,i  #aaith ,,congress  #ast ,session    
,h4 ,r4 #fbee  ,,in ,,the ,,house ,,of  
,,representatives  ,november #ba1       
#bjbe,ms4 ,craig 7for herself1 ,mrs4    
,mc,bath1 ,mr4 ,horsford1 ,mr4          
,landsman1 and ,ms4 ,schrier7 introduced
 the following bill2 which was referred 
to the ,committee on ,energy and        
,commerce1 and in addition to the       
,committees on ,ways and ,means1 and    
,education and ,workforce1 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 amend title ,,xxvii of   
the ,public ,health ,service ,act1 the  
,internal ,revenue ,code of #aihf1 and  
the ,employee ,retirement ,income       
,security ,act of #aigd to establish    
requirements with respect to            
cost-sharing for certain insulin        
products1 and for other purposes4  #a4  
,short title ,this ,act may be cited as 
the ,affordable ,insulin ,now ,act4  #b4

 ,requirements with respect to          
cost-sharing for insulin products  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        
following new section3  #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
 #bjbf1 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  7b7 ,,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 certain insulin        
products  7a7 ,in general ,for plan     
years beginning on or after ,january #a1
 #bjbf1 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 the ,internal ,revenue ,code of 
#aihf is amended by adding at the end   
the following new item3  ,sec4 #ihbf4   
,requirements with respect to           
cost-sharing for certain insulin        
products4  4  7c7 ,,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 #bjbf1 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  7d7 ,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  7e7 ,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 for a plan year before an
 enrolled individual has incurred       
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