Acting to Cancel Copays and Ensure Substantial Savings for Biosimilars Act of 2019

To amend title XVIII of the Social Security Act to eliminate cost sharing for biosimilar biological products furnished under part B of the Medicare program. 1. Short title This Act may be cited as the Acting to Cancel Copays and Ensure Substantial Savings for Biosimilars Act of 2019 ACCESS for Biosimilars Act of 2019 2. Eliminating cost sharing for biosimilar biological products furnished under part B of the Medicare program Section 1833 of the Social Security Act ( 42 U.S.C. 1395l (1) in subsection (a)(1)(S), by inserting (or, in the case of such a biological that is a specified biosimilar biological product (as defined in subsection (cc)) furnished during a year (beginning with 2020) to an individual who is a cost-sharing reduction eligible individual (as defined in such subsection) with respect to such year, 100 percent) 80 percent (2) by adding at the end the following new subsection: (cc) Specified biosimilar biological product reduced cost-Sharing provisions (1) Definitions (A) Cost-sharing reduction eligible individual defined For purposes of subsection (a)(1)(S) and with respect to a year, the term cost-sharing reduction eligible individual (i) is enrolled under this part; and (ii) does not have qualifying coverage (as defined in subparagraph (B)). (B) Qualifying coverage (i) In general For purposes of subparagraph (A), the term qualifying coverage (I) under— (aa) a group health plan or health insurance coverage (as such terms are defined in section 2791 of the Public Health Service Act); (bb) a Federal health care program (as defined in section 1128B(f)), other than the program established under this title; (cc) the health insurance program under chapter 89 (dd) a medicare supplemental policy under section 1882; or (ee) an MA or MA–PD plan; and (II) that meets— (aa) in the case of coverage described in any of items (aa) through (dd) of subclause (I), the condition described in clause (ii); and (bb) in the case of coverage described in item (ee) of subclause (I), the condition described in clause (iii). (ii) Condition for coverage other than part C coverage For purposes of clause (i)(II)(aa), the condition described in this clause, with respect to an individual enrolled in coverage described in any of items (aa) through (dd) of clause (i)(I) during a year, is that such coverage provides for the payment of all cost sharing owed by such individual under this part (or, if applicable, under an MA or MA–PD plan) with respect to a specified biosimilar biological product (as defined in subparagraph (C)) furnished under this part (or, if applicable, under an MA or MA–PD plan) during such year, not taking into account the application of any deductible under such coverage. (iii) Condition for part C coverage For purposes of clause (i)(II)(bb), the condition described in this clause, with respect to an individual enrolled in an MA or MA–PD plan during a year, is that such plan provides for no cost sharing for such individual with respect to a specified biological biosimilar product (as defined in subparagraph (C)) furnished under such plan during such year. (C) Specified biosimilar biological product For purposes of subsection (a)(1)(S), the term specified biosimilar biological product (2) Determinations The Secretary shall establish a process— (A) for determining whether an individual is a cost-sharing reduction eligible individual for a year; and (B) for notifying MA organizations of such a determination made with respect to an individual enrolled under an MA plan or MA–PD plan offered by such organization during such year. .

Summary: Acting to Cancel Copays and Ensure Substantial Savings for Biosimilars Act of 2019 or the ACCESS for Biosimilars Act of 2019 This bill eliminates cost-sharing for biosimilar biological products for certain qualifying beneficiaries under Medicare medical services. Specifically, the bill eliminates cost-sharing for beneficiaries whose coverage under private health insurance, a federal program (other than Medicare), a Medicare supplemental policy, or Medicare Advantage does not already do so. The Centers for Medicare & Medicaid Services must establish a process for determining a beneficiary's eligibility and notifying Medicare Advantage organizations of such determinations.