,,ii  #aah? ,,congress  #a/ ,session    
,s4 #adf  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,janu>y #cj1 #bjbc,mr4 
,hawley introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to r$uce ! price ( insul9 = 
pati5ts4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,cap ,insul9 ,prices ,act4  
#b4 ,r$uction 9 co/-%>+ = cov]$ insul9  
products "u ,m$ic>e "p ,d ,section      
#ahfj;,d-#b7;b77#i77;,d7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajb7;b77#i77;,d77 is am5d$--    
7#a7 by r$esignat+ clause 7ii7 z clause 
7iii72  7#b7 9 clause 7i7-- 7,a7 by     
/rik+ plan ye>s #bjbc1 #bjbd1 & #bjbe & 
ins]t+ plan ye> #bjbc2 &  7,b7 by /rik+ 
& aft] ! semicolon at ! end2  7#c7 by   
ins]t+ aft] clause 7i7 ! foll[+ new     
clause3  7ii7 dur+ plan ye>s #bjbd &    
#bjbe1 #be2 &  2 &  7#d7 9 clause       
7iii77,i71 z r$esignat$ by p>agraph 7#a7
 ( ?is section1 by /rik+ #ce & ins]t+   
#be4  #c4 ,requirem5ts ) respect to     

co/-%>+ = insul9 products  7a7 ,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 
#bjbd1 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$uctible2  7#b7 impose any   
co/-%>+ requirem5t 9 excess ( ! less] (1
 p] #cj-;day supply-- 7,a7 #be2 or  7,b7
 ! am\nt equal to #be p]c5t ( !         
negotiat$ 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]vices2 or  7#c7 impose any utilization

 managem5t practices su* z prior        
au?orization1 /ep !rapy protocols1 or   
o!r simil> conditions on su* products1  
except z cl9ically ju/ifi$ & z specifi$ 
by ! ,secret>y4  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* section4  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$uctible
 or out-(-pocket maximum t applies "u ! 
plan or cov]age4  4  7b7 ,no effect on  
o!r co/-,%>+ ,section #acjb7;d77#b7 ( ! 
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjbb7;d77#b77 is  
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,d7 ,special rule relat+ 

to insul9 cov]age ,= plan ye>s beg9n+ on
 or aft] ,janu>y #a1 #bjbd1 ! 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  7c7 ,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 = a plan   

ye> be=e an enroll$ individual has      
incurr$ 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  7d7       
,,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 #bjbd1 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$uctible2  7#b7 impose any co/-%>+     
requirem5t 9 excess ( ! less] (1 p]     
#cj-;day supply-- 7,a7 #be2 or  7,b7 !  
am\nt equal to #be p]c5t ( ! negotiat$  
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]vices2 or    
7#c7 impose any utilization managem5t   
practices su* z prior au?orization1 /ep 
!rapy protocols1 or o!r simil>          
conditions on su* products1 except z    
cl9ically ju/ifi$ & z specifi$ by !     
,secret>y4  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* section4
  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 #gbf ,requirem5ts 
) respect to co/-%>+ = c]ta9 insul9     
products4  4  7e7 ,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 #bjbd1 a gr\p heal? plan    

%all provide cov]age ( select$ insul9   
products1 & ) respect to su* products1  
%all n-- 7#a7 apply any d$uctible2  7#b7
 impose any co/-%>+ requirem5t 9 excess 
( ! less] (1 p] #cj-;day supply-- 7,a7  
#be2 or  7,b7 ! am\nt equal to #be p]c5t
 ( ! negotiat$ 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]vices2 or  7#c7 impose any  
utilization managem5t practices su* z   
prior au?orization1 /ep !rapy protocols1
 or o!r simil> conditions on su*        
products1 except z cl9ically ju/ifi$ & z
 specifi$ by ! ,secret>y4  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* section4  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 #ihbf           
,requirem5ts ) respect to co/-%>+ =     
c]ta9 insul9 products4  4  7f7          
,implem5tation ,! ,secret>y ( ,heal? &  
,human ,s]vices1 ! ,secret>y ( ,labor1 &
 ! ,secret>y ( ! ,treasury %all implem5t
 ! provisions ( ?is section1 includ+ !  
am5dm5ts made by ?is section1 ?r\gh     
subregulatory guidance or program       
in/ruction4