,,ii  #aaith ,,congress  #b;d ,session  
,s4 #dibd  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,june #bd1     
#bjbf,ms4 ,rosen 7for herself and ,mr4  
,curtis7 introduced the following bill2 
which was read twice and referred to the
 ,committee on ,health1 ,education1     
,labor1 and ,pensions  ,a ,,bill  ,to   
preserve patient access to health care  
providers and prescription drug coverage
 under ,medicare and individual market  
plans4  #a4 ,short title ,this ,act may 
be cited as the ,preserving ,patient    
,access ,act4  #b4 ,preserving patient  
access to health care providers and     
prescription drug coverage under        
,medicare and individual market plans   
7a7 ,medicare  7#a7 ,medicare ,advantage
 plans ,section #ahea7;e77#d7 of the    
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ba7;e77#d77 is amended-- 7,a7 in
 subparagraph 7,c77ii71 by striking or  
at the end2  7,b7 by redesignating      
subparagraph 7,d7 as subparagraph 7,e72 
and  7,c7 by inserting after            

subparagraph 7,c7 the following new     
subparagraph3  7,d7 a health care       
provider with whom the individual has   
had an in-person or telehealth visit1   
within the preceding #b year period1 and
 who was listed as an in-network        
provider under the plan during the      
annual1 coordinated election period     
described in paragraph 7#c7 for the plan
 year becomes an out-of-network provider
 under the plan4  4  7#b7 ,prescription 
drug plans and ,,ma-,,pd plans ,section 
#ahfj;,d-#a7;b77#c7 of the ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#aja7;b77#c77 is amended by      
adding at the end the following new     
subparagraph3  7,f7 ,mid-year negative  
formulary changes  7i7 ,in general ,in  
the case where a prescription drug plan 
or ,,ma-,,pd plan implements a negative 
formulary change with respect to a      
covered part ,d drug dispensed to the   
part ,d eligible individual within the  
previous #f-month period1 for which the 
plan provided coverage1 and for which   

approval or licensure under section #eje
 of the ,federal ,food1 ,drug1 and      
,cosmetic ,act or section #cea of the   
,public ,health ,service ,act is still  
in effect4  7ii7 ,negative formulary    
change ,in this subparagraph1 the term  
negative formulary change has the       
meaning given such term in section      
#dbc4ajj of title #db1 ,code of ,federal
 ,regulations 7or successor             
regulations74  4  7#c7 ,effective date  
,the amendments made by this subsection 
shall apply with respect to plan years  
beginning on or after ,january #a1      
#bjbg4  7b7 ,individual market plans    
7#a7 ,in general ,section #bgjb7;b77#b7 
of the ,public ,health ,service ,act    
7#db ,u4,s4,c4 #cjj;gg-#a7;b77#b77 is   
amended-- 7,a7 by inserting and1 as     
applicable1 for mid-plan year changes to
 provider networks or formularies       
described in subparagraph 7,b7 before   
the period at the end2  7,b7 by striking
 ,a health and inserting the following3 
7,a7 ,in general ,a health  2 and  7,c7 

by adding at the end the following3     
7,b7 ,special enrollment period for     
individual market plans  7i7 ,in general
 ,a health insurance issuer offering    
individual health insurance coverage    
shall establish a special enrollment    
period under which any individual may   
enroll in the coverage during a plan    
year if the individual1 during the same 
plan year1 is enrolled in other         
individual health insurance coverage    
7referred to in this subparagraph as the
 initial plan7 and-- 7,i7 a provider    
with whom the individual had an         
in-person or telehealth visit within the
 preceding #b-year period1 and who was  
listed as an in-network provider under  
the initial plan during the most recent 
open enrollment period1 becomes an      
out-of-network provider under the       
initial plan2 or  7,,ii7 the initial    
plan implements a negative formulary    
change with respect to a prescription   
drug dispensed or administered to the   
individual within the previous #f-month 

period1 for which the initial plan      
provided benefits1 and for which        
approval or licensure under section #eje
 of the ,federal ,food1 ,drug1 and      
,cosmetic ,act or section #cea of this  
,act is still in effect4  7ii7 ,negative
 formulary change ,in this subparagraph1
 the term negative formulary change has 
the meaning given such term in section  
#dbc4ajj of title #db1 ,code of ,federal
 ,regulations 7or successor             
regulations71 except that1 for purposes 
of this subparagraph1 the term a drug   
covered by the initial plan shall be    
substituted for the term a covered ,part
 ,d drug4  4  7#b7 ,exchanges ,section  
#acaa7;c77#f77;,c7 of the ,patient      
,protection and ,affordable ,care ,act  
7#db ,u4,s4,c4 #ahjca7;c77#f77;,c77 is  
amended by inserting 1 section          
#bgjb7;b77#a77;,b71 after of #aihf4