I 

116TH CONGRESS 

1ST SESSION H. R. 3805 

To reform prescription drug pricing and reduce out-of-pocket costs by 

ensuring consumers benefit from negotiated rebates. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 17, 2019 

Mr. GALLAGHER introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To reform prescription drug pricing and reduce out-of-pocket 

costs by ensuring consumers benefit from negotiated rebates. 

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 ‘‘Prescription Drug Re5 bate Reform Act of 2019’’. 

6 SEC. 2. COST-SHARING WITH RESPECT TO PRESCRIPTION 

7 DRUGS. 

8 (a) IN GENERAL.—Subpart II of part A of title 

9 XXVII of the Public Health Service Act (42 U.S.C. 


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1 300gg–11 et seq.) is amended by adding at the end the 

2 following: 

3 ‘‘SEC. 2729A. COST-SHARING WITH RESPECT TO PRESCRIP4 TION DRUGS. 

5 ‘‘(a) IN GENERAL.—A group health plan or health 

6 insurance issuer offering group or individual health insur7 ance coverage shall set any coinsurance obligation an en8 rollee has with respect to a prescription drug covered by 

9 the plan or coverage based on the net price of the drug, 

10 such that no payment by the enrollee with respect to the 

11 drug is based on a percentage of the list price of a drug. 

12 ‘‘(b) APPLICABILITY.—Subsection (a)— 

13 ‘‘(1) shall apply with respect to a prescription 

14 drug benefit when the enrollee is required to pay a 

15 deductible with respect to such benefits and— 

16 ‘‘(A) has not yet satisfied the deductible 

17 under the plan or coverage; or 

18 ‘‘(B) has another coinsurance obligation 

19 with respect to such benefits under the plan or 

20 coverage; and 

21 ‘‘(2) shall not apply if, with respect to the dis22 pensed quantity of a prescription drug, the net price 

23 and list price are the same, or are different by not 

24 more than 1 cent. 


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1 ‘‘(c) COPAYMENTS.—Nothing in this section prevents 

2 a group health plan or health insurance issuer from re3 quiring a copayment for any prescription drug if such co4 payment is not tied to a percent of the specified cost of 

5 the drug. 

6 ‘‘(d) DEFINITIONS.—In this section— 

7 ‘‘(1) the term ‘coinsurance’ means, with respect 

8 to prescription drug coverage under a group health 

9 plan or group or individual health insurance cov10 erage, a payment obligation of an enrollee in such 

11 health plan or health insurance coverage that is 

12 based on a portion or percentage of the specified 

13 cost of a prescription drug, which may be up to 100 

14 percent of that cost; 

15 ‘‘(2) the term ‘deductible’ means the payment 

16 obligation of an enrollee in a group health plan or 

17 group or individual health insurance coverage before 

18 the group health plan or group or individual health 

19 insurance coverage will pay any portion of the cost 

20 of prescription drug coverage; 

21 ‘‘(3) the term ‘list price’ has the meaning given 

22 the term ‘wholesale acquisition cost’ in section 

23 1847A(c)(6)(B) of the Social Security Act; 

24 ‘‘(4) the term ‘net price’ means, with respect to 

25 prescription drug coverage under a group health 


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1 plan or group or individual health insurance cov2 erage, the list price of the drug net all rebates, dis3 counts, concessions, and other adjustments applied 

4 to the cost paid by the group health plan or health 

5 insurance issuer, or by any other entity that pro6 vides pharmacy benefit management services under 

7 a contract with any such group health plan or health 

8 insurance issuer, regardless of whether such adjust9 ments are prospective or retrospective; and 

10 ‘‘(5) the term ‘prescription drug’ mean a drug, 

11 as defined in section 201(g) of the Federal Food, 

12 Drug, and Cosmetic Act, that is subject to section 

13 503(b)(1) of such Act.’’. 

14 (b) EFFECTIVE DATE.—Section 2729A of the Public 

15 Health Service Act, as added by subsection (a), shall apply 

16 with respect to plan years beginning on or after January 

17 1, 2021. 

Æ 


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