,,ii  #aai? ,,congress  #a/ ,session    
,s4 #bgef  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #aj1         
#bjbe,ms4 ,alsobrooks 7= h]self & ,mr4  
,van ,holl57 introduc$ ! foll[+ bill2   
:i* 0 read twice & ref]r$ to !          
,committee on ,f9ance  ,a ,,bill  ,to   
am5d title ,,xxvii ( ! ,public ,heal?   
,s]vice ,act1 ! ,int]nal ,rev5ue ,code (
 #aihf1 & ! ,employee ,retirem5t ,income
 ,security ,act ( #aigd to r$uce pati5t 
co/-%>+ = prescription drug inhal]      
products us$ to treat brea?+ disord]s   
su* z a/hma & *ronic ob/ructive pulmon>y
 disease1 & = o!r purposes4  #a4 ,%ort  
title ,?is ,act may be cit$ z !         
,af=dable ,inhal]s & ,nebuliz]s ,act (  
#bjbe4  #b4 ,r$uc+ pati5t co/-%>+ =     
prescription drug inhal] products us$ to
 treat brea?+ disord]s su* z a/hma &    
*ronic ob/ructive pulmon>y disease  7a7 
,cov]age & co/-,%>+ requirem5ts  7#a7   
,private insurance  7,a7 ,,phsa ,"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[+ new section3  #bgii;,a-#aa4      
,cov]age & co/-%>+ requirem5ts =        
specifi$ inhal] products  7a7 ,9 g5]al  
,a gr\p heal? plan1 & a heal? insurance 
issu] (f]+ gr\p or individual heal?     
insurance cov]age1 %all provide b5efits 
"u su* plan or cov]age 7z applicable7 = 
all specifi$ inhal] products &1 )       
respect to su* a product1 may n-- 7#a7  
apply any d$uctible2 or  7#b7 impose any
 co/-%>+ requirem5t 9 excess ( #ae p]   
#cj-;day supply ( su* product4  7b7     
,c\nt+ co/-,%>+ t[>ds d$uctible &       
out-(-,pocket maximum ,a gr\p heal?     
plan1 & a heal? insurance issu] (f]+    
gr\p or individual heal? insurance      
cov]age1 %all c\nt any co/-%>+          
requirem5t describ$ 9 subsection 7a77#b7
 incurr$ by a p>ticipant1 b5efici>y1 or 
enrollee ( su* plan or cov]age ) respect
 to a specifi$ inhal] product t[>ds any 
out-(-pocket maximum & any d$uctible t1 
b = application ( subsection 7a71 w\ld h
 appli$ to su* p>ticipant1 b5efici>y1 or

 enrollee ) respect to su* product4  7c7
 ,specifi$ inhal] product def9$ ,=      
purposes ( ?is section1 ! t]m specifi$  
inhal] product means any ma9t5ance or   
reliev] or rescue inhalation drug       
7includ+ inhalation a]osols1 met]$ dose 
inhal]s1 dry p[d] inhal]s1 inhalation   
solutions1 bron*odilators1 &            
cortico/]oids7 ) a m$ically accept$     
indication 7z def9$ 9 section           
#aibg7k77#f7 ( ! ,social ,security ,act7
 = ! treatm5t = lung diseases su* z     
a/hma & *ronic ob/ructive pulmon>y      
disease4 ,su* t]m includes any equipm5t 
us$ 9 ! adm9i/ration ( su* drug 7su* z  
masks & tub+1 spac]s1 nebuliz]s1 &      
valve-hold+ *amb]s74  4  7,b7 ,,irc  7i7
 ,9 g5]al ,sub*apt] ,b ( *apt] #ajj ( ! 
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
by add+ at ! end ! foll[+ new section3  
#ihbf4 ,cov]age & co/-%>+ requirem5ts = 
specifi$ inhal] products  7a7 ,9 g5]al  
,a gr\p heal? plan %all provide b5efits 
"u su* plan = all specifi$ inhal]       
products &1 ) respect to su* a product1 

may n-- 7#a7 apply any d$uctible2 or    
7#b7 impose any co/-%>+ requirem5t 9    
excess ( #ae p] #cj-;day supply ( su*   
product4  7b7 ,c\nt+ co/-,%>+ t[>ds     
d$uctible & out-(-,pocket maximum ,a    
gr\p heal? plan %all c\nt any co/-%>+   
requirem5t describ$ 9 subsection 7a77#b7
 incurr$ by a p>ticipant or b5efici>y ( 
su* plan ) respect to a specifi$ inhal] 
product t[>ds any out-(-pocket maximum &
 any d$uctible t1 b = application (     
subsection 7a71 w\ld h appli$ to su*    
p>ticipant or b5efici>y ) respect to su*
 product4  7c7 ,specifi$ inhal] product 
def9$ ,= purposes ( ?is section1 ! t]m  
specifi$ inhal] product means any       
ma9t5ance or reliev] or rescue          
inhalation drug 7includ+ inhalation     
a]osols1 met]$ dose inhal]s1 dry p[d]   
inhal]s1 inhalation solutions1          
bron*odialators1 & cortico/]oids7 ) a   
m$ically accept$ indication 7z def9$ 9  
section #aibg7k77#f7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acifd-h7k77#f777 = ! treatm5t ( a/hma  

or ( *ronic ob/ructive pulmon>y disease4
 ,su* t]m includes any equipm5t us$ 9 ! 
adm9i/ration ( su* drug 7su* z masks &  
tub+1 spac]s1 nebuliz]s1 & valve-hold+  
*amb]s74  4  7ii7 ,cl]ical am5dm5t ,!   
table ( sections = sub*apt] ,b ( *apt]  
#ajj ( ! ,int]nal ,rev5ue ,code ( #aihf 
is am5d$ by add+ at ! end ! foll[+ new  
item3  ,sec4 #ihbf4 ,cov]age & co/-%>+  
requirem5ts = specifi$ inhal] products4 
4  7,c7 ,,erisa  7i7 ,9 g5]al ,subp>t ,b
 ( "p #g ( subtitle ,b ( title ,i ( !   
,employee ,retirem5t ,income ,security  
,act ( #aigd is am5d$ by add+ at ! end !
 foll[+ new section3  #gbf4 ,cov]age &  
co/-%>+ requirem5ts = specifi$ inhal]   
products  7a7 ,9 g5]al ,a gr\p heal?    
plan1 & a heal? insurance issu] (f]+    
gr\p heal? insurance cov]age1 %all      
provide b5efits "u su* plan or cov]age  
7z applicable7 = all specifi$ inhal]    
products &1 ) respect to su* a product1 
may n-- 7#a7 apply any d$uctible2 or    
7#b7 impose any co/-%>+ requirem5t 9    
excess ( #ae p] #cj-;day supply ( su*   

product4  7b7 ,c\nt+ co/-,%>+ t[>ds     
d$uctible & out-(-,pocket maximum ,a    
gr\p heal? plan1 & a heal? insurance    
issu] (f]+ gr\p heal? insurance cov]age1
 %all c\nt any co/-%>+ requirem5t       
describ$ 9 subsection 7a77#b7 incurr$ by
 a p>ticipant or b5efici>y ( su* plan ) 
respect to a specifi$ inhal] product    
t[>ds any out-(-pocket maximum & any    
d$uctible t1 b = application (          
subsection 7a71 w\ld h appli$ to su*    
p>ticipant or b5efici>y ) respect to su*
 product4  7c7 ,specifi$ inhal] product 
def9$ ,= purposes ( ?is section1 ! t]m  
specifi$ inhal] product means any       
ma9t5ance or reliev] or rescue          
inhalation drug 7includ+ inhalation     
a]osols1 met]$ dose inhal]s1 dry p[d]   
inhal]s1 inhalation solutions1          
bron*odialators1 & cortico/]oids7 ) a   
m$ically accept$ indication 7z def9$ 9  
section #aibg7k77#f7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acifd-h7k77#f777 = ! treatm5t ( a/hma  
or ( *ronic ob/ructive pulmon>y disease4

 ,su* t]m includes any equipm5t us$ 9 ! 
adm9i/ration ( su* drug 7su* z masks &  
tub+1 spac]s1 nebuliz]s1 & valve-hold+  
*amb]s74  4  7ii7 ,cl]ical am5dm5t ,!   
table ( cont5ts 9 section #a ( !        
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#bi ,u4,s4,c4 #ajja note7 
is am5d$ by ins]t+ aft] ! item relat+ to
 section #gbe ! foll[+ new item3  ,sec4 
#gbf4 ,cov]age & co/-%>+ requirem5ts =  
specifi$ inhal] products4  4  7,d7      
,con=m+ am5dm5ts  7i7 ,,hdhp safe h>bor 
,section #bbc7;c77#b7 ( ! ,int]nal      
,rev5ue ,code ( #aihf is am5d$ by add+  
at ! end ! foll[+ new subp>agraph3  7,i7
 ,safe h>bor = abs5ce ( d$uctible =     
specifi$ inhal] products ,= plan ye>s   
beg9n+ on or aft] ,janu>y #a1 #bjbf1 a  
plan %all n fail to be treat$ z a high  
d$uctible heal? plan by reason ( fail+  
to h a d$uctible = specifi$ inhal]      
products 7z def9$ 9 section #bgii;,a-#aa
 ( ! ,public ,heal? ,s]vice ,act74  4   
7ii7 ,cata/rophic plan safe h>bor       
,section #acjb7;e77#a77;,b77i7 ( !      

,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4                     
#ahjbb7;e77#a77;,b77i77 is am5d$ by     
ins]t+ or #bgii;,a-#aa ( ! ,public      
,heal? ,s]vice ,act aft] section #bgac4 
7,e7 ,effective date ,! am5dm5ts made by
 ?is p>agraph %all apply to plan ye>s   
beg9n+ on or aft] ,janu>y #a1 #bjbf4    
7#b7 ,m$ic>e  7,a7 ,"p ,b ,section #ahcc
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #aciel7 is am5d$-- 7i7 9      
subsection 7a77#a77,s7-- 7,i7 9 clause  
7i71 by ins]t+ or 7iii7 aft] clause     
7ii72 &  7,,ii7 by add+ at ! end !      
foll[+ new clause3 & 7iii7 ) respect to 
a specifi$ inhal] product 7z def9$ 9    
section #bgii;,a-#aa ( ! ,public ,heal? 
,s]vice ,act7 furni%$ on or aft] ,janu>y
 #a1 #bjbf1 ! am\nts paid %all be #ajj  
p]c5t ( ! less] ( ! actual *>ge or !    
paym5t am\nt e/abli%$ 9 section #ahdb7o7
 7or1 if applicable1 "u section #ahdg1  
#ahdg;,a1 or #ahdg;,b71 less1 p]        
#cj-;day supply ( su* product1 #ae12 &  
7ii7 9 subsection 7b71 9 ! fir/ s5t5ce--

 7,i7 9 p>agraph 7#ab71 by /rik+ 1 &2 & 
7,,ii7 by /rik+ 44 & ins]t+ 1 & 7#ad7   
su* d$uctible %all n apply ) respect to 
a specifi$ inhal] product 7z def9$ 9    
section #bgii;,a-#aa ( ! ,public ,heal? 
,s]vice ,act7 furni%$ on or aft] ,janu>y
 #a1 #bjbf44  7,b7 ,"p ,d  7i7 ,9 g5]al 
,section #ahfj;,d-#b7;b7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajb7;b77 is am5d$-- 7,i7 9      
p>agraph 7#a77;,a71 by /rik+ p>agraphs  
7#h7 & 7#i7 & ins]t+ p>agraphs 7#h71    
7#i71 & 7#aj72  7,,ii7 9 p>agraph       
7#b77;,a71 by /rik+ p>agraphs 7#h7 &    
7#i7 & ins]t+ p>agraphs 7#h71 7#i71 &   
7#aj72  7,,iii7 9 p>agraph 7#d77;,a77i71
 by /rik+ p>agraphs 7#h7 & 7#i7 & ins]t+
 p>agraphs 7#h71 7#i71 & 7#aj72 &       
7,,iv7 by add+ at ! end ! foll[+ new    
p>agraph3  7#aj7 ,treatm5t ( co/-%>+ =  
specifi$ inhal] products  7,a7 ,no      
application ( d$uctible ,= plan ye>     
#bjbf & subsequ5t plan ye>s1 ! d$uctible
 "u p>agraph 7#a7 %all n apply ) respect
 to any specifi$ inhal] product4  7,b7  

,application ( co/-%>+  ,= plan ye>     
#bjbf & subsequ5t plan ye>s1 ! cov]age  
provides b5efits = any specifi$ inhal]  
product ) co/-%>+ = a mon?'s supply t   
does n exce$ #ae4  7,c7  ,def9ition  ,= 
purposes ( ?is p>agraph1 ! t]m specifi$ 
inhal] product has ! mean+ giv5 su* t]m 
9 section #bgii;,a-#aa ( ! ,public      
,heal? ,s]vice ,act4  4  7ii7 ,con=m+   
am5dm5t = alt]native prescription drug  
cov]age ,section #ahfj;,d-#b7;c7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ajb7;c77 is am5d$ by add+ at !  
end ! foll[+ new p>agraph3  7#g7        
,treatm5t ( co/-%>+ = specifi$ insul9   
products ,! cov]age 9 provid$ 9         
accordance ) subsection 7b77#aj74  4    
7iii7  ,con=m+ am5dm5ts to co/-%>+ =    
l[-income individuals  ,section         
#ahfj;,d-#ad7;a77#a7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciew-#aad7;a77#a77 is am5d$--  7,i7 9 
subp>agraph 7,d77iii71 by add+ at ! end 
! foll[+ new s5t5ce3 ,= plan ye> #bjbf &
 subsequ5t plan ye>s1 ! copaym5t am\nt  

applicable "u ! prec$+ s5t5ce to a      
mon?'s supply ( a specifi$ inhal]       
product 7z def9$ 9 section              
#ahfj;,d-#b7;b77#aj77 disp5s$ to !      
individual may n exce$ #ae42 &  7,,ii7 9
 subp>agraph 7,e71 by ins]t+ or "u      
section #ahfj;,d-#b7;b77#aj7 9 ! case ( 
a specifi$ inhal] product 7z def9$ 9 su*
 section7 aft] 7z def9$ 9 subp>agraph   
7,c7 ( su* section74  7b7 ,paym5t       
program = un9sur$ individuals ,"p ,p (  
title ,,iii ( ! ,public ,heal? ,s]vice  
,act 7#db ,u4,s4,c4 #bhj;g et seq47 is  
am5d$ by add+ at ! end ! foll[+ new     
section3  #cii,v-#h4 ,specifi$ inhal]   
product paym5t program  7a7 ,9 g5]al    
,beg9n+ ,janu>y #a1 #bjbf1 ! ,secret>y  
%all e/abli% a program "u :i*-- 7#a7    
program-regi/]$ provid]s submit claims  
to ! ,secret>y ) respect to ! furni%+ ( 
specifi$ inhal] products 7z def9$ 9     
subsection 7b77 to un9sur$ individuals2 
&  7#b7 ! ,secret>y1 subject to !       
availability ( appropriations1 pays ea* 
su* provid] = su* products 9 an am\nt   

det]m9$ appropriate by ! ,secret>y4  7b7
 ,def9itions ,9 ?is section3 7#a7       
,program-regi/]$ provid] ,! t]m         
program-regi/]$ provid] means a heal?   
c>e provid] t-- 7,a7 is lic5s$ or       
o!rwise au?oriz$ to adm9i/] or disp5se  
specifi$ inhal] products 9 ! ,/ate 9 :i*
 su* provid] s adm9i/]s or disp5ses su* 
products "u ! program e/abli%$ "u ?is   
section2 &  7,b7 ent]s into an agreem5t 
) ! ,secret>y "u :i* ! provid] agrees n 
to hold an un9sur$ individual liable = !
 co/ ( any su* product adm9i/]$ or      
disp5s$ to su* individual 9 an am\nt    
exce$+ #ae = a mon?'s supply ( su*      
product if a paym5t is made "u          
subsection 7a77#b7 ) respect to su*     
product s adm9i/]$ or disp5s$4  7#b7    
,specifi$ inhal] product ,! t]m specifi$
 inhal] product has ! mean+ giv5 su* t]m
 9 section #bgii;,a-#aa4  7#c7 ,un9sur$ 
individual ,! t]m un9sur$ individual    
means1 ) respect to an individual       
furni%$ a specifi$ inhal] product1 an   
individual :o is n enroll$ 9-- 7,a7 a   

,f$]al heal? c>e program 7z def9$ 9     
section #aabh;,b7f7 ( ! ,social         
,security ,act72  7,b7 a gr\p heal? plan
 or heal? insurance cov]age (f]$ by a   
heal? insurance issu] 9 ! gr\p or       
individual m>ket 7z su* t]ms are def9$ 9
 section #bgia72 or  7,c7 a heal? plan  
(f]$ "u *apt] #hi ( title #e1 ,unit$    
,/ates ,code4  4  7c7 ,implem5tation ,! 
,secret>y ( ,heal? & ,human ,s]vices may
 implem5t ! am5dm5ts made by ?is section
 by program in/ruction1 subregulatory   
guidance1 or o!rwise4