CLAY Act

I 116TH CONGRESS 1ST SESSION H. R. 2757 To amend title XVIII of the Social Security Act to provide for adjustments to the Medicare part D cost-sharing reductions for low-income individuals. IN THE HOUSE OF REPRESENTATIVES MAY 15, 2019 Mr. CUNNINGHAM (for himself, Mr. BILIRAKIS, and Mr. EVANS) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the com- mittee concerned A BILL To amend title XVIII of the Social Security Act to provide for adjustments to the Medicare part D cost-sharing reductions for low-income individuals. 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 ‘‘Creating Lower cost 4 Alternative for Your prescription drugs Act’’ or the 5 ‘‘CLAY Act’’. 6 VerDate Sep 11 2014 22:57 May 29, 2019 Jkt 034408 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2757.IH H2757 pbinns on DSK79D2C42PROD with BILLS 2 •HR 2757 IH SEC. 2. ADJUSTMENTS TO MEDICARE PART D COST-SHAR- 1 ING REDUCTIONS FOR LOW-INCOME INDIVID- 2 UALS. 3 Section 1860D–14(a) of the Social Security Act (42 4 U.S.C. 1395w–114(a)) is amended— 5 (1) in paragraph (1)— 6 (A) in subparagraph (D)— 7 (i) in clause (ii)— 8 (I) by striking ‘‘that does not ex- 9 ceed $1 for’’ and all that follows 10 through the period at the end and in- 11 serting ‘‘that does not exceed— 12 ‘‘(I) for plan years before plan 13 year 2021— 14 ‘‘(aa) for a generic drug or a 15 preferred drug that is a multiple 16 source drug (as defined in section 17 1927(k)(7)(A)(i)), $1 or, if less, 18 the copayment amount applicable 19 to an individual under clause 20 (iii); and 21 ‘‘(bb) for any other drug, $3 22 or, if less, the copayment amount 23 applicable to an individual under 24 clause (iii); and’’; and 25 VerDate Sep 11 2014 22:57 May 29, 2019 Jkt 034408 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2757.IH H2757 pbinns on DSK79D2C42PROD with BILLS 3 •HR 2757 IH (II) by adding at the end the fol- 1 lowing new subclauses: 2 ‘‘(II) for plan year 2021— 3 ‘‘(aa) for a generic drug, $0; 4 and 5 ‘‘(bb) for any other drug, 6 the dollar amount applied under 7 this clause (after application of 8 paragraph (4)(A)) for plan year 9 2020 for a drug described in sub- 10 clause (I)(bb); and 11 ‘‘(III) for a subsequent year, the 12 dollar amount applied under this 13 clause for the previous year for the 14 drug, increased by the annual percent- 15 age increase in the consumer price 16 index (all items; U.S. city average) as 17 of September of such previous year.’’; 18 and 19 (ii) in clause (iii)— 20 (I) by striking ‘‘does not exceed 21 the copayment amount specified 22 under’’ and inserting ‘‘does not ex- 23 ceed— 24 VerDate Sep 11 2014 22:57 May 29, 2019 Jkt 034408 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2757.IH H2757 pbinns on DSK79D2C42PROD with BILLS 4 •HR 2757 IH ‘‘(I) for plan years beginning be- 1 fore plan year 2021, the copayment 2 amount specified under’’; 3 (II) by striking the period at the 4 end and inserting ‘‘; and’’; and 5 (III) by adding at the end the 6 following new subclause: 7 ‘‘(II) for plan year 2021 and 8 each subsequent plan year the copay- 9 ment amount applied under clause (ii) 10 for the drug and year involved.’’; and 11 (B) by adding at the end the following new 12 subparagraph: 13 ‘‘(F) ROUNDING.—Any amount established 14 under clause (ii) of subparagraph (D), including 15 as applied under clause (iii) of such subpara- 16 graph or paragraph (2)(E), that is based on an 17 increase of $3, that is not a multiple of 5 cents 18 or 10 cents, respectively, shall be rounded to 19 the nearest multiple of 5 cents or 10 cents, re- 20 spectively.’’; 21 (2) in paragraph (2)— 22 (A) in subparagraph (C), by inserting ‘‘and 23 subparagraph (E)’’ before the period; 24 (B) in subparagraph (D)— 25 VerDate Sep 11 2014 22:57 May 29, 2019 Jkt 034408 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2757.IH H2757 pbinns on DSK79D2C42PROD with BILLS 5 •HR 2757 IH (i) by striking ‘‘of coinsurance of’’ and 1 inserting ‘‘of— 2 ‘‘(I) for plan years before plan 3 year 2021, coinsurance of’’; 4 (ii) by striking the period at the end 5 and inserting ‘‘; and’’; and 6 (iii) by adding at the end the fol- 7 lowing new subclause: 8 ‘‘(II) for plan year 2021 and 9 each subsequent plan year, a copay- 10 ment amount that does not exceed the 11 copayment amount applied under 12 paragraph (1)(D)(ii) for the drug and 13 year involved.’’; and 14 (C) in subparagraph (E)— 15 (i) by striking ‘‘subsection (c), the 16 substitution for’’ and inserting ‘‘subsection 17 (c)— 18 ‘‘(i) for plan years before plan year 19 2021, the substitution for’’; 20 (ii) by striking the period at the end 21 and inserting ‘‘; and’’; and 22 (iii) by adding at the end the fol- 23 lowing new clause: 24 VerDate Sep 11 2014 22:57 May 29, 2019 Jkt 034408 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2757.IH H2757 pbinns on DSK79D2C42PROD with BILLS 6 •HR 2757 IH ‘‘(ii) for plan year 2021 and each sub- 1 sequent plan year, the elimination of any 2 cost-sharing imposed under section 3 1860D–2(b)(4)(A).’’; and 4 (3) in paragraph (4)(A)(ii), by inserting ‘‘(be- 5 fore 2021)’’ after ‘‘subsequent year’’. 6 Æ VerDate Sep 11 2014 22:57 May 29, 2019 Jkt 034408 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\H2757.IH H2757 pbinns on DSK79D2C42PROD with BILLS