,,ii  #aag? ,,congress  #a/ ,session    
,s4 #aacb  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,april #ae1 #bjba,mr4  
,k5n$y introduc$ ! foll[+ bill2 :i* 0   
read twice & ref]r$ to ! ,committee on  
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to e/abli% a cap on         
out-(-pocket co/s = insul94  #a4 ,%ort  
title ,?is ,act may be cit$ z ! ,end+   
,pricey ,insul9 ,act or ! ,,epi ,act4   
#b4 ,capp+ out-(-pockets co/ ( insul9   
7a7 ,individuals enroll$ 9 c]ta9 heal?  
plans ,title ,,xxvii ( ! ,public ,heal? 
,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg et  
seq47 is am5d$ by ins]t+ aft] section   
#bgbi ! foll[+3  #bgbi;,a4 ,cov]age (   
insul9 drugs  ,beg9n+ ) plan ye> #bjbb1 
a gr\p heal? plan or heal? insurance    
issu] (f]+ gr\p or individual heal?     
insurance cov]age t provides cov]age =  
prescription insul9 drugs may n impose  
any d$uctible1 copaym5t1 co9surance1 or 
o!r co/-%>+ requirem5t ) respect to su* 
drugs t results 9 out-(-pocket co/s to !
 enrollee t exce$ #ej p] prescription = 

a #cj-;day supply ( cov]$ prescription  
insul9 drugs1 reg>dless ( ! am\nt (     
insul9 drugs ne$$ to fill ! enrollee's  
insul9 prescriptions4  4  7b7           
,individuals enroll$ 9 o!r cov]age  7#a7
 ,m$ic>e1 ,m$icaid1 & ,,*ip ,! ,secret>y
 ( ,heal? & ,human ,s]vices %all take   
su* adm9i/rative action z is necess>y to
 ensure t 9 no ev5t %all any ,/ate plan 
or waiv] "u title ,,xix or ,,xxi ( !    
,social ,security ,act or prescription  
drug plan "u "p ,d ( title ,,xviii ( su*
 ,act or ,,ma-,,pd plan "u "p ,c ( su*  
title ( su* ,act t provides cov]age =   
prescription insul9 drugs impose any    
d$uctible1 copaym5t1 co9surance1 or o!r 
co/-%>+ requirem5t ) respect to su*     
drugs t results 9 out-(-pocket co/s to  
an individual enroll$ 9 su* cov]age t   
exce$s #ej p] prescription = a #cj-;day 
supply ( cov]$ prescription insul9      
drugs1 reg>dless ( ! am\nt ( insul9     
drugs ne$$ to fill ! enrollee's insul9  
prescriptions4  7#b7 ,vet]ans ,!        
,secret>y ( ,vet]ans ,affairs %all take 

su* adm9i/rative action z is necess>y to
 ensure t prescription insul9 drugs     
writt5 by eligible heal? c>e provid]s = 
vet]ans d n impose any d$uctible1       
copaym5t1 co9surance1 or o!r co/-%>+    
requirem5t ) respect to su* drugs t     
results 9 out-(-pocket co/s to ! vet]an 
t exce$s #ej p] prescription = a        
#cj-;day supply ( cov]$ prescription    
insul9 drugs1 reg>dless ( ! am\nt (     
insul9 drugs ne$$ to fill ! vet]an's    
insul9 prescriptions4 ,= purposes ( !   
prec$+ s5t5ce1 ! t]m eligible heal? c>e 
provid] means a heal? c>e provid] "u    
section #agjc7;c7 ( title #ch1 ,unit$   
,/ates ,code1 or an eligible entity or  
provid] "u section #agjc;,a7b7 ( su*    
title4  7#c7 ,,tric>e ,! ,secret>y (    
,def5se %all take su* adm9i/rative      
action z is necess>y to ensure t        
prescription insul9 drugs writt5 by     
heal? c>e provid]s = enrollees 9 !      
,,tric>e program "u *apt] #ee ( title   
#aj1 ,unit$ ,/ates ,code1 d n impose any
 d$uctible1 copaym5t1 co9surance1 or o!r

 co/-%>+ requirem5t ) respect to su*    
drugs t results 9 out-(-pocket co/s to  
enrollees t exce$s #ej p] prescription =
 a #cj-;day supply ( cov]$ prescription 
insul9 drugs1 reg>dless ( ! am\nt (     
insul9 drugs ne$$ to fill ! enrollee's  
insul9 prescriptions4  #c4 ,cap on ca%  
price = insul9 = individuals )\t heal?  
insurance ,beg9n+ on ,janu>y #a1 #bjbb1 
9 ! case ( an individual :o is n enroll$
 9 any public or private heal? plan1 !  
ca% price = a #cj-;day supply ( su*     
individual's prescription insul9 drugs1 
reg>dless ( ! am\nt ( insul9 drugs ne$$ 
to fill ! individual's insul9           
prescriptions1 %all be n m ?an #ej4  #d4
 ,retroactive effect ,9 ! ev5t t ?is    
,act is enact$ aft] ,janu>y #a1 #bjbb-- 
7#a7 any out-(-pocket co/ to an enrollee
 = insul9 9 plan ye> #bjbb or a         
subsequ5t plan ye> t is 9 excess ( !    
am\nt specifi$ 9 section #bgbi;,a ( !   
,public ,heal? ,s]vice ,act 7z add$ by  
section #b7 %all be reimburs$ by ! gr\p 
heal? plan or heal? insurance issu] to !

 enrollee2  7#b7 any am\nt paid by an   
un9sur$ individual = insul9 on or aft]  
,janu>y #a1 #bjbb1 t is 9 excess ( !    
am\nt specifi$ 9 section #c %all be     
reimburs$ by ! insul9 manufactur] to !  
individual2 &  7#c7 any am\nt paid by an
 enrollee or vet]an = insul9 on or aft] 
,janu>y #a1 #bjbb1 t is 9 excess ( !    
am\nt specifi$ 9 p>agraph 7#a7 7#b71 or 
7#c71 z applicable1 ( section #b7;b7    
%all be reimburs$ by ! ,secret>y (      
,heal? & ,human ,s]vices1 ! ,secret>y ( 
,vet]ans ,affairs1 or ! ,secret>y (     
,def5se1 z applicable1 to ! enrollee or 
vet]an4