,,ii  #aaith ,,congress  #b;d ,session  
,s4 #deab  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #ac1      
#bjbf,mr4 ,kennedy introduced the       
following bill2 which was read twice and
 referred to the ,committee on ,health1 
,education1 ,labor1 and ,pensions  ,a   
,,bill  ,to provide for appropriate     
cost-sharing for insulin products       
covered under private health plans1 and 
to establish a program to support health
 care providers and pharmacies in       
providing discounted insulin products to
 uninsured individuals4  #a4 ,short     
title ,this ,act may be cited as the    
,affordable ,insulin ,now ,act of #bjbf4
  #b4 ,appropriate cost-sharing for     
insulin products covered under private  
health plans  7a7 ,in general ,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-#ab4 ,requirements with respect
 to cost-sharing for certain insulin    

products  7a7 ,in general ,for plan     
years beginning on or after ,january #a1
 #bjbg1 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 insulin1 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 section4  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 ,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-#ab7;b7 of the ,public
 ,health ,service ,act7 from the        
application of any deductible pursuant  
to section #bgii;,a-#ab7;a77#a7 of such 
,act1 section #gbg7;a77#a7 of the       
,employee ,retirement ,income ,security 
,act of #aigd1 or section #ihbg7;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  7c7 ,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-#ab of the ,public ,health     
,service ,act1 before an enrolled       

individual has incurred1 during the plan
 year1 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-#ab7;b7 of the ,public ,health 
,service ,act2 and  7ii7 the            
requirements of section #bgii;,a-#ab 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  7d7 ,,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  #gbg4 ,requirements with    
respect to cost-sharing for certain     
insulin products  7a7 ,in general ,for  
plan years beginning on or after        

,january #a1 #bjbg1 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 insulin1 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 section4  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 #gbf 
the following3  ,sec4 #gbg4             
,requirements with respect to           
cost-sharing for certain insulin        
products4  4  7e7 ,internal ,revenue    

,code  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  #ihbg4 ,requirements with     
respect to cost-sharing for certain     
insulin products  7a7 ,in general ,for  
plan years beginning on or after        
,january #a1 #bjbg1 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 insulin1  
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     
section4  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 such ,code is amended by adding 
at the end the following new item3      
,sec4 #ihbg4 ,requirements with respect 
to cost-sharing for certain insulin     

products4  4  7f7 ,implementation ,the  
,secretary of ,health and ,human        
,services1 the ,secretary of ,labor1 and
 the ,secretary of the ,treasury may    
implement the provisions of1 including  
the amendments made by1 this subsection 
through sub-regulatory guidance1 program
 instruction or otherwise4  #c4         
,reimbursement for insulin furnished to 
uninsured individuals  7a7 ,in general  
,the ,secretary of ,health and ,human   
,services 7in this section referred to  
as the ,secretary7 shall establish a    
program under which the ,secretary      
enters into agreements with qualifying  
entities for purposes of furnishing     
insulin products to uninsured           
individuals4  7b7 ,payment ,the         
,secretary shall pay to each qualifying 
entity with an agreement in effect under
 this section1 with respect to each     
#cj-;day supply of insulin products     
furnished to an uninsured individual by 
such entity on or after ,january #a1    
#bjbg1 an amount equal to the difference

 between the out-of-pocket cost to the  
individual for a #cj-;day supply of such
 insulin products and #ce4  7c7         
,definitions ,in this section3 7#a7     
,insulin product ,the term insulin      
product has the meaning given the term  
insulin in section #bgii;,a-#ab of the  
,public ,health ,service ,act1 as added 
by section #b4  7#b7 ,qualifying entity 
,the term qualifying entity means a     
health care provider or pharmacy that-- 
7,a7 agrees1 with respect to an insulin 
product furnished by such provider or   
pharmacy to an uninsured individual     
after ,january #a1 #bjbg1 for which     
payment is made by the ,secretary under 
this section1 not to hold such          
individual liable for any payment amount
 for such product2 and  7,b7 meets such 
other standards and requirements as may 
be determined appropriate by the        
,secretary4  7#c7 ,specified health plan
 ,the term specified health plan means a
 ,federal health care program 7as       
defined in section #aabh;,b of the      

,social ,security ,act 7#db ,u4,s4,c4   
#acbj;a-#g;b771 the health program      
established under chapter #hi of title  
#e1 ,united ,states ,code1 a group      
health plan 7as defined in section #bgia
 of the ,public ,health ,service ,act   
7#db ,u4,s4,c4 #cjj;gg-#ia771 and group 
or individual health insurance coverage 
7as defined in such section #bgia74     
7#d7 ,uninsured individual ,the term    
uninsured individual means1 with respect
 to an individual and an insulin        
product1 an individual who does not have
 benefits available for such product 7or
 for another insulin product of the same
 dosage form 7such as vial1 pump1 or    
inhaler dosage forms7 and type 7such as 
rapid-acting1 short-acting1             
intermediate-acting1 long-acting1       
ultra-long-acting1 and premixed77 under 
a specified health plan4  #d4 ,sense of 
,congress ,it is the sense of ,congress 
that subsequent legislation should be   
enacted by ,congress that provides for  
an offset for any costs to the ,federal 

,government resulting from the enactment
 of this ,act4