Ensuring Seniors’ Access to COVID Treatments Act

I 117TH CONGRESS 1ST SESSION H. R. 975 To amend title XVIII of the Social Security Act to require coverage under Medicare PDPs and MA–PD plans, without the imposition of cost shar- ing or utilization management requirements, of drugs intended to treat COVID–19 during certain emergencies. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 11, 2021 Mr. CASTEN introduced the following bill; which was referred to the Com- mittee on Energy and Commerce, and in addition to the Committee on Foreign Affairs, for a period to be subsequently determined by the Speak- er, in each case for consideration of such provisions as fall within the ju- risdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to require coverage under Medicare PDPs and MA–PD plans, with- out the imposition of cost sharing or utilization manage- ment requirements, of drugs intended to treat COVID– 19 during certain emergencies. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Ensuring Seniors’ Ac- 4 cess to COVID Treatments Act’’. 5 VerDate Sep 11 2014 03:16 Mar 06, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H975.IH H975 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 975 IH SEC. 2. REQUIRING COVERAGE UNDER MEDICARE PDPS 1 AND MA–PD PLANS, WITHOUT THE IMPOSI- 2 TION OF COST SHARING OR UTILIZATION 3 MANAGEMENT REQUIREMENTS, OF DRUGS 4 INTENDED TO TREAT COVID–19 DURING CER- 5 TAIN EMERGENCIES. 6 (a) COVERAGE REQUIREMENT.— 7 (1) IN GENERAL.—Section 1860D–4(b)(3) of 8 the Social Security Act (42 U.S.C. 1395w– 9 104(b)(3)) is amended by adding at the end the fol- 10 lowing new subparagraph: 11 ‘‘(I) REQUIRED INCLUSION OF DRUGS IN- 12 TENDED TO TREAT COVID–19.— 13 ‘‘(i) IN GENERAL.—Notwithstanding 14 any other provision of law, a PDP sponsor 15 offering a prescription drug plan shall, 16 with respect to a plan year, any portion of 17 which occurs during the period described 18 in clause (ii), be required to— 19 ‘‘(I) include in any formulary— 20 ‘‘(aa) all covered part D 21 drugs with a medically accepted 22 indication (as defined in section 23 1860D–2(e)(4)) to treat COVID– 24 19 that are marketed in the 25 United States; and 26 VerDate Sep 11 2014 03:16 Mar 06, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H975.IH H975 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 975 IH ‘‘(bb) all drugs authorized 1 under section 564 or 564A of the 2 Federal Food Drug and Cosmetic 3 Act to treat COVID–19; and 4 ‘‘(II) not impose any prior au- 5 thorization or other utilization man- 6 agement requirement with respect to 7 such drugs described in item (aa) or 8 (bb) of subclause (I) (other than such 9 a requirement that limits the quantity 10 of drugs due to safety). 11 ‘‘(ii) PERIOD DESCRIBED.—For pur- 12 poses of clause (i), the period described in 13 this clause is the period during which there 14 exists the public health emergency declared 15 by the Secretary pursuant to section 319 16 of the Public Health Service Act on Janu- 17 ary 31, 2020, entitled ‘Determination that 18 a Public Health Emergency Exists Nation- 19 wide as the Result of the 2019 Novel 20 Coronavirus’ (including any renewal of 21 such declaration pursuant to such sec- 22 tion).’’. 23 (b) ELIMINATION OF COST SHARING.— 24 VerDate Sep 11 2014 03:16 Mar 06, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H975.IH H975 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 975 IH (1) ELIMINATION OF COST SHARING FOR 1 DRUGS INTENDED TO TREAT COVID–19 UNDER 2 STANDARD AND ALTERNATIVE PRESCRIPTION DRUG 3 COVERAGE.—Section 1860D–2 of the Social Security 4 Act (42 U.S.C. 1395w–102) is amended— 5 (A) in subsection (b)— 6 (i) in paragraph (1)(A), by striking 7 ‘‘The coverage’’ and inserting ‘‘Subject to 8 paragraph (8), the coverage’’; 9 (ii) in paragraph (2)— 10 (I) in subparagraph (A), by in- 11 serting after ‘‘Subject to subpara- 12 graphs (C) and (D)’’ the following: 13 ‘‘and paragraph (8)’’; 14 (II) in subparagraph (C)(i), by 15 striking ‘‘paragraph (4)’’ and insert- 16 ing ‘‘paragraphs (4) and (8)’’; and 17 (III) in subparagraph (D)(i), by 18 striking ‘‘paragraph (4)’’ and insert- 19 ing ‘‘paragraphs (4) and (8)’’; 20 (iii) in paragraph (4)(A)(i), by strik- 21 ing ‘‘The coverage’’ and inserting ‘‘Subject 22 to paragraph (8), the coverage’’; and 23 (iv) by adding at the end the following 24 new paragraph: 25 VerDate Sep 11 2014 03:16 Mar 06, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H975.IH H975 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 975 IH ‘‘(8) ELIMINATION OF COST-SHARING FOR 1 DRUGS INTENDED TO TREAT COVID–19.—The cov- 2 erage does not impose any deductible, copayment, 3 coinsurance, or other cost-sharing requirement for 4 drugs described in section 1860D–4(b)(3)(I)(i)(I) 5 with respect to a plan year, any portion of which oc- 6 curs during the period during which there exists the 7 public health emergency declared by the Secretary 8 pursuant to section 319 of the Public Health Service 9 Act on January 31, 2020, entitled ‘Determination 10 that a Public Health Emergency Exists Nationwide 11 as the Result of the 2019 Novel Coronavirus’ (in- 12 cluding any renewal of such declaration pursuant to 13 such section).’’; and 14 (B) in subsection (c), by adding at the end 15 the following new paragraph: 16 ‘‘(4) SAME ELIMINATION OF COST-SHARING FOR 17 DRUGS INTENDED TO TREAT COVID–19.—The cov- 18 erage is in accordance with subsection (b)(8).’’. 19 (2) ELIMINATION OF COST SHARING FOR 20 DRUGS INTENDED TO TREAT COVID–19 DISPENSED 21 TO INDIVIDUALS WHO ARE SUBSIDY ELIGIBLE INDI- 22 VIDUALS.—Section 1860D–14(a) of the Social Secu- 23 rity Act (42 U.S.C. 1395w–114(a)) is amended— 24 (A) in paragraph (1)— 25 VerDate Sep 11 2014 03:16 Mar 06, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H975.IH H975 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 975 IH (i) in subparagraph (D)— 1 (I) in clause (ii), by striking ‘‘In 2 the case of’’ and inserting ‘‘Subject to 3 subparagraph (F), in the case of’’; 4 and 5 (II) in clause (iii), by striking 6 ‘‘In the case of’’ and inserting ‘‘Sub- 7 ject to subparagraph (F), in the case 8 of’’; and 9 (ii) by adding at the end the following 10 new subparagraph: 11 ‘‘(F) ELIMINATION OF COST-SHARING FOR 12 DRUGS INTENDED TO TREAT COVID–19.—Cov- 13 erage that is in accordance with section 14 1860D–2(b)(8).’’; and 15 (B) in paragraph (2)— 16 (i) in subparagraph (B), by striking 17 ‘‘A reduction’’ and inserting ‘‘Subject to 18 subparagraph (F), a reduction’’; 19 (ii) in subparagraph (D), by striking 20 ‘‘The substitution’’ and inserting ‘‘Subject 21 to subparagraph (F), the substitution’’; 22 (iii) in subparagraph (E), by inserting 23 after ‘‘Subject to’’ the following: ‘‘subpara- 24 graph (F) and’’; and 25 VerDate Sep 11 2014 03:16 Mar 06, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H975.IH H975 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 975 IH (iv) by adding at the end the following 1 new subparagraph: 2 ‘‘(F) ELIMINATION OF COST-SHARING FOR 3 DRUGS INTENDED TO TREAT COVID–19.—Cov- 4 erage that is in accordance with section 5 1860D–2(b)(8).’’. 6 (c) IMPLEMENTATION.—Notwithstanding any other 7 provision of law, the Secretary of Health and Human 8 Services may implement the amendments made by this 9 section by program instruction or otherwise. 10 Æ VerDate Sep 11 2014 03:16 Mar 06, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H975.IH H975 kjohnson on DSK79L0C42PROD with BILLS