EPI Act

II 117TH CONGRESS 1ST SESSION S. 1132 To establish a cap on out-of-pocket costs for insulin. IN THE SENATE OF THE UNITED STATES APRIL 15, 2021 Mr. KENNEDY introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To establish a cap on out-of-pocket costs for insulin. 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 ‘‘Ending Pricey Insulin 4 Act’’ or the ‘‘EPI Act’’. 5 SEC. 2. CAPPING OUT-OF-POCKETS COST OF INSULIN. 6 (a) INDIVIDUALS ENROLLED IN CERTAIN HEALTH 7 PLANS.—Title XXVII of the Public Health Service Act 8 (42 U.S.C. 300gg et seq.) is amended by inserting after 9 section 2729 the following: 10 VerDate Sep 11 2014 16:28 May 11, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1132.IS S1132 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 1132 IS ‘‘SEC. 2729A. COVERAGE OF INSULIN DRUGS. 1 ‘‘Beginning with plan year 2022, a group health plan 2 or health insurance issuer offering group or individual 3 health insurance coverage that provides coverage for pre- 4 scription insulin drugs may not impose any deductible, co- 5 payment, coinsurance, or other cost-sharing requirement 6 with respect to such drugs that results in out-of-pocket 7 costs to the enrollee that exceed $50 per prescription for 8 a 30-day supply of covered prescription insulin drugs, re- 9 gardless of the amount of insulin drugs needed to fill the 10 enrollee’s insulin prescriptions.’’. 11 (b) INDIVIDUALS ENROLLED IN OTHER COV- 12 ERAGE.— 13 (1) MEDICARE, MEDICAID, AND CHIP.—The 14 Secretary of Health and Human Services shall take 15 such administrative action as is necessary to ensure 16 that in no event shall any State plan or waiver 17 under title XIX or XXI of the Social Security Act 18 or prescription drug plan under part D of title 19 XVIII of such Act or MA–PD plan under part C of 20 such title of such Act that provides coverage for pre- 21 scription insulin drugs impose any deductible, copay- 22 ment, coinsurance, or other cost-sharing requirement 23 with respect to such drugs that results in out-of- 24 pocket costs to an individual enrolled in such cov- 25 erage that exceeds $50 per prescription for a 30-day 26 VerDate Sep 11 2014 16:28 May 11, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1132.IS S1132 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 1132 IS supply of covered prescription insulin drugs, regard- 1 less of the amount of insulin drugs needed to fill the 2 enrollee’s insulin prescriptions. 3 (2) VETERANS.—The Secretary of Veterans Af- 4 fairs shall take such administrative action as is nec- 5 essary to ensure that prescription insulin drugs writ- 6 ten by eligible health care providers for veterans do 7 not impose any deductible, copayment, coinsurance, 8 or other cost-sharing requirement with respect to 9 such drugs that results in out-of-pocket costs to the 10 veteran that exceeds $50 per prescription for a 30- 11 day supply of covered prescription insulin drugs, re- 12 gardless of the amount of insulin drugs needed to fill 13 the veteran’s insulin prescriptions. For purposes of 14 the preceding sentence, the term ‘‘eligible health 15 care provider’’ means a health care provider under 16 section 1703(c) of title 38, United States Code, or 17 an eligible entity or provider under section 1703A(b) 18 of such title. 19 (3) TRICARE.—The Secretary of Defense shall 20 take such administrative action as is necessary to 21 ensure that prescription insulin drugs written by 22 health care providers for enrollees in the TRICARE 23 program under chapter 55 of title 10, United States 24 Code, do not impose any deductible, copayment, co- 25 VerDate Sep 11 2014 16:28 May 11, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1132.IS S1132 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 1132 IS insurance, or other cost-sharing requirement with re- 1 spect to such drugs that results in out-of-pocket 2 costs to enrollees that exceeds $50 per prescription 3 for a 30-day supply of covered prescription insulin 4 drugs, regardless of the amount of insulin drugs 5 needed to fill the enrollee’s insulin prescriptions. 6 SEC. 3. CAP ON CASH PRICE FOR INSULIN FOR INDIVID- 7 UALS WITHOUT HEALTH INSURANCE. 8 Beginning on January 1, 2022, in the case of an indi- 9 vidual who is not enrolled in any public or private health 10 plan, the cash price for a 30-day supply of such individ- 11 ual’s prescription insulin drugs, regardless of the amount 12 of insulin drugs needed to fill the individual’s insulin pre- 13 scriptions, shall be not more than $50. 14 SEC. 4. RETROACTIVE EFFECT. 15 In the event that this Act is enacted after January 16 1, 2022— 17 (1) any out-of-pocket cost to an enrollee for in- 18 sulin in plan year 2022 or a subsequent plan year 19 that is in excess of the amount specified in section 20 2729A of the Public Health Service Act (as added 21 by section 2) shall be reimbursed by the group 22 health plan or health insurance issuer to the en- 23 rollee; 24 VerDate Sep 11 2014 16:28 May 11, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1132.IS S1132 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 1132 IS (2) any amount paid by an uninsured individual 1 for insulin on or after January 1, 2022, that is in 2 excess of the amount specified in section 3 shall be 3 reimbursed by the insulin manufacturer to the indi- 4 vidual; and 5 (3) any amount paid by an enrollee or veteran 6 for insulin on or after January 1, 2022, that is in 7 excess of the amount specified in paragraph (1) (2), 8 or (3), as applicable, of section 2(b) shall be reim- 9 bursed by the Secretary of Health and Human Serv- 10 ices, the Secretary of Veterans Affairs, or the Sec- 11 retary of Defense, as applicable, to the enrollee or 12 veteran. 13 Æ VerDate Sep 11 2014 16:28 May 11, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\S1132.IS S1132 pamtmann on DSKBC07HB2PROD with BILLS