I 

116TH CONGRESS 

1ST SESSION H. R. 366 

To amend titles XVIII and XIX of the Social Security Act to eliminate 

cost sharing with respect to coverage of insulin as a covered part D 

drug under the Medicare program or as a covered outpatient drug under 

the Medicaid program. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 9, 2019 

Mr. RUSH (for himself, Ms. CLARKE of New York, Ms. KELLY of Illinois, Ms. 

LEE of California, Ms. ADAMS, Mrs. WATSON COLEMAN, Mr. PAYNE, Mr. 

EVANS, Ms. FUDGE, Mrs. DEMINGS, Mr. BROWN of Maryland, Mr. 

SCOTT of Virginia, Mr. LAWSON of Florida, Mr. CLAY, Mr. DANNY K. 

DAVIS of Illinois, Ms. PRESSLEY, Mr. LEWIS, Mr. THOMPSON of Mississippi, Mr. CLYBURN, Mr. RICHMOND, Ms. JACKSON LEE, Mr. BISHOP

of Georgia, Mr. HORSFORD, Mr. JOHNSON of Georgia, Mr. 

BUTTERFIELD, Ms. WILSON of Florida, Mr. CARSON of Indiana, Mr. 

MCEACHIN, Mrs. BEATTY, Ms. PLASKETT, Ms. SEWELL of Alabama, Mr. 

DAVID SCOTT of Georgia, Ms. SCHAKOWSKY, and Ms. BASS) 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 titles XVIII and XIX of the Social Security Act 

to eliminate cost sharing with respect to coverage of 

insulin as a covered part D drug under the Medicare 

program or as a covered outpatient drug under the Medicaid program. 


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•HR 366 IH

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 ‘‘Insulin Access for All 

5 Act of 2019’’. 

6 SEC. 2. ELIMINATING COST SHARING WITH RESPECT TO 

7 COVERAGE OF INSULIN AS A COVERED PART 

8 D DRUG UNDER THE MEDICARE PROGRAM 

9 OR AS A COVERED OUTPATIENT DRUG 

10 UNDER THE MEDICAID PROGRAM. 

11 (a) MEDICARE.— 

12 (1) ELIMINATION OF COST-SHARING FOR INSU13 LIN AND CERTAIN ASSOCIATED MEDICAL SUPPLIES

14 FURNISHED TO PART D ELIGIBLE INDIVIDUALS.— 

15 Section 1860D–2 of the Social Security Act (42 

16 U.S.C. 1395w–102) is amended— 

17 (A) in subsection (b)— 

18 (i) in paragraph (1)(A), by striking 

19 ‘‘The coverage’’ and inserting ‘‘Subject to 

20 paragraph (8), the coverage’’; 

21 (ii) in paragraph (2)— 

22 (I) in subparagraph (A), by in23 serting after ‘‘Subject to subpara24 graphs (C) and (D)’’ the following: 

25 ‘‘and paragraph (8)’’; 


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1 (II) in subparagraph (C)(i), by 

2 striking ‘‘paragraph (4)’’ and insert3 ing ‘‘paragraphs (4) and (8)’’; and 

4 (III) in subparagraph (D)(i), by 

5 striking ‘‘paragraph (4)’’ and insert6 ing ‘‘paragraphs (4) and (8)’’; 

7 (iii) in paragraph (4)(A)(i), by strik8 ing ‘‘The coverage’’ and inserting ‘‘Subject 

9 to paragraph (8), the coverage’’; and 

10 (iv) by adding at the end the following 

11 new paragraph: 

12 ‘‘(8) ELIMINATION OF COST-SHARING FOR CER13 TAIN COVERED PART D DRUGS.—The coverage does 

14 not impose any deductible, copayment, coinsurance, 

15 or other cost-sharing for insulin (as described in 

16 subparagraph (B) of subsection (e)(1)) or medical 

17 supplies associated with the injection of insulin (as 

18 described in such subparagraph).’’; and 

19 (B) in subsection (c), by adding at the end 

20 the following new paragraph: 

21 ‘‘(4) SAME ELIMINATION OF COST-SHARING FOR

22 CERTAIN COVERED PART D DRUGS.—The coverage is 

23 in accordance with subsection (b)(8).’’. 

24 (2) ELIMINATION OF COST-SHARING FOR INSU25 LIN AND CERTAIN ASSOCIATED MEDICAL SUPPLIES


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1 FURNISHED TO PART D ELIGIBLE INDIVIDUALS WHO

2 ARE SUBSIDY ELIGIBLE INDIVIDUALS.—Section 

3 1860D–14(a) of the Social Security Act (42 U.S.C. 

4 1395w–114(a)) is amended— 

5 (A) in paragraph (1)— 

6 (i) in subparagraph (D)— 

7 (I) in clause (ii), by striking ‘‘In 

8 the case of’’ and inserting ‘‘Subject to 

9 subparagraph (F), in the case of’’; 

10 and 

11 (II) in clause (iii), by striking 

12 ‘‘In the case of’’ and inserting ‘‘Sub13 ject to subparagraph (F), in the case 

14 of’’; and 

15 (ii) by adding at the end the following 

16 new subparagraph: 

17 ‘‘(F) ELIMINATION OF COST-SHARING FOR

18 CERTAIN COVERED PART D DRUGS.—Coverage 

19 that is in accordance with section 1860D– 

20 2(b)(8).’’; and 

21 (B) in paragraph (2)— 

22 (i) in subparagraph (D), by striking 

23 ‘‘The substitution’’ and inserting ‘‘Subject 

24 to subparagraph (F), the substitution’’; 


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1 (ii) in subparagraph (E), by inserting 

2 after ‘‘Subject to’’ the following: ‘‘subpara3 graph (F) and’’; and 

4 (iii) by adding at the end the fol5 lowing new subparagraph: 

6 ‘‘(F) ELIMINATION OF COST-SHARING FOR

7 CERTAIN COVERED PART D DRUGS.—Coverage 

8 that is in accordance with section 1860D– 

9 2(b)(8).’’. 

10 (3) APPLICABILITY.—The amendments made 

11 by this subsection shall apply with respect to insulin, 

12 and medical supplies associated with the injection of 

13 insulin, furnished on or after January 1, 2020. 

14 (b) MEDICAID.— 

15 (1) IN GENERAL.—Section 1916 of the Social 

16 Security Act (42 U.S.C. 1396o) is amended— 

17 (A) in subsection (a)(2)— 

18 (i) in subparagraph (D), by striking 

19 ‘‘or’’ at the end; 

20 (ii) in subparagraph (E), by striking 

21 ‘‘; and’’ and inserting ‘‘, or’’; and 

22 (iii) by adding at the end the fol23 lowing new subparagraph: 

24 ‘‘(F) insulin furnished as a covered out25 patient drug (as defined in section 1927(k)(2)) 


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1 and medical supplies associated with the injec2 tion of such insulin; and’’; and 

3 (B) in subsection (b)(2)— 

4 (i) in subparagraph (D), by striking 

5 ‘‘or’’ at the end; 

6 (ii) in subparagraph (E), by striking 

7 ‘‘; and’’ and inserting ‘‘, or’’; and 

8 (iii) by adding at the end the fol9 lowing new subparagraph: 

10 ‘‘(F) insulin furnished as a covered out11 patient drug (as defined in section 1927(k)(2)) 

12 and medical supplies associated with the injec13 tion of such insulin; and’’. 

14 (2) ALTERNATIVE COST SHARING LIMITA15 TION.—Section 1916A(c)(2) of the Social Security 

16 Act (42 U.S.C. 13960–1(c)(2)) is amended by add17 ing at the end the following new subparagraph: 

18 ‘‘(D) NONAPPLICABILITY OF COST SHAR19 ING TO INSULIN.—In no case may the cost 

20 sharing under paragraph (1)(A) apply with re21 spect to insulin furnished as a covered out22 patient drug (as defined in section 1927(k)(2)) 

23 and medical supplies associated with the injec24 tion of such insulin.’’. 

25 (3) EFFECTIVE DATE.— 


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1 (A) IN GENERAL.—Subject to subpara2 graph (B), the amendments made by this sub3 section shall apply with respect to covered out4 patient drugs furnished on or after January 1, 

5 2020. 

6 (B) EXCEPTION FOR STATE LEGISLA7 TION.—In the case of a State plan under title 

8 XIX of the Social Security Act (42 U.S.C. 1396 

9 et seq.) that the Secretary of Health and 

10 Human Services determines requires State leg11 islation in order for the respective plan to meet 

12 any requirement imposed by amendments made 

13 by this subsection, the respective plan shall not 

14 be regarded as failing to comply with the re15 quirements of such title solely on the basis of 

16 its failure to meet such an additional require17 ment before the first day of the first calendar 

18 quarter beginning after the close of the first 

19 regular session of the State legislature that be20 gins after the date of the enactment of this Act. 

21 For purposes of the previous sentence, in the 

22 case of a State that has a 2-year legislative ses23 sion, each year of the session shall be considVerDate Sep 11 2014 02:18 Jan 19, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H366.IH H366

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1 ered to be a separate regular session of the 

2 State legislature. 

Æ 


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