,,ii  #aai? ,,congress  #b;d ,session   
,s4 #deab  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #ac1 #bjbf,mr4    
,k5n$y introduc$ ! foll[+ bill2 :i* 0   
read twice & ref]r$ to ! ,committee on  
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to provide = appropriate    
co/-%>+ = insul9 products cov]$ "u      
private heal? plans1 & to e/abli% a     
program to support heal? c>e provid]s & 
ph>macies 9 provid+ disc\nt$ insul9     
products to un9sur$ individuals4  #a4   
,%ort title ,?is ,act may be cit$ z !   
,af=dable ,insul9 ,n[ ,act ( #bjbf4  #b4
 ,appropriate co/-%>+ = insul9 products 
cov]$ "u private heal? plans  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-#ab4       
,requirem5ts ) respect to co/-%>+ =     
c]ta9 insul9 products  7a7 ,9 g5]al ,=  
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjbg1 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$uctible2 or  7#b7 impose any
 co/-%>+ 9 excess ( ! less] (1 p]       
#cj-;day supply-- 7,a7 #ce2 or  7,b7 !  
am\nt equal to #be p]c5t ( ! negotiat$  
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]vices4  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$7 (
 insul91 :5 available1 z select$ 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 ,! exemption ( cov]age
 ( select$ insul9 products 7z def9$ 9   
section #bgii;,a-#ab7;b7 ( ! ,public    
,heal? ,s]vice ,act7 f ! application (  
any d$uctible pursuant to section       
#bgii;,a-#ab7;a77#a7 ( su* ,act1 section
 #gbg7;a77#a7 ( ! ,employee ,retirem5t  
,income ,security ,act ( #aigd1 or      
section #ihbg7;a77#a7 ( ! ,int]nal      
,rev5ue ,code ( #aihf %all n be consid]$
 :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-#ab ( ! ,public ,heal? ,s]vice 
,act1 be=e an enroll$ individual has    
incurr$1 dur+ ! plan ye>1 co/-%>+       
exp5ses 9 an am\nt equal to ! annual    
limitation 9 effect "u subsection       
7c77#a7 = ! plan ye>4  7,b7 ,t]m9ology  
,= purposes ( subp>agraph 7,a7-- 7i7 !  
t]m select$ insul9 products has ! mean+ 
giv5 su* t]m 9 section #bgii;,a-#ab7;b7 
( ! ,public ,heal? ,s]vice ,act2 &  7ii7
 ! requirem5ts ( section #bgii;,a-#ab ( 
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  #gbg4 ,requirem5ts ) respect to
 co/-%>+ = c]ta9 insul9 products  7a7 ,9
 g5]al ,= plan ye>s beg9n+ on or aft]   
,janu>y #a1 #bjbg1 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$uctible2 or  7#b7 impose any co/-%>+ 9
 excess ( ! less] (1 p] #cj-;day        
supply-- 7,a7 #ce2 or  7,b7 ! am\nt     
equal to #be p]c5t ( ! negotiat$ 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]vices4  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$7 (
 insul91 :5 available1 z select$ 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    
#gbf ! foll[+3  ,sec4 #gbg4 ,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  #ihbg4 ,requirem5ts ) respect 
to co/-%>+ = c]ta9 insul9 products  7a7 
,9 g5]al ,= plan ye>s beg9n+ on or aft] 

,janu>y #a1 #bjbg1 a gr\p heal? plan    
%all provide cov]age ( select$ insul9   
products1 & ) respect to su* products1  
%all n-- 7#a7 apply any d$uctible2 or   
7#b7 impose any co/-%>+ 9 excess ( !    
less] (1 p] #cj-;day supply-- 7,a7 #ce2 
or  7,b7 ! am\nt equal to #be p]c5t ( ! 
negotiat$ 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]vices4  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$7 ( insul91 :5
 available1 z select$ 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 #ihbg4          
,requirem5ts ) respect to co/-%>+ =     
c]ta9 insul9 products4  4  7f7          
,implem5tation ,! ,secret>y ( ,heal? &  
,human ,s]vices1 ! ,secret>y ( ,labor1 &
 ! ,secret>y ( ! ,treasury may implem5t 
! provisions (1 includ+ ! am5dm5ts made 
by1 ?is subsection ?r\gh sub-regulatory 
guidance1 program in/ruction or o!rwise4
  #c4 ,reimbursem5t = insul9 furni%$ to 
un9sur$ individuals  7a7 ,9 g5]al ,!    
,secret>y ( ,heal? & ,human ,s]vices 79 
?is section ref]r$ to z ! ,secret>y7    
%all e/abli% a program "u :i* !         
,secret>y ent]s into agreem5ts )        
qualify+ entities = purposes ( furni%+  
insul9 products to un9sur$ individuals4 
7b7 ,paym5t ,! ,secret>y %all pay to ea*
 qualify+ entity ) an agreem5t 9 effect 
"u ?is section1 ) respect to ea*        

#cj-;day supply ( insul9 products       
furni%$ to an un9sur$ individual by su* 
entity on or aft] ,janu>y #a1 #bjbg1 an 
am\nt equal to ! diff]5ce betwe5 !      
out-(-pocket co/ to ! individual = a    
#cj-;day supply ( su* insul9 products & 
#ce4  7c7 ,def9itions ,9 ?is section3   
7#a7 ,insul9 product ,! t]m insul9      
product has ! mean+ giv5 ! t]m insul9 9 
section #bgii;,a-#ab ( ! ,public ,heal? 
,s]vice ,act1 z add$ by section #b4     
7#b7 ,qualify+ entity ,! t]m qualify+   
entity means a heal? c>e provid] or     
ph>macy t-- 7,a7 agrees1 ) respect to an
 insul9 product furni%$ by su* provid]  
or ph>macy to an un9sur$ individual aft]
 ,janu>y #a1 #bjbg1 = :i* paym5t is made
 by ! ,secret>y "u ?is section1 n to    
hold su* individual liable = any paym5t 
am\nt = su* product2 &  7,b7 meets su*  
o!r /&>ds & requirem5ts z may be det]m9$
 appropriate by ! ,secret>y4  7#c7      
,specifi$ heal? plan ,! t]m specifi$    
heal? plan means a ,f$]al heal? c>e     
program 7z def9$ 9 section #aabh;,b ( ! 

,social ,security ,act 7#db ,u4,s4,c4   
#acbj;a-#g;b771 ! heal? program e/abli%$
 "u *apt] #hi ( title #e1 ,unit$ ,/ates 
,code1 a gr\p heal? plan 7z def9$ 9     
section #bgia ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4 #cjj;gg-#ia771 &   
gr\p or individual heal? insurance      
cov]age 7z def9$ 9 su* section #bgia74  
7#d7 ,un9sur$ individual ,! t]m un9sur$ 
individual means1 ) respect to an       
individual & an insul9 product1 an      
individual :o does n h b5efits available
 = su* product 7or = ano!r insul9       
product ( ! same dosage =m 7su* z vial1 
pump1 or inhal] dosage =ms7 & type 7su* 
z rapid-act+1 %ort-act+1                
int]m$iate-act+1 long-act+1             
ultra-long-act+1 & premix$77 "u a       
specifi$ heal? plan4  #d4 ,s5se (       
,congress ,x is ! s5se ( ,congress t    
subsequ5t legislation %\ld be enact$ by 
,congress t provides = an (fset = any   
co/s to ! ,f$]al ,gov]nm5t result+ f !  
enactm5t ( ?is ,act4