,,ii  #aag? ,,congress  #b;d ,session   
,s4 #cgjj  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,febru>y #ag1 #bjbb    
,mr4 ,w>nock 7= himself1 ,mr4 ,s*um]1   
,mr4 ,durb91 ,mr4 ,wyd51 ,mr4 ,b5net1   
,mr4 ,blum5?al1 ,ms4 ,baldw91 ,mr4      
,kelly1 ,ms4 ,/ab5[1 ,mr4 ,re$1 ,mr4    
,van ,holl51 ,ms4 ,hirono1 ,ms4         
,klobu*>1 ,mr4 ,murphy1 ,ms4 ,hassan1   
,mrs4 ,%ahe51 ,mr4 ,book]1 ,mr4 ,k+1    
,ms4 ,smi?1 & ,mr4 ,padilla7 introduc$ !
 foll[+ bill2 :i* 0 read twice & ref]r$ 
to ! ,committee on ,f9ance  ,a ,,bill   
,to provide = appropriate co/-%>+ =     
insul9 products cov]$ "u ,m$ic>e "p ,d &
 private heal? plans4  #a4 ,%ort title  
,?is ,act may be cit$ z ! ,af=dable     
,insul9 ,n[ ,act4  #b4 ,appropriate     
co/-%>+ = insul9 products cov]$ "u      
,m$ic>e "p ,d & private heal? plans  7a7
 ,m$ic>e "p ,d  7#a7 ,9 g5]al ,section  
#ahfj;,d-#b ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #aciew-#ajb7 is am5d$--  
7,a7 9 subsection 7b7-- 7i7 9 p>agraph  
7#a77;,a71 9 ! matt] prec$+ clause 7i71 

by /rik+ ,! cov]age & ins]t+ ,subject to
 p>agraph 7#h71 ! cov]age2  7ii7 9      
p>agraph 7#b7-- 7,i7 9 subp>agraph 7,a71
 9 ! matt] prec$+ clause 7i71 by /rik+ &
 7,d7 & ins]t+ & 7,d7 & p>agraph 7#h72  
7,,ii7 9 subp>agraph 7,c77i71 9 ! matt] 
prec$+ subclause 7,i71 by /rik+ p>agraph
 7#d7 & ins]t+ p>agraphs 7#d7 & 7#h72 & 
7,,iii7 9 subp>agraph 7,d77i71 9 ! matt]
 prec$+ subclause 7,i71 by /rik+        
p>agraph 7#d7 & ins]t+ p>agraphs 7#d7 & 
7#h72  7iii7 9 p>agraph 7#c77;,a71 9 !  
matt] prec$+ clause 7i71 by /rik+ & 7#d7
 & ins]t+ 7#d71 & 7#h72  7iv7 9 p>agraph
 7#d77;,a77i71 9 ! matt] prec$+         
subclause 7,i71 by /rik+ ,! cov]age &   
ins]t+ ,subject to p>agraph 7#h71 !     
cov]age2 &  7v7 by add+ at ! end !      
foll[+ new p>agraph3  7#h7 ,treatm5t (  
co/-%>+ = cov]$ insul9 products  7,a7 ,9
 g5]al ,= ! portion ( plan ye> #bjbb    
beg9n+ on ,octob] #a1 #bjbb1 & end+ on  
,decemb] #ca1 #bjbb1 & = plan ye> #bjbc 
& subsequ5t plan ye>s1 ! foll[+ rules   
%all apply ) respect to co/-%>+ = a     

mon?'s supply ( any cov]$ insul9 product
 7z def9$ 9 subp>agraph 7,b77 t is cov]$
 "u ! prescription drug plan or         
,,ma-,,pd plan3  7i7 ,no application (  
d$uctible ,! d$uctible "u p>agraph 7#a7 
%all n apply ) respect to any su* cov]$ 
insul9 product4  7ii7 ,maximum co/-%>+  
7,i7 ,9 g5]al ,! cov]age %all provide   
b5efits = su* any cov]$ insul9 product1 
reg>dless ( :e!r an individual has rea*$
 ! initial cov]age limit "u p>agraph    
7#c7 or ! annual out-(-pocket ?re%old "u
 p>agraph 7#d71 ) co/-%>+ = a mon?'s    
supply t does n exce$ ! maximum co/-%>+ 
am\nt4  7,,ii7 ,maximum co/-%>+ am\nt ,=
 purposes ( subclause 7,i71 ! t]m       
maximum co/-%>+ am\nt means1 ) respect  
to a cov]$ insul9 product "u a          
prescription drug plan or an ,,ma-,,pd  
plan disp5s$-- 7aa7 on or aft] ,octob]  
#a1 #bjbb1 & be=e ,janu>y #a1 #bjbd1    
#ce2 &  7bb7 dur+ plan ye> #bjbd or     
subsequ5t plan ye>1 ! less] (-- 7,,aa7  
#ce2 or 7,,bb7 an am\nt equal to #be    
p]c5t ( ! negotiat$ price ( ! cov]$     

insul9 product "u ! prescription drug   
plan or ,,ma-,,pd plan4  7,b7 ,cov]$    
insul9 product ,= purposes ( ?is        
p>agraph1 ! t]m cov]$ 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 & cont9ues to be    
m>ket$1 includ+ any insul9 product t has
 be5 deem$ to be lic5s$ "u section #cea 
( ! ,public ,heal? ,s]vice ,act pursuant
 to section #gjjb7;e77#d7 ( ! ,biologics
 ,price ,competition & ,innovation ,act 
( #bjji & cont9ues to be m>ket$4  2 &   
7,b7 9 subsection 7c71 by add+ at ! end 
! foll[+ new p>agraph3  7#d7 ,treatm5t (
 co/-%>+ = insul9 products ,! cov]age is
 provid$ 9 accordance ) subsection      
7b77#h74  4  7#b7 ,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--  7i7 9   
subp>agraph 7,d77iii71 by add+ at ! end 

! foll[+ new s5t5ce3 ,= ! portion ( plan
 ye> #bjbb beg9n+ on ,octob] #a1 #bjbb1 
& end+ on ,decemb] #ca1 #bjbb1 & = plan 
ye> #bjbc & subsequ5t plan ye>s1 !      
copaym5t am\nt applicable "u ! prec$+   
s5t5ce to a mon?'s supply ( a cov]$     
insul9 product 7z describ$ 9 section    
#ahfj;,d-#b7;b77#h77 disp5s$ to !       
individual may n exce$ ! applicable     
copaym5t or co9surance am\nt = ! product
 "u ! prescription drug plan or         
,,ma-,,pd plan 9 :i* ! individual is    
enroll$42 &  7ii7 9 subp>agraph 7,e71 by
 ins]t+ ! foll[+ be=e ! p]iod at ! end3 
or "u section #ahfj;,d-#b7;b77#h7 9 !   
case ( a cov]$ insul9 product 7z        
describ$ 9 su* section72 &  7,b7 9      
p>agraph 7#b7-- 7i7 9 subp>agraph 7,d71 
by add+ at ! end ! foll[+ new s5t5ce3 ,=
 ! portion ( plan ye> #bjbb beg9n+ on   
,octob] #a1 #bjbb1 & end+ on ,decemb]   
#ca1 #bjbb1 & = plan ye> #bjbc &        
subsequ5t plan ye>s1 ! am\nt ( !        
co9surance applicable "u ! prec$+ s5t5ce
 to a mon?'s supply ( a cov]$ insul9    

product 7z describ$ 9 section           
#ahfj;,d-#b7;b77#h77 disp5s$ to !       
individual may n exce$ ! applicable     
copaym5t or co9surance am\nt = ! product
 "u ! prescription drug plan or         
,,ma-,,pd plan 9 :i* ! individual is    
enroll$42 &  7ii7 9 subp>agraph 7,e71 by
 add+ at ! end ! foll[+ new s5t5ce3 ,= !
 portion ( plan ye> #bjbb beg9n+ on     
,octob] #a1 #bjbb1 & end+ on ,decemb]   
#ca1 #bjbb1 & = plan ye> #bjbc &        
subsequ5t plan ye>s1 ! am\nt ( !        
copaym5t or co9surance applicable "u !  
prec$+ s5t5ce to a mon?'s supply ( a    
cov]$ insul9 product 7z describ$ 9      
section #ahfj;,d-#b7;b77#h77 disp5s$ to 
! individual may n exce$ ! applicable   
copaym5t or co9surance am\nt = ! product
 "u ! prescription drug plan or         
,,ma-,,pd plan 9 :i* ! individual is    
enroll$44  7#c7 ,implem5tation ,not)/&+ 
any o!r provision ( law1 ! ,secret>y (  
,heal? & ,human ,s]vices may implem5t ! 
provisions (1 includ+ ! am5dm5ts made   
by1 ?is subsection = plan ye>s #bjbb1   

#bjbc1 & #bjbd by program in/ruction or 
o!rwise4  7#d7 ,fund+ ,9 addition to    
am\nts o!rwise available1 !re is        
appropriat$ to ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices1 out ( any money 9 !  
,treasury n o!rwise appropriat$1        
#a1ejj1jjj = fiscal ye> #bjbb1 to rema9 
available until exp5d$1 to c>ry out !   
provisions (1 includ+ ! am5dm5ts made   
by1 ?is subsection4  7b7 ,private heal? 
plans  7#a7 ,9 g5]al ,"p ,d ( title     
,,xxvii ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #cjj;gg-#aaa et seq47 is 
am5d$ by add+ at ! end ! foll[+3        
#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        
products1 & ) 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$uctible or out-(-pocket maximum t 
applies "u ! plan or cov]age4  4  7#b7  
,no effect on o!r co/-%>+ ,section      
#acjb7;d77#b7 ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjbb7;d77#b77 is am5d$ 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  7#c7 ,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$1 dur+ ! plan ye>1 co/-%>+       
exp5ses 9 an am\nt equal to ! annual    
limitation 9 effect "u subsection       
7c77#a7 = ! plan ye>4  7,b7 ,t]m9ology  
,= purposes ( subp>agraph 7,a7--  7i7 ! 
t]m select$ 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  
7#d7 ,,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 products1 & ) 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 7#db       
,u4,s4,c4 #bfb7 & 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 7,public ,law #aaa-adh7 &        
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  7#e7 ,int]nal ,rev5ue     
,code  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 products1 & ) 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 7#db    
,u4,s4,c4 #bfb7 & 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 7,public ,law #aaa-adh7 &        
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$uctible or out-(-pocket maximum t 
applies "u ! plan4  4  7,b7 ,cl]ical    
am5dm5t ,! table ( sections = sub*apt]  
,b ( *apt] #ajj ( su* ,code is am5d$ by 
add+ at ! end ! foll[+ new item3  ,sec4 
#ihbf4 ,requirem5ts ) respect to co/-%>+
 = c]ta9 insul9 products4  4  7#f7      
,implem5tation ,! ,secret>y ( ,heal? &  

,human ,s]vices1 ! ,secret>y ( ,labor1 &
 ! ,secret>y ( ! ,treasury may implem5t 
! provisions (1 includ+ ! am5dm5ts made 
by1 ?is subsection ?r\gh sub-regulatory 
guidance1 program in/ruction or o!rwise4