Prescription Drug Rebate Reform Act of 2019

II 116TH CONGRESS 1ST SESSION S. 1384 To reform prescription drug pricing and reduce out-of-pocket costs by ensuring consumers benefit from negotiated rebates. IN THE SENATE OF THE UNITED STATES MAY 9, 2019 Mr. ROMNEY (for himself and Mr. BRAUN) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To reform prescription drug pricing and reduce out-of-pocket costs by ensuring consumers benefit from negotiated rebates. 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 ‘‘Prescription Drug Re- 4 bate Reform Act of 2019’’. 5 SEC. 2. COST-SHARING WITH RESPECT TO PRESCRIPTION 6 DRUGS. 7 (a) IN GENERAL.—Subpart II of part A of title 8 XXVII of the Public Health Service Act (42 U.S.C. 9 VerDate Sep 11 2014 04:16 May 17, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1384.IS S1384 kjohnson on DSK79L0C42 with BILLS 2 •S 1384 IS 300gg–11 et seq.) is amended by adding at the end the 1 following: 2 ‘‘SEC. 2729A. COST-SHARING WITH RESPECT TO PRESCRIP- 3 TION DRUGS. 4 ‘‘(a) IN GENERAL.—A group health plan or health 5 insurance issuer offering group or individual health insur- 6 ance coverage shall set any coinsurance obligation an en- 7 rollee has with respect to a prescription drug covered by 8 the plan or coverage based on the net price of the drug, 9 such that no payment by the enrollee with respect to the 10 drug is based on a percentage of the list price of a drug. 11 ‘‘(b) APPLICABILITY.—Subsection (a)— 12 ‘‘(1) shall apply with respect to a prescription 13 drug benefit when the enrollee is required to pay a 14 deductible with respect to such benefits and— 15 ‘‘(A) has not yet satisfied the deductible 16 under the plan or coverage; or 17 ‘‘(B) has another coinsurance obligation 18 with respect to such benefits under the plan or 19 coverage; and 20 ‘‘(2) shall not apply if, with respect to the dis- 21 pensed quantity of a prescription drug, the net price 22 and list price are the same, or are different by not 23 more than 1 cent. 24 VerDate Sep 11 2014 04:16 May 17, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1384.IS S1384 kjohnson on DSK79L0C42 with BILLS 3 •S 1384 IS ‘‘(c) COPAYMENTS.—Nothing in this section prevents 1 a group health plan or health insurance issuer from re- 2 quiring a copayment for any prescription drug if such co- 3 payment is not tied to a percent of the specified cost of 4 the drug. 5 ‘‘(d) DEFINITIONS.—In this section— 6 ‘‘(1) the term ‘coinsurance’ means, with respect 7 to prescription drug coverage under a group health 8 plan or group or individual health insurance cov- 9 erage, a payment obligation of an enrollee in such 10 health plan or health insurance coverage that is 11 based on a portion or percentage of the specified 12 cost of a prescription drug, which may be up to 100 13 percent of that cost; 14 ‘‘(2) the term ‘deductible’ means the payment 15 obligation of an enrollee in a group health plan or 16 group or individual health insurance coverage before 17 the group health plan or group or individual health 18 insurance coverage will pay any portion of the cost 19 of prescription drug coverage; 20 ‘‘(3) the term ‘list price’ has the meaning given 21 the term ‘wholesale acquisition cost’ in section 22 1847A(c)(6)(B) of the Social Security Act; 23 ‘‘(4) the term ‘net price’ means, with respect to 24 prescription drug coverage under a group health 25 VerDate Sep 11 2014 04:16 May 17, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1384.IS S1384 kjohnson on DSK79L0C42 with BILLS 4 •S 1384 IS plan or group or individual health insurance cov- 1 erage, the list price of the drug net all rebates, dis- 2 counts, concessions, and other adjustments applied 3 to the cost paid by the group health plan or health 4 insurance issuer, or by any other entity that pro- 5 vides pharmacy benefit management services under 6 a contract with any such group health plan or health 7 insurance issuer, regardless of whether such adjust- 8 ments are prospective or retrospective; and 9 ‘‘(5) the term ‘prescription drug’ mean a drug, 10 as defined in section 201(g) of the Federal Food, 11 Drug, and Cosmetic Act, that is subject to section 12 503(b)(1) of such Act.’’. 13 (b) EFFECTIVE DATE.—Section 2729A of the Public 14 Health Service Act, as added by subsection (a), shall apply 15 with respect to plan years beginning on or after January 16 1, 2021. 17 Æ VerDate Sep 11 2014 04:16 May 17, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\S1384.IS S1384 kjohnson on DSK79L0C42 with BILLS