,i #aahth ,,congress #ast ,session ,h4 ,r4 #cbhe ,,in ,,the ,,house ,,of ,,representatives ,may #ae1 #bjbc ,mr4 ,griffith introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,education and the ,workforce1 and ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to establish patient protections with respect to highly rebated drugs4 #a4 ,short title ,this ,act may be cited as the ,fairness for ,patient ,medications ,act4 #b4 ,requirements with respect to cost-sharing for highly rebated drugs 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 following3 #bgii;,a-#aa4 ,requirements with respect to cost-sharing for highly rebated drugs 7a7 ,in general ,no later than ,april #a1 #bjbd1 and annually thereafter1 the ,secretary shall certify 7or recertify1 if applicable7 as a highly rebated drug any drug identified in reports submitted under sections #bgii;,a-#aj1 #gbe of the ,employee ,retirement ,income ,security ,act1 and #ihbe of the ,internal ,revenue ,code of #aihf for which total rebates1 reductions in price1 and other forms of remuneration in the previous year aggregated across all commercial markets exceeded #ej percent of total annual spending on such drug in such year4 7b7 ,deductible and cost-,sharing limitations for certified drugs ,for plan years that begin on or after ,january #a1 #bjbe1 a group health plan or a health insurance issuer offering group or individual health insurance coverage 7or entity that provides pharmacy benefits management services on behalf of such a plan or issuer7 that provides coverage of any highly rebated drug shall not impose cost-sharing in excess of1 per #cj-;day supply1 the quotient of the annual net price paid by such group health plan or health insurance issuer 7or entity that provides pharmacy benefits management services on behalf of such a plan or issuer71 in the most recent calendar year for which a final net price has been calculated by such plan or coverage 7or entity that provides pharmacy benefit management services on behalf of such plan or issuer71 per #cj-;day supply of such specific highly rebated drug1 divided by #ab4 7c7 ,highly rebated drug previously subject to formulary exclusion ,beginning on ,january #a1 #bjbe1 in the case of a specific highly rebated drug covered by a group health plan or health insurance issuer offering group or individual health insurance coverage 7or entity that provides pharmacy benefits management services on behalf of such plan or issuer7 that provides coverage of a specific highly rebated drug that was not covered in the previous year1 such group health plan or health insurance issuer shall not receive from a drug manufacturer a reduction in price or other remuneration with respect to such specific highly rebated drug received by an enrollee in the plan or coverage and covered by the plan or coverage1 unless-- 7#a7 any such reduction in price is reflected at the point of sale to the enrollee2 and 7#b7 any such other remuneration is a flat fee-based service fee not contingent on total volume of sales that a manufacturer of prescription drugs pays to an entity that provides pharmacy benefits management services4 7d7 ,definitions ,in this section3 7#a7 ,entity that provides pharmacy benefits management services ,the term entity that provides pharmacy benefits management services means-- 7,a7 any entity that1 pursuant to a written agreement with a group health plan or a health insurance issuer offering group or individual health insurance coverage1 directly or through an intermediary-- 7i7 acts as a price negotiator on behalf of the plan or coverage2 or 7ii7 manages the prescription drug benefits provided by the plan or coverage1 which may include the processing and payment of claims for prescription drugs1 the performance of drug utilization review1 the processing of drug prior authorization requests1 the adjudication of appeals or grievances related to the prescription drug benefit1 contracting with network pharmacies1 controlling the cost of covered prescription drugs1 or the provision of related services2 or 7,b7 any entity that is owned1 affiliated1 or related under a common ownership structure with an entity described in subparagraph 7,a74 7#b7 ,net price ,the term net price1 with respect to a prescription drug1 means the final price paid by a group health plan or health insurance issuer offering group or individual health insurance coverage 7or entity that provides pharmacy benefits management services on behalf of such a plan or issuer7 after applying any rebates and other remuneration under the plan or coverage from drug manufacturers during the plan year4 7e7 ,specification ,a health insurance plan will not fail to be treated as an ,,hdhp for complying with the cost-sharing cap in this section4 4 7b7 ,,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 #gbe4 ,requirements with respect to cost-sharing for highly rebated drugs 7a7 ,in general ,no later than ,april #a1 #bjbd1 and annually thereafter1 the ,secretary shall certify 7or recertify1 if applicable7 as a highly rebated drug any drug identified in reports submitted under sections #gbe1 #bgii;,a-#aj of the ,public ,health ,service ,act1 and #ihbe of the ,internal ,revenue ,code of #aihf for which total rebates1 reductions in price1 and other forms of remuneration in the previous year aggregated across all commercial markets exceeded #ej percent of total annual spending on such drug in such year4 7b7 ,deductible and cost-,sharing limitations for certified drugs ,for plan years that begin on or after ,january #a1 #bjbe1 a group health plan or a health insurance issuer offering group health insurance coverage 7or entity that provides pharmacy benefits management services on behalf of such a plan or issuer7 that provides coverage of any highly rebated drug shall not impose cost-sharing in excess of1 per #cj-;day supply1 the quotient of the annual net price paid by such group health plan or health insurance issuer 7or entity that provides pharmacy benefits management services on behalf of such a plan or issuer71 in the most recent calendar year for which a final net price has been calculated by such plan or coverage 7or entity that provides pharmacy benefit management services on behalf of such plan or issuer71 per #cj-;day supply of such specific highly rebated drug1 divided by #ab4 7c7 ,highly rebated drug previously subject to formulary exclusion ,beginning on ,january #a1 #bjbe1 in the case of a specific highly rebated drug covered by a group health plan or health insurance issuer offering group health insurance coverage 7or entity that provides pharmacy benefits management services on behalf of such plan or issuer7 that provides coverage of a specific highly rebated drug that was not covered in the previous year1 such group health plan or health insurance issuer shall not receive from a drug manufacturer a reduction in price or other remuneration with respect to such specific highly rebated drug received by an enrollee in the plan or coverage and covered by the plan or coverage1 unless-- 7#a7 any such reduction in price is reflected at the point of sale to the enrollee2 and 7#b7 any such other remuneration is a flat fee-based service fee not contingent on total volume of sales that a manufacturer of prescription drugs pays to an entity that provides pharmacy benefits management services4 7d7 ,definitions ,in this section3 7#a7 ,entity that provides pharmacy benefits management services ,the term entity that provides pharmacy benefits management services means-- 7,a7 any entity that1 pursuant to a written agreement with a group health plan or a health insurance issuer offering group health insurance coverage1 directly or through an intermediary-- 7i7 acts as a price negotiator on behalf of the plan or coverage2 or 7ii7 manages the prescription drug benefits provided by the plan or coverage1 which may include the processing and payment of claims for prescription drugs1 the performance of drug utilization review1 the processing of drug prior authorization requests1 the adjudication of appeals or grievances related to the prescription drug benefit1 contracting with network pharmacies1 controlling the cost of covered prescription drugs1 or the provision of related services2 or 7,b7 any entity that is owned1 affiliated1 or related under a common ownership structure with an entity described in subparagraph 7,a74 7#b7 ,net price ,the term net price1 with respect to a prescription drug1 means the final price paid by a group health plan or health insurance issuer offering group health insurance coverage 7or entity that provides pharmacy benefits management services on behalf of such a plan or issuer7 after applying any rebates and other remuneration under the plan or coverage from drug manufacturers during the plan year4 7e7 ,specification ,a health insurance plan will not fail to be treated as an ,,hdhp for complying with the cost-sharing cap in this section4 4 7#b7 ,clerical amenmdnet ,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 related to section #gbe the following3 ,sec4 #gbe4 ,requirements with respect to cost-sharing for highly rebated drugs4 4 7c7 ,,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 highly rebated drugs 7a7 ,in general ,no later than ,april #a1 #bjbd1 and annually thereafter1 the ,secretary shall certify 7or recertify1 if applicable7 as a highly rebated drug any drug identified in reports submitted under sections #ihbe1 #bgii;,a-#aj of the ,public ,health ,service ,act1 and #gbe of the ,employee ,retirement ,income ,security ,act for which total rebates1 reductions in price1 and other forms of remuneration in the previous year aggregated across all commercial markets exceeded #ej percent of total annual spending on such drug in such year4 7b7 ,deductible and cost-,sharing limitations for certified drugs ,for plan years that begin on or after ,january #a1 #bjbe1 a group health plan 7or entity that provides pharmacy benefits management services on behalf of such a plan7 that provides coverage of any highly rebated drug shall not impose cost-sharing in excess of1 per #cj-;day supply1 the quotient of the annual net price paid by such group health plan 7or entity that provides pharmacy benefits management services on behalf of such a plan71 in the most recent calendar year for which a final net price has been calculated by such plan 7or entity that provides pharmacy benefit management services on behalf of such plan71 per #cj-;day supply of such specific highly rebated drug1 divided by #ab4 7c7 ,highly rebated drug previously subject to formulary exclusion ,beginning on ,january #a1 #bjbe1 in the case of a specific highly rebated drug covered by a group health plan 7or entity that provides pharmacy benefits management services on behalf of such plan7 that provides coverage of a specific highly rebated drug that was not covered in the previous year1 such group health plan shall not receive from a drug manufacturer a reduction in price or other remuneration with respect to such specific highly rebated drug received by an enrollee in the plan and covered by the plan1 unless-- 7#a7 any such reduction in price is reflected at the point of sale to the enrollee2 and 7#b7 any such other remuneration is a flat fee-based service fee not contingent on total volume of sales that a manufacturer of prescription drugs pays to an entity that provides pharmacy benefits management services4 7d7 ,definitions ,in this section3 7#a7 ,entity that provides pharmacy benefits management services ,the term entity that provides pharmacy benefits management services means-- 7,a7 any entity that1 pursuant to a written agreement with a group health plan1 directly or through an intermediary-- 7i7 acts as a price negotiator on behalf of the plan2 or 7ii7 manages the prescription drug benefits provided by the plan1 which may include the processing and payment of claims for prescription drugs1 the performance of drug utilization review1 the processing of drug prior authorization requests1 the adjudication of appeals or grievances related to the prescription drug benefit1 contracting with network pharmacies1 controlling the cost of covered prescription drugs1 or the provision of related services2 or 7,b7 any entity that is owned1 affiliated1 or related under a common ownership structure with an entity described in subparagraph 7,a74 7#b7 ,net price ,the term net price1 with respect to a prescription drug1 means the final price paid by a group health plan 7or entity that provides pharmacy benefits management services on behalf of such a plan7 after applying any rebates and other remuneration under the plan from drug manufacturers during the plan year4 7e7 ,specification ,a health insurance plan will not fail to be treated as an ,,hdhp for complying with the cost-sharing cap in this section4 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 highly rebated drugs4 4