H.R. 6965 — Introduced in House

I 118th CONGRESS 2d Session H. R. 6965 IN THE HOUSE OF REPRESENTATIVES January 11, 2024Mr. Frost (for himself and Ms. Matsui) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to establish requirements with respect to cost sharing for epinephrine injectors under group health plans and group and individual health insurance coverage. 1. Short title This Act may be cited as the Epinephrine’s Pharma Inflated Price Ends Now Act or the EPIPEN Act. 2. Requirements with respect to cost sharing for epinephrine injectors (a) PHSA Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–111 et seq.) is amended by adding at the end the following new section: 2799A–11. Requirements with respect to cost sharing for epinephrine injectors (a) In general A group health plan, and a health insurance issuer offering group or individual health insurance coverage, shall provide coverage of epinephrine injectors, and with respect to such injectors, may not— (1) apply any deductible; or (2) impose any cost sharing in excess of $60 per package of 2 injectors (or the equivalent). (b) Application of cost sharing toward deductibles and out-of-Pocket maximums Any cost-sharing payments made pursuant to subsection (a)(2) shall be counted toward any deductible or out-of-pocket maximum that applies under the plan or coverage. (c) Out-of-network providers Nothing in this section requires a plan or issuer that has a network of providers to provide benefits for an epinephrine injector described in this section that is delivered by an out-of-network provider, or precludes a plan or issuer that has a network of providers from imposing higher cost sharing than the levels specified in subsection (a)(2) for an epinephrine injector described in this section that is delivered by an out-of-network provider. (d) Epinephrine injector defined In this section, the term epinephrine injector means an auto-injector approved by the Food and Drug Administration for the administration of epinephrine. . (b) ERISA (1) In general Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following new section: 726. Requirements with respect to cost sharing for epinephrine injectors (a) In general A group health plan, and a health insurance issuer offering group health insurance coverage, shall provide coverage of epinephrine injectors, and with respect to such injectors, may not— (1) apply any deductible; or (2) impose any cost sharing in excess of $60 per package of 2 injectors (or the equivalent). (b) Application of cost sharing toward deductibles and out-of-Pocket maximums Any cost-sharing payments made pursuant to subsection (a)(2) shall be counted toward any deductible or out-of-pocket maximum that applies under the plan or coverage. (c) Out-of-Network providers Nothing in this section requires a plan or issuer that has a network of providers to provide benefits for an epinephrine injector described in this section that is delivered by an out-of-network provider, or precludes a plan or issuer that has a network of providers from imposing higher cost sharing than the levels specified in subsection (a)(2) for an epinephrine injector described in this section that is delivered by an out-of-network provider. (d) Epinephrine injector defined In this section, the term epinephrine injector means an auto-injector approved by the Food and Drug Administration for the administration of epinephrine. . (2) Clerical amendment The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.) is amended by inserting after the item relating to section 725 the following: Sec. 726. Requirements with respect to cost sharing for epinephrine injectors. . (c) IRC (1) In general Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section: 9826. Requirements with respect to cost sharing for epinephrine injectors (a) In general A group health plan shall provide coverage of epinephrine injectors, and with respect to such injectors, may not— (1) apply any deductible; or (2) impose any cost sharing in excess of $60 per package of 2 injectors (or the equivalent). (b) Application of cost sharing toward deductibles and out-of-Pocket maximums Any cost-sharing payments made pursuant to subsection (a)(2) shall be counted toward any deductible or out-of-pocket maximum that applies under the plan. (c) Out-of-Network providers Nothing in this section requires a plan that has a network of providers to provide benefits for an epinephrine injector described in this section that is delivered by an out-of-network provider, or precludes a plan that has a network of providers from imposing higher cost sharing than the levels specified in subsection (a)(2) for an epinephrine injector described in this section that is delivered by an out-of-network provider. (d) Epinephrine injector defined In this section, the term epinephrine injector means an auto-injector approved by the Food and Drug Administration for the administration of epinephrine. . (2) Clerical amendment The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item: Sec. 9826. Requirements with respect to cost sharing for epinephrine injectors. . (d) Effective date The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2025.