SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Patients’ Access to 
Treatments Act of 2013’’. 
SEC. 2. COST-SHARING REQUIREMENTS APPLICABLE TO 
PRESCRIPTION DRUGS IN A SPECIALTY DRUG 
TIER. 
(a) IN GENERAL.—Subpart II of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 300gg 
et seq.) is amended by adding at the end the following: 
‘‘SEC. 2719B. COST-SHARING REQUIREMENTS APPLICABLE 
TO PRESCRIPTION DRUGS IN A SPECIALTY 
DRUG TIER. 
‘‘(a) REQUIREMENT.—A group health plan, or a 
health insurance issuer offering group or individual health 
insurance, that provides coverage for prescription drugs 
and uses a formulary or other tiered cost-sharing struc-
ture shall not impose cost-sharing requirements applicable 
to prescription drugs in a specialty drug tier that exceed 
the dollar amount (or its equivalent) of cost-sharing re-
quirements applicable to prescription drugs in a non-pre-
ferred brand drug tier (or prescription drugs in a brand 
drug tier if there is no non-preferred brand drug tier). 
‘‘(b) SPECIAL RULE.—If a formulary used by a group 
health plan or a health insurance issuer offering group or 
individual health insurance contains more than one non- 
preferred brand drug tier, then the requirements of sub-
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section (a) shall be applied with respect to the non-pre-
ferred brand drug tier for which beneficiary cost-sharing 
is lowest. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) The term ‘cost-sharing’ includes co-pay-
ment and coinsurance. 
‘‘(2) The term ‘drug tier’ means, with respect 
to a group health plan or health insurance issuer of-
fering group or individual health insurance coverage 
that uses a formulary or other cost-sharing struc-
ture, a category of drugs— 
‘‘(A) within such formulary or structure 
for which the total dollar amount of cost-shar-
ing requirements for any drug does not vary by 
more than ten percent from the total dollar 
amount of cost-sharing requirements for any 
other drug; and 
‘‘(B) that are prescription drugs. 
‘‘(3) The term ‘non-preferred brand drug tier’ 
means, with respect to a group health plan or health 
insurance issuer offering group or individual health 
insurance coverage that uses a formulary or other 
tiered cost-sharing structure, a category of drugs— 
‘‘(A) within a drug tier in such formulary 
or structure for which beneficiary cost-sharing 
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is greater than drug tiers for generic drugs or 
preferred brand drugs in the formulary or 
structure; 
‘‘(B) that are prescription drugs; and 
‘‘(C) that are not included within a spe-
cialty drug tier. 
‘‘(4) The term ‘prescription drug’ means— 
‘‘(A) a drug subject to section 503(b)(1) of 
the Federal Food, Drug, or Cosmetic Act; and 
‘‘(B) includes a drug described in subpara-
graph (A) that is a biological product (as de-
fined in section 351(i) of this Act). 
‘‘(5) The term ‘specialty drug tier’ means, with 
respect to a group health plan or health insurance 
issuer offering group or individual health insurance 
coverage that uses a formulary or other tiered cost- 
sharing structure, a category of drugs— 
‘‘(A) within a drug tier in such formulary 
or structure for which beneficiary cost-sharing 
is greater than drug tiers for generic drugs, 
preferred brand drugs, or non-preferred drugs 
in the plan’s formulary; and 
‘‘(B) that are prescription drugs.’’. 
(b) EFFECTIVE DATE.—Section 2719B of the Public 
Health Service Act, as added by subsection (a), applies 
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to plan years beginning on or after the date of the enact-
ment of this Act. 
Æ 
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