I 

116TH CONGRESS 

2D SESSION H. R. 7722 

To limit the price of insulin drugs accessible for participants, beneficiaries, 

and enrollees enrolled in group or individual health insurance coverage 

and group health plans and for uninsured individuals who have diabetes, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 22, 2020 

Mr. FORTENBERRY (for himself and Ms. CRAIG) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Education and Labor, 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 committee concerned 

A BILL 

To limit the price of insulin drugs accessible for participants, 

beneficiaries, and enrollees enrolled in group or individual 

health insurance coverage and group health plans and 

for uninsured individuals who have diabetes, and for 

other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as ‘‘Matt’s Act’’. 


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1 SEC. 2. INSULIN NET PRICE PROTECTION. 

2 (a) PUBLISHING OF NET PRICE BY MANUFACTUR3 ERS.— 

4 (1) IN GENERAL.—A manufacturer of an insu5 lin drug shall, on a quarterly basis, publish on the 

6 internet website of such manufacturer the average 

7 net price of each such insulin drug for the preceding 

8 calendar quarter. 

9 (2) ENFORCEMENT.—In the case that a manu10 facturer of an insulin drug fails to comply with para11 graph (1), a Federal agency or program may not 

12 make payment for such insulin drug of such until 

13 such manufacturer complies with such paragraph. 

14 (b) NET PRICE FOR INSULIN DRUGS FOR CERTAIN

15 INDIVIDUALS.— 

16 (1) APPLICATION TO PHSA PLANS.—Subpart 1 

17 of part A of the Public Health Service Act (42 

18 U.S.C. 300gg et seq.) is amended by adding at the 

19 end the following new section: 

20 ‘‘SEC. 2730. NET PRICE FOR INSULIN DRUGS. 

21 ‘‘(a) AVAILABILITY OF NET PRICE.—With respect to 

22 plan years beginning on and after January 1, 2021, a 

23 health insurance issuer offering group or individual health 

24 insurance coverage shall provide a participant, beneficiary, 

25 or enrollee who has diabetes access to an insulin drug at— 

26 ‘‘(1) the lesser of— 


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1 ‘‘(A) the 10 percent of the average net 

2 price for such drug published pursuant to sec3 tion 2(a) of Matt’s Act, plus the average 

4 charges for distribution and dispensing de5 scribed in subsection (c) for such drug; 

6 ‘‘(B) the coinsurance amount for an insu7 lin drug under the health insurance coverage 

8 under which such an individual is a participant, 

9 beneficiary, or enrollee would otherwise be re10 sponsible notwithstanding this section; or 

11 ‘‘(C) $20; or 

12 ‘‘(2) $0, in the case such a participant, bene13 ficiary, or enrollee is enrolled in a high deductible 

14 health plan (as defined in section 223(c)(2) of the 

15 Internal Revenue Code of 1986). 

16 ‘‘(b) WAIVER OF DEDUCTIBLE.—In applying sub17 section (a), such a participant, beneficiary, or enrollee 

18 shall have access to an insulin drug without regard to a 

19 deductible. 

20 ‘‘(c) CHARGES FOR DISTRIBUTING AND DIS21 PENSING.— 

22 ‘‘(1) IN GENERAL.—For purposes of subsection 

23 (a), charges for distribution and dispensing de24 scribed in this subsection— 


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1 ‘‘(A) are charges associated with the trans2 actions, with respect to an insulin drug, be3 tween wholesalers, distributors, retailers, and 

4 pharmacies; and 

5 ‘‘(B) may not exceed 10 percent of the av6 erage net price of such an insulin drug. 

7 ‘‘(2) REPORTING REQUIREMENT FOR PLANS.— 

8 In the case that a health insurance issuer offering 

9 group or individual health insurance coverage 

10 charges a participant, beneficiary, or enrollee for av11 erage charges for distribution and dispensing pursu12 ant to subsection (a)(1), the health insurance issuer 

13 shall submit to the Inspector General of the Depart14 ment of Health and Human Services information 

15 with respect to such charges and the amount of the 

16 charges. 

17 ‘‘(3) REPORT TO CONGRESS BY INSPECTOR

18 GENERAL.—Beginning January 1, 2022, and annu19 ally thereafter, the Inspector General shall review 

20 the charges described in paragraph (2) and submit 

21 to Congress a report on such on review. 

22 ‘‘(d) DEFINITIONS.—In this section: 

23 ‘‘(1) INSULIN.— 

24 ‘‘(A) IN GENERAL.—The term ‘insulin’ 

25 means a prescription drug containing insulin 


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1 that is approved by the Food and Drug Admin2 istration to improve glycemic control in patients 

3 with diabetes mellitus (and may include any 

4 medical supplies included with such drug or as5 sociated with the injection of such drug). 

6 ‘‘(B) EXCLUSION.—Such term does not in7 clude any medical supplies that provides for the 

8 monitoring of insulin levels. 

9 ‘‘(2) LIST PRICE.—The term ‘list price’ has the 

10 meaning given the term wholesale acquisition cost in 

11 section 1847A(c)(6)(B) of the Social Security Act. 

12 ‘‘(3) NET PRICE.—The term ‘net price’ means, 

13 with respect to prescription drug coverage under 

14 group or individual health insurance coverage of15 fered by a health insurance issuer, the list price of 

16 the drug net all rebates, discounts, concessions, and 

17 other adjustments applied to the cost paid by the 

18 health insurance issuer, or by any other entity that 

19 provides pharmacy benefit management services 

20 under a contract with any such health insurance 

21 issuer, regardless of whether such adjustments are 

22 prospective or retrospective. 

23 ‘‘(4) PRESCRIPTION DRUG.—The term ‘pre24 scription drug’ mean a drug, as defined in section 

25 201(g) of the Federal Food, Drug, and Cosmetic 


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1 Act, that is subject to section 503(b)(1) of such 

2 Act.’’. 

3 (2) APPLICATION TO ERISA PLANS.—Subpart A 

4 of part 7 of the Employee Retirement Income Secu5 rity Act of 1974 (29 U.S.C. 1185 et seq.) is amend6 ed by adding at the end the following new section 

7 (and amending the table of contents accordingly): 

8 ‘‘SEC. 704. NET PRICE FOR INSULIN DRUGS. 

9 ‘‘(a) AVAILABILITY OF NET PRICE.—With respect to 

10 plan years beginning on and after January 1, 2021, a 

11 group health plan shall provide a participant, beneficiary, 

12 or enrollee who has diabetes access to an insulin drug at— 

13 ‘‘(1) the lesser of— 

14 ‘‘(A) the 10 percent of the average net 

15 price for such drug published pursuant to sec16 tion 2(a) of Matt’s Act, plus the average 

17 charges for distribution and dispensing de18 scribed in subsection (c) for such drug; 

19 ‘‘(B) the coinsurance amount for an insu20 lin drug under the group health plan which 

21 such an individual is a participant, beneficiary, 

22 or enrollee would otherwise be responsible not23 withstanding this section; or 

24 ‘‘(C) $20; or 


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1 ‘‘(2) $0, in the case such a participant, bene2 ficiary, or enrollee is enrolled in a high deductible 

3 health plan (as defined in section 223(c)(2) of the 

4 Internal Revenue Code of 1986). 

5 ‘‘(b) WAIVER OF DEDUCTIBLE.—In applying sub6 section (a), such a participant, beneficiary, or enrollee 

7 shall have access to an insulin drug without regard to a 

8 deductible. 

9 ‘‘(c) CHARGES FOR DISTRIBUTING AND DIS10 PENSING.— 

11 ‘‘(1) IN GENERAL.—For purposes of subsection 

12 (a), charges for distribution and dispensing de13 scribed in this subsection— 

14 ‘‘(A) are charges associated with the trans15 actions, with respect to an insulin drug, be16 tween wholesalers, distributors, retailers, and 

17 pharmacies; and 

18 ‘‘(B) may not exceed 10 percent of the av19 erage net price of such an insulin drug. 

20 ‘‘(2) REPORTING REQUIREMENT FOR PLANS.— 

21 In the case that a group health plan charges a par22 ticipant, beneficiary, or enrollee for average charges 

23 for distribution and dispensing pursuant to sub24 section (a)(1), the group health plan shall submit to 

25 the Inspector General of the Department of Health 


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1 and Human Services information with respect to 

2 such charges and the amount of the charges. 

3 ‘‘(3) REPORT TO CONGRESS BY INSPECTOR

4 GENERAL.—Beginning January 1, 2022, and annu5 ally thereafter, the Inspector General shall review 

6 the charges described in paragraph (2) and submit 

7 to Congress a report on such on review. 

8 ‘‘(d) DEFINITIONS.—In this section: 

9 ‘‘(1) INSULIN.— 

10 ‘‘(A) IN GENERAL.—The term ‘insulin’ 

11 means a prescription drug containing insulin 

12 that is approved by the Food and Drug Admin13 istration to improve glycemic control in patients 

14 with diabetes mellitus (and may include any 

15 medical supplies included with such drug or as16 sociated with the injection of such drug). 

17 ‘‘(B) EXCLUSION.—Such term does not in18 clude any medical supplies that provides for the 

19 monitoring of insulin levels. 

20 ‘‘(2) LIST PRICE.—The term ‘list price’ has the 

21 meaning given the term wholesale acquisition cost in 

22 section 1847A(c)(6)(B) of the Social Security Act. 

23 ‘‘(3) NET PRICE.—The term ‘net price’ means, 

24 with respect to prescription drug coverage under a 

25 group health plan, the list price of the drug net all 


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1 rebates, discounts, concessions, and other adjust2 ments applied to the cost paid by the group health 

3 plan, or by any other entity that provides pharmacy 

4 benefit management services under a contract with 

5 any such group health plan, regardless of whether 

6 such adjustments are prospective or retrospective. 

7 ‘‘(4) PRESCRIPTION DRUG.—The term ‘pre8 scription drug’ mean a drug, as defined in section 

9 201(g) of the Federal Food, Drug, and Cosmetic 

10 Act, that is subject to section 503(b)(1) of such 

11 Act.’’. 

12 (3) UNINSURED INDIVIDUALS.— 

13 (A) IN GENERAL.—Beginning on and after 

14 January 1, 2021, a pharmacy shall provide to 

15 any individual who has diabetes and is not en16 rolled in any health plan access to an insulin 

17 drug at the average net price for such drug 

18 published pursuant to subsection (a), plus the 

19 average charges for the distribution and dis20 pensing described in subparagraph (C) for such 

21 drug. 

22 (B) REVIEW OF CHARGES.—Beginning 

23 January 1, 2022, and annually thereafter, the 

24 Inspector General of the Department of Health 

25 and Human Services shall review the amount of 


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1 charges paid by an individual described in sub2 paragraph (A) and submit to Congress a report 

3 on such review. 

4 (C) CHARGES FOR DISTRIBUTING AND DIS5 PENSING.—For purposes of subparagraph (A), 

6 charges for distribution and dispensing de7 scribed in this subsection— 

8 (i) are charges associated with the 

9 transactions, with respect to an insulin 

10 drug, between wholesalers, distributors, re11 tailers, and pharmacies; and 

12 (ii) may not exceed 10 percent of the 

13 average net price of such an insulin drug. 

14 (D) DEFINITIONS.—In this section: 

15 (i) INSULIN.— 

16 (I) IN GENERAL.—The term ‘‘in17 sulin’’ means a prescription drug con18 taining insulin that is approved by the 

19 Food and Drug Administration to im20 prove glycemic control in patients with 

21 diabetes mellitus (and may include 

22 any medical supplies included with 

23 such drug or associated with the in24 jection of such drug). 


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1 (II) EXCLUSION.—Such term 

2 does not include any medical supplies 

3 that provides for the monitoring of in4 sulin levels. 

5 (ii) LIST PRICE.—The term ‘‘list 

6 price’’ has the meaning given the term 

7 wholesale acquisition cost in section 

8 1847A(c)(6)(B) of the Social Security Act 

9 (42 U.S.C. 1395w–3a(c)(6)(B)). 

10 (iii) NET PRICE.—The term ‘‘net 

11 price’’ means, with respect to prescription 

12 drug coverage under a group health plan, 

13 the list price of the drug net all rebates, 

14 discounts, concessions, and other adjust15 ments applied to the cost paid by the 

16 group health plan, or by any other entity 

17 that provides pharmacy benefit manage18 ment services under a contract with any 

19 such group health plan, regardless of 

20 whether such adjustments are prospective 

21 or retrospective. 

22 (iv) PRESCRIPTION DRUG.—The term 

23 ‘‘prescription drug’’ mean a drug, as de24 fined in section 201(g) of the Federal 

25 Food, Drug, and Cosmetic Act (21 U.S.C. 


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1 321(g)), that is subject to section 

2 503(b)(1) of such Act (21 U.S.C. 

3 353(b)(1)). 

Æ 


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