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 committee 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. 

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 the ‘‘Creating Lower cost 

5 Alternative for Your prescription drugs Act’’ or the 

6 ‘‘CLAY Act’’. 


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1 SEC. 2. ADJUSTMENTS TO MEDICARE PART D COST-SHAR2 ING REDUCTIONS FOR LOW-INCOME INDIVID3 UALS. 

4 Section 1860D–14(a) of the Social Security Act (42 

5 U.S.C. 1395w–114(a)) is amended— 

6 (1) in paragraph (1)— 

7 (A) in subparagraph (D)— 

8 (i) in clause (ii)— 

9 (I) by striking ‘‘that does not ex10 ceed $1 for’’ and all that follows 

11 through the period at the end and in12 serting ‘‘that does not exceed— 

13 ‘‘(I) for plan years before plan 

14 year 2021— 

15 ‘‘(aa) for a generic drug or a 

16 preferred drug that is a multiple 

17 source drug (as defined in section 

18 1927(k)(7)(A)(i)), $1 or, if less, 

19 the copayment amount applicable 

20 to an individual under clause 

21 (iii); and 

22 ‘‘(bb) for any other drug, $3 

23 or, if less, the copayment amount 

24 applicable to an individual under 

25 clause (iii); and’’; and 


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1 (II) by adding at the end the fol2 lowing new subclauses: 

3 ‘‘(II) for plan year 2021— 

4 ‘‘(aa) for a generic drug, $0; 

5 and 

6 ‘‘(bb) for any other drug, 

7 the dollar amount applied under 

8 this clause (after application of 

9 paragraph (4)(A)) for plan year 

10 2020 for a drug described in sub11 clause (I)(bb); and 

12 ‘‘(III) for a subsequent year, the 

13 dollar amount applied under this 

14 clause for the previous year for the 

15 drug, increased by the annual percent16 age increase in the consumer price 

17 index (all items; U.S. city average) as 

18 of September of such previous year.’’; 

19 and 

20 (ii) in clause (iii)— 

21 (I) by striking ‘‘does not exceed 

22 the copayment amount specified 

23 under’’ and inserting ‘‘does not ex24 ceed— 


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1 ‘‘(I) for plan years beginning be2 fore plan year 2021, the copayment 

3 amount specified under’’; 

4 (II) by striking the period at the 

5 end and inserting ‘‘; and’’; and 

6 (III) by adding at the end the 

7 following new subclause: 

8 ‘‘(II) for plan year 2021 and 

9 each subsequent plan year the copay10 ment amount applied under clause (ii) 

11 for the drug and year involved.’’; and 

12 (B) by adding at the end the following new 

13 subparagraph: 

14 ‘‘(F) ROUNDING.—Any amount established 

15 under clause (ii) of subparagraph (D), including 

16 as applied under clause (iii) of such subpara17 graph or paragraph (2)(E), that is based on an 

18 increase of $3, that is not a multiple of 5 cents 

19 or 10 cents, respectively, shall be rounded to 

20 the nearest multiple of 5 cents or 10 cents, re21 spectively.’’; 

22 (2) in paragraph (2)— 

23 (A) in subparagraph (C), by inserting ‘‘and 

24 subparagraph (E)’’ before the period; 

25 (B) in subparagraph (D)— 


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1 (i) by striking ‘‘of coinsurance of’’ and 

2 inserting ‘‘of— 

3 ‘‘(I) for plan years before plan 

4 year 2021, coinsurance of’’; 

5 (ii) by striking the period at the end 

6 and inserting ‘‘; and’’; and 

7 (iii) by adding at the end the fol8 lowing new subclause: 

9 ‘‘(II) for plan year 2021 and 

10 each subsequent plan year, a copay11 ment amount that does not exceed the 

12 copayment amount applied under 

13 paragraph (1)(D)(ii) for the drug and 

14 year involved.’’; and 

15 (C) in subparagraph (E)— 

16 (i) by striking ‘‘subsection (c), the 

17 substitution for’’ and inserting ‘‘subsection 

18 (c)— 

19 ‘‘(i) for plan years before plan year 

20 2021, the substitution for’’; 

21 (ii) by striking the period at the end 

22 and inserting ‘‘; and’’; and 

23 (iii) by adding at the end the fol24 lowing new clause: 


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1 ‘‘(ii) for plan year 2021 and each sub2 sequent plan year, the elimination of any 

3 cost-sharing imposed under section 

4 1860D–2(b)(4)(A).’’; and 

5 (3) in paragraph (4)(A)(ii), by inserting ‘‘(be6 fore 2021)’’ after ‘‘subsequent year’’. 

Æ 


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