Ensuring Seniors’ Access to COVID Treatments Act

To amend title XVIII of the Social Security Act to require coverage under Medicare PDPs and MA–PD plans, without the imposition of cost sharing or utilization management requirements, of drugs intended to treat COVID–19 during certain emergencies. 1. Short title This Act may be cited as the Ensuring Seniors’ Access to COVID Treatments Act 2. Requiring coverage under Medicare PDPs and MA–PD plans, without the imposition of cost sharing or utilization management requirements, of drugs intended to treat COVID–19 during certain emergencies (a) Coverage requirement (1) In general Section 1860D–4(b)(3) of the Social Security Act ( 42 U.S.C. 1395w–104(b)(3) (I) Required inclusion of drugs intended to treat COVID–19 (i) In general Notwithstanding any other provision of law, a PDP sponsor offering a prescription drug plan shall, with respect to a plan year, any portion of which occurs during the period described in clause (ii), be required to— (I) include in any formulary— (aa) all covered part D drugs with a medically accepted indication (as defined in section 1860D–2(e)(4)) to treat COVID–19 that are marketed in the United States; and (bb) all drugs authorized under section 564 or 564A of the Federal Food Drug and Cosmetic Act to treat COVID–19; and (II) not impose any prior authorization or other utilization management requirement with respect to such drugs described in item (aa) or (bb) of subclause (I) (other than such a requirement that limits the quantity of drugs due to safety). (ii) Period described For purposes of clause (i), the period described in this clause is the period during which there exists the public health emergency declared by the Secretary pursuant to section 319 of the Public Health Service Act on January 31, 2020, entitled Determination that a Public Health Emergency Exists Nationwide as the Result of the 2019 Novel Coronavirus . (b) Elimination of cost sharing (1) Elimination of cost sharing for drugs intended to treat COVID–19 under standard and alternative prescription drug coverage Section 1860D–2 of the Social Security Act ( 42 U.S.C. 1395w–102 (A) in subsection (b)— (i) in paragraph (1)(A), by striking The coverage Subject to paragraph (8), the coverage (ii) in paragraph (2)— (I) in subparagraph (A), by inserting after Subject to subparagraphs (C) and (D) and paragraph (8) (II) in subparagraph (C)(i), by striking paragraph (4) paragraphs (4) and (8) (III) in subparagraph (D)(i), by striking paragraph (4) paragraphs (4) and (8) (iii) in paragraph (4)(A)(i), by striking The coverage Subject to paragraph (8), the coverage (iv) by adding at the end the following new paragraph: (8) Elimination of cost-sharing for drugs intended to treat COVID–19 The coverage does not impose any deductible, copayment, coinsurance, or other cost-sharing requirement for drugs described in section 1860D–4(b)(3)(I)(i)(I) with respect to a plan year, any portion of which occurs during the period during which there exists the public health emergency declared by the Secretary pursuant to section 319 of the Public Health Service Act on January 31, 2020, entitled Determination that a Public Health Emergency Exists Nationwide as the Result of the 2019 Novel Coronavirus ; and (B) in subsection (c), by adding at the end the following new paragraph: (4) Same elimination of cost-sharing for drugs intended to treat COVID–19 The coverage is in accordance with subsection (b)(8). . (2) Elimination of cost sharing for drugs intended to treat COVID–19 dispensed to individuals who are subsidy eligible individuals Section 1860D–14(a) of the Social Security Act ( 42 U.S.C. 1395w–114(a) (A) in paragraph (1)— (i) in subparagraph (D)— (I) in clause (ii), by striking In the case of Subject to subparagraph (F), in the case of (II) in clause (iii), by striking In the case of Subject to subparagraph (F), in the case of (ii) by adding at the end the following new subparagraph: (F) Elimination of cost-sharing for drugs intended to treat COVID–19 Coverage that is in accordance with section 1860D–2(b)(8). ; and (B) in paragraph (2)— (i) in subparagraph (B), by striking A reduction Subject to subparagraph (F), a reduction (ii) in subparagraph (D), by striking The substitution Subject to subparagraph (F), the substitution (iii) in subparagraph (E), by inserting after Subject to subparagraph (F) and (iv) by adding at the end the following new subparagraph: (F) Elimination of cost-sharing for drugs intended to treat COVID–19 Coverage that is in accordance with section 1860D–2(b)(8). . (c) Implementation Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the amendments made by this section by program instruction or otherwise.

Summary: Ensuring Seniors' Access to COVID Treatments Act This bill requires prescription drug plans under Medicare and Medicare Advantage to cover drugs that are approved to treat COVID-19 (i.e., coronavirus disease 2019) without cost-sharing during the public health emergency.