice ,act & cont9ues 
to be m>ket$ "u su* section1 includ+ any
 insul9 product t has be5 deem$ to be   
lic5s$ "u section #cea7;a7 ( su* ,act   
pursuant to section #gjjb7;e77#d7 ( !   
,biologics ,price ,competition &        
,innovation ,act ( #bjji & cont9ues to  

be m>ket$ pursuant to su* lic5sure4  7c7
 ,out-(-,network provid]s ,no?+ 9 ?is   
section requires a plan or issu] t has a
 network ( provid]s to provide b5efits =
 select$ insul9 products describ$ 9 ?is 
section t are deliv]$ by an             
out-(-network provid]1 or precludes a   
plan or issu] t has a network ( provid]s
 f impos+ high] co/-%>+ ?an ! levels    
specifi$ 9 subsection 7a7 = select$     
insul9 products describ$ 9 ?is section t
 are deliv]$ by an out-(-network        
provid]4  7d7 ,rule ( con/ruction       
,subsection 7a7 %all n be con/ru$ to    
require cov]age (1 or prev5t a gr\p     
heal? plan or heal? insurance cov]age f 
impos+ co/-%>+ o!r ?an ! levels specifi$
 9 subsection 7a7 on1 insul9 products t 
are n select$ insul9 products1 to !     
ext5t t su* cov]age is n o!rwise requir$
 & su* co/-%>+ is o!rwise p]mitt$ "u    
,f$]al & applicable ,/ate law4  7e7     
,application ( co/-,%>+ t[>ds d$uctibles
 & out-(-,pocket maximums ,any co/-%>+  
paym5ts made pursuant to subsection     

7a77#b7 %all be c\nt$ t[>d any d$uctible
 or out-(-pocket maximum t applies "u ! 
plan or cov]age4  4  7#b7 ,cl]ical      
am5dm5t ,! table ( cont5ts 9 section #a 
( ! ,employee ,retirem5t ,income        
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#ajja et seq47 is am5d$ by ins]t+ aft] !
 item relat+ to section #gbe ! foll[+3  
,sec4 #gbf4 ,requirem5ts ) respect to   
co/-%>+ = c]ta9 insul9 products4  4  7d7
 ,no effect on o!r co/-,%>+ ,section    
#acjb7;d77#b7 ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjbb7;d77#b77 is am5d$ by add+ at !   
end ! foll[+ new subp>agraph3  7,d7     
,special rule relat+ to insul9 cov]age  
,! exemption ( cov]age ( select$ insul9 
products 7z def9$ 9 section             
#bgii;,a-#aa7;b7 ( ! ,public ,heal?     
,s]vice ,act7 f ! application ( any     
d$uctible pursuant to section           
#bgii;,a-#aa7;a77#a7 ( su* ,act1 section
 #gbf7;a77#a7 ( ! ,employee ,retirem5t  
,income ,security ,act ( #aigd1 or      
section #ihbf7;a77#a7 ( ! ,int]nal      

,rev5ue ,code ( #aihf %all n be consid]$
 :5 det]m9+ ! actu>ial value ( a        
qualifi$ heal? plan "u ?is subsection4  
4  7e7 ,cov]age ( c]ta9 insul9 products 
"u cata/rophic plans ,section #acjb7;e7 
( ! ,pati5t ,protection & ,af=dable ,c>e
 ,act 7#db ,u4,s4,c4 #ahjbb7;e77 is     
am5d$ by add+ at ! end ! foll[+3  7#d7  
,cov]age ( c]ta9 insul9 products  7,a7  
,9 g5]al ,not)/&+ p>agraph 7#a77;,b77i71
 a heal? plan describ$ 9 p>agraph 7#a7  
%all provide cov]age ( select$ insul9   
products1 9 accordance ) section        
#bgii;,a-#aa ( ! ,public ,heal? ,s]vice 
,act1 be=e an enroll$ individual has    
incurr$1 dur+ a plan ye>1 co/-%>+       
exp5ses 9 an am\nt equal to ! annual    
limitation 9 effect "u subsection       
7c77#a7 = ! plan ye>4  7,b7 ,t]m9ology  
,= purposes ( subp>agraph 7,a7-- 7i7 !  
t]m select$ insul9 products has ! mean+ 
giv5 su* t]m 9 section #bgii;,a-#aa7;b7 
( ! ,public ,heal? ,s]vice ,act2 &  7ii7
 ! requirem5ts ( section #bgii;,a-#aa ( 
su* ,act %all be appli$ by deem+ ea*    

ref]5ce 9 su* section to individual     
heal? insurance cov]age to be a ref]5ce 
to a plan describ$ 9 p>agraph 7#a74  4  
7f7 ,implem5tation ,! ,secret>y ( ,heal?
 & ,human ,s]vices1 ! ,secret>y (       
,labor1 & ! ,secret>y ( ! ,treasury may 
implem5t ! provisions (1 includ+ !      
am5dm5ts made by1 ?is section ?r\gh     
sub-regulatory guidance1 program        
in/ruction1 or o!rwise4  #c4            
,appropriate co/-%>+ = c]ta9 insul9     
products "u ,m$ic>e "p ,d  7a7 ,9 g5]al 
,section #ahfj;,d-#b ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajb7 is am5d$-- 7#a7 9          
subsection 7b7-- 7,a7 9 p>agraph        
7#a77;,a71 by /rik+ ,! cov]age & ins]t+ 
,subject to p>agraph 7#h71 ! cov]age2   
7,b7 9 p>agraph 7#b7-- 7i7 9 subp>agraph
 7,a71 by /rik+ & 7,d7 & ins]t+ & 7,d7 &
 p>agraph 7#h72  7ii7 9 subp>agraph     
7,b71 by /rik+ & 7,d7 & ins]t+ & 7,d7 & 
p>agraph 7#h72  7iii7 9 subp>agraph     
7,c77i71 by /rik+ p>agraph 7#d7 & ins]t+
 p>agraphs 7#d7 & 7#h72 &  7iv7 9       

subp>agraph 7,d77i71 by /rik+ p>agraph  
7#d7 & ins]t+ p>agraphs 7#d7 & 7#h72    
7,c7 9 p>agraph 7#c77;,a71 by /rik+ &   
7#d7 & ins]t+ 7#d71 & 7#h72  7,d7 9     
p>agraph 7#d77;,a77i71 by /rik+ ,!      
cov]age & ins]t+ ,subject to p>agraph   
7#h71 ! cov]age2 &  7,e7 by add+ at !   
end ! foll[+ new p>agraph3  7#h7        
,treatm5t ( co/-%>+ = c]ta9 insul9      
products  7,a7 ,9 g5]al ,= plan ye>s    
beg9n+ on or aft] ,janu>y #a1 #bjbc1 )  
respect to an individual1 ! foll[+ %all 
apply ) respect to any insul9 product 7z
 def9$ 9 subp>agraph 7,b77 t is cov]$ "u
 ! prescription drug plan or ,,ma-,,pd  
plan 9 :i* ! individual is enroll$3 7i7 
,no application ( d$uctible ,! d$uctible
 "u p>agraph 7#a7 %all n apply ) respect
 to su* insul9 product4  7ii7           
,application ( co/-%>+  7,i7 ,9 g5]al ,!
 cov]age provides b5efits = su* insul9  
product1 reg>dless ( :e!r an individual 
has rea*$ ! initial cov]age limit "u    
p>agraph 7#c7 or ! out-(-pocket ?re%old 
"u p>agraph 7#d71 ) co/-%>+ = a "o-mon? 

supply t is equal to ! applicable       
copaym5t am\nt4  7,,ii7 ,applicable     
copaym5t am\nt ,= purposes ( ?is clause1
 ! t]m applicable copaym5t am\nt means1 
) respect to an insul9 product "u a     
prescription drug plan or an ,,ma-,,pd  
plan1 an am\nt t is n m ?an #ce4  7,b7  
,insul9 product ,= purposes ( ?is       
p>agraph1 ! t]m insul9 product means a  
cov]$ "p ,d drug t is an insul9 product 
t is approv$ "u section #eje ( ! ,f$]al 
,food1 ,drug1 & ,cosmetic ,act or lic5s$
 "u section #cea ( ! ,public ,heal?     
,s]vice ,act & m>ket$ pursuant to su*   
approval or lic5sure1 includ+ any insul9
 product t has be5 deem$ to be lic5s$ "u
 section #cea ( ! ,public ,heal? ,s]vice
 ,act pursuant to section #gjjb7;e77#d7 
( ! ,biologics ,price ,competition &    
,innovation ,act ( #bjji & m>ket$       
pursuant to su* section4  2 &  7#b7 9   
subsection 7c71 by add+ at ! end !      
foll[+ new p>agraph3  7#d7 ,treatm5t (  
co/-%>+ = insul9 products ,! cov]age is 
provid$ 9 accordance ) subsection       

7b77#h74  4  7b7 ,con=m+ am5dm5ts to    
co/-,%>+ = l[-,income individuals       
,section #ahfj;,d-#ad7;a7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#aciew-#aad7;a77 is am5d$-- 7#a7 9      
p>agraph 7#a7-- 7,a7 9 subp>agraph      
7,d77iii71 by add+ at ! end ! foll[+ new
 s5t5ce3 ,= plan ye> #bjbc & subsequ5t  
plan ye>s1 ! copaym5t am\nt applicable  
"u ! prec$+ s5t5ce = a "o-mon? supply ( 
an insul9 product 7z def9$ 9 subp>agraph
 7,b7 ( section #ahfj;,d-#b7;b77#h77    
disp5s$ to ! individual may n exce$ !   
applicable copaym5t am\nt 7z def9$ 9    
subp>agraph 7,a77ii77,,ii7 ( su*        
section7 = ! product "u ! prescription  
drug plan or ,,ma-,,pd plan 9 :i* !     
individual is enroll$42 &  7,b7 9       
subp>agraph 7,e71 by ins]t+ ! foll[+    
be=e ! p]iod at ! end or "u section     
#ahfj;,d-#b7;b77#h7 9 ! case ( an insul9
 product 7z def9$ 9 subp>agraph 7,b7 (  
su* section72 &  7#b7 9 p>agraph 7#b7-- 
7,a7 9 subp>agraph 7,b71 by add+ at !   
end ! foll[+ new s5t5ce3 ,= plan ye>    

#bjbc & subsequ5t plan ye>s1 ! annual   
d$uctible applicable "u su* section1    
includ+ z r$uc$ "u ! prec$+ s5t5ce1 %all
 n apply ) respect to an insul9 product 
7z def9$ 9 subp>agraph 7,b7 ( section   
#ahfj;,d-#b7;b77#h77 disp5s$ to !       
individual42  7,b7 9 subp>agraph 7,d71  
by add+ at ! end ! foll[+ new s5t5ce3 ,=
 plan ye> #bjbc & subsequ5t plan ye>s1 !
 am\nt ( ! co9surance applicable "u !   
prec$+ s5t5ce = a "o-mon? supply ( an   
insul9 product 7z def9$ 9 subp>agraph   
7,b7 ( section #ahfj;,d-#b7;b77#h77     
disp5s$ to ! individual may n exce$ !   
applicable copaym5t am\nt 7z def9$ 9    
subp>agraph 7,a77ii77,,ii7 ( su*        
section7 = ! product "u ! prescription  
drug plan or ,,ma-,,pd plan 9 :i* !     
individual is enroll$42 &  7,c7 9       
subp>agraph 7,e71 by add+ at ! end !    
foll[+ new s5t5ce3 ,= plan ye> #bjbc &  
subsequ5t plan ye>s1 ! am\nt ( !        
copaym5t or co9surance applicable "u !  
prec$+ s5t5ce = a "o-mon? supply ( an   
insul9 product 7z def9$ 9 subp>agraph   

7,b7 ( section #ahfj;,d-#b7;b77#h77     
disp5s$ to ! individual may n exce$ !   
applicable copaym5t am\nt 7z def9$ 9    
subp>agraph 7,a77ii77,,ii7 ( su*        
section7 = ! product "u ! prescription  
drug plan or ,,ma-,,pd plan 9 :i* !     
individual is enroll$4  7c7             
,implem5tation ,not)/&+ any o!r         
provision ( law1 ! ,secret>y ( ,heal? & 
,human ,s]vices %all implem5t ?is       
section = plan ye>s #bjbc & #bjbd by    
program in/ruction or o!rwise4  #d4 ,"o 
ye>-ext5sion on moratorium on           
implem5tation ( rule relat+ to elim9at+ 
! anti-kickback /atute safe h>bor       
protection = prescription drug rebates  
,section #ijjjf ( ! ,infra/ructure      
,inve/m5t & ,jobs ,act 7,p4,l4 #aag-eh7 
is am5d$ by /rik+ ,janu>y #a1 #bjbf &   
ins]t+ ,janu>y #a1 #bjbg4  #e4 ,m$ic>e  
,improvem5t ,fund ,section #ahih7;b77#a7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acie;iii7b77#a771 z am5d$ by 
section #cac ( division ,p ( !          
,consolidat$ ,appropriations ,act1      

#bjbb1 is am5d$ by /rik+ #e1jjj1jjj &   
ins]t+ #i1jdf1ejj1jjj4  ,pass$ ! ,h\se (
 ,repres5tatives ,m>* #ca1 #bjbb4;,*]yl 
,l4 ,johnson1,cl]k4  ,may #be1          
#bjbb,read ! second "t & plac$ on !     
cal5d>