,,ii  #aagth ,,congress  #b;d ,session  
,s4 #cgjj  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,february #ag1 
#bjbb ,mr4 ,warnock 7for himself1 ,mr4  
,schumer1 ,mr4 ,durbin1 ,mr4 ,wyden1    
,mr4 ,bennet1 ,mr4 ,blumenthal1 ,ms4    
,baldwin1 ,mr4 ,kelly1 ,ms4 ,stabenow1  
,mr4 ,reed1 ,mr4 ,van ,hollen1 ,ms4     
,hirono1 ,ms4 ,klobuchar1 ,mr4 ,murphy1 
,ms4 ,hassan1 ,mrs4 ,shaheen1 ,mr4      
,booker1 ,mr4 ,king1 ,ms4 ,smith1 and   
,mr4 ,padilla7 introduced the following 
bill2 which was read twice and referred 
to the ,committee on ,finance  ,a ,,bill
  ,to provide for appropriate           
cost-sharing for insulin products       
covered under ,medicare part ,d and     
private health plans4  #a4 ,short title 
,this ,act may be cited as the          
,affordable ,insulin ,now ,act4  #b4    
,appropriate cost-sharing for insulin   
products covered under ,medicare part ,d
 and private health plans  7a7 ,medicare
 part ,d  7#a7 ,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-- 7i7 
in paragraph 7#a77;,a71 in the matter   
preceding clause 7i71 by striking ,the  
coverage and inserting ,subject to      
paragraph 7#h71 the coverage2  7ii7 in  
paragraph 7#b7-- 7,i7 in subparagraph   
7,a71 in the matter preceding clause    
7i71 by striking and 7,d7 and inserting 
and 7,d7 and paragraph 7#h72  7,,ii7 in 
subparagraph 7,c77i71 in the matter     
preceding subclause 7,i71 by striking   
paragraph 7#d7 and inserting paragraphs 
7#d7 and 7#h72 and  7,,iii7 in          
subparagraph 7,d77i71 in the matter     
preceding subclause 7,i71 by striking   
paragraph 7#d7 and inserting paragraphs 
7#d7 and 7#h72  7iii7 in paragraph      
7#c77;,a71 in the matter preceding      
clause 7i71 by striking and 7#d7 and    
inserting 7#d71 and 7#h72  7iv7 in      
paragraph 7#d77;,a77i71 in the matter   
preceding subclause 7,i71 by striking   
,the coverage and inserting ,subject to 
paragraph 7#h71 the coverage2 and  7v7  

by adding at the end the following new  
paragraph3  7#h7 ,treatment of          
cost-sharing for covered insulin        
products  7,a7 ,in general ,for the     
portion of plan year #bjbb beginning on 
,october #a1 #bjbb1 and ending on       
,december #ca1 #bjbb1 and for plan year 
#bjbc and subsequent plan years1 the    
following rules shall apply with respect
 to cost-sharing for a month's supply of
 any covered insulin product 7as defined
 in subparagraph 7,b77 that is covered  
under the prescription drug plan or     
,,ma-,,pd plan3  7i7 ,no application of 
deductible ,the deductible under        
paragraph 7#a7 shall not apply with     
respect to any such covered insulin     
product4  7ii7 ,maximum cost-sharing    
7,i7 ,in general ,the coverage shall    
provide benefits for such any covered   
insulin product1 regardless of whether  
an individual has reached the initial   
coverage limit under paragraph 7#c7 or  
the annual out-of-pocket threshold under
 paragraph 7#d71 with cost-sharing for a

 month's supply that does not exceed the
 maximum cost-sharing amount4  7,,ii7   
,maximum cost-sharing amount ,for       
purposes of subclause 7,i71 the term    
maximum cost-sharing amount means1 with 
respect to a covered insulin product    
under a prescription drug plan or an    
,,ma-,,pd plan dispensed-- 7aa7 on or   
after ,october #a1 #bjbb1 and before    
,january #a1 #bjbd1 #ce2 and  7bb7      
during plan year #bjbd or subsequent    
plan year1 the lesser of-- 7,,aa7 #ce2  
or 7,,bb7 an amount equal to #be percent
 of the negotiated price of the covered 
insulin product under the prescription  
drug plan or ,,ma-,,pd plan4  7,b7      
,covered insulin product ,for purposes  
of this paragraph1 the term covered     
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   
continues to be marketed1 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 continues 
to be marketed4  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  
7#b7 ,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--  7i7 in subparagraph   
7,d77iii71 by adding at the end the     
following new sentence3 ,for the portion
 of plan year #bjbb beginning on        
,october #a1 #bjbb1 and ending on       
,december #ca1 #bjbb1 and for plan year 
#bjbc and subsequent plan years1 the    
copayment amount applicable under the   

preceding sentence to a month's supply  
of a covered insulin product 7as        
described in section                    
#ahfj;,d-#b7;b77#h77 dispensed to the   
individual may not exceed the applicable
 copayment or coinsurance amount for the
 product under the prescription drug    
plan or ,,ma-,,pd plan in which the     
individual is enrolled42 and  7ii7 in   
subparagraph 7,e71 by inserting the     
following before the period at the end3 
or under section #ahfj;,d-#b7;b77#h7 in 
the case of a covered insulin product   
7as described in such section72 and     
7,b7 in paragraph 7#b7-- 7i7 in         
subparagraph 7,d71 by adding at the end 
the following new sentence3 ,for the    
portion of plan year #bjbb beginning on 
,october #a1 #bjbb1 and ending on       
,december #ca1 #bjbb1 and for plan year 
#bjbc and subsequent plan years1 the    
amount of the coinsurance applicable    
under the preceding sentence to a       
month's supply of a covered insulin     
product 7as described in section        

#ahfj;,d-#b7;b77#h77 dispensed to the   
individual may not exceed the applicable
 copayment or coinsurance amount for the
 product under the prescription drug    
plan or ,,ma-,,pd plan in which the     
individual is enrolled42 and  7ii7 in   
subparagraph 7,e71 by adding at the end 
the following new sentence3 ,for the    
portion of plan year #bjbb beginning on 
,october #a1 #bjbb1 and ending on       
,december #ca1 #bjbb1 and for plan year 
#bjbc and subsequent plan years1 the    
amount of the copayment or coinsurance  
applicable under the preceding sentence 
to a month's supply of a covered insulin
 product 7as described in section       
#ahfj;,d-#b7;b77#h77 dispensed to the   
individual may not exceed the applicable
 copayment or coinsurance amount for the
 product under the prescription drug    
plan or ,,ma-,,pd plan in which the     
individual is enrolled44  7#c7          
,implementation ,notwithstanding any    
other provision of law1 the ,secretary  
of ,health and ,human ,services may     

implement the provisions of1 including  
the amendments made by1 this subsection 
for plan years #bjbb1 #bjbc1 and #bjbd  
by program instruction or otherwise4    
7#d7 ,funding ,in addition to amounts   
otherwise available1 there is           
appropriated to the ,centers for        
,medicare  ,medicaid ,services1 out of  
any money in the ,treasury not otherwise
 appropriated1 #a1ejj1jjj for fiscal    
year #bjbb1 to remain available until   
expended1 to carry out the provisions   
of1 including the amendments made by1   
this subsection4  7b7 ,private health   
plans  7#a7 ,in general ,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 following3        
#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 products1 and 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  7#b7 ,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  7#c7 ,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 the 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  7#d7 ,,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    
products1 and 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 7#db ,u4,s4,c4 #bfb7 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 7,public ,law #aaa-adh7 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  7#e7 ,internal ,revenue   
,code  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 products1 and 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 7#db ,u4,s4,c4    
#bfb7 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 7,public  
,law #aaa-adh7 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 such ,code is       
amended by adding at the end the        
following new item3  ,sec4 #ihbf4       
,requirements with respect to           
cost-sharing for certain insulin        
products4  4  7#f7 ,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 subsection 
through sub-regulatory guidance1 program
 instruction or otherwise4