‘‘(A) the 10 percent of the average net 
price for such drug published pursuant to sec-
tion 2(a) of Matt’s Act, plus the average 
charges for distribution and dispensing de-
scribed in subsection (c) for such drug; 
‘‘(B) the coinsurance amount for an insu-
lin drug under the health insurance coverage 
under which such an individual is a participant, 
beneficiary, or enrollee would otherwise be re-
sponsible notwithstanding this section; or 
‘‘(C) $20; or 
‘‘(2) $0, in the case such a participant, bene-
ficiary, or enrollee is enrolled in a high deductible 
health plan (as defined in section 223(c)(2) of the 
Internal Revenue Code of 1986). 
‘‘(b) WAIVER OF DEDUCTIBLE.—In applying sub-
section (a), such a participant, beneficiary, or enrollee 
shall have access to an insulin drug without regard to a 
deductible. 
‘‘(c) CHARGES
FOR
DISTRIBUTING
AND
DIS-
PENSING.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a), charges for distribution and dispensing de-
scribed in this subsection— 
VerDate Sep 11 2014 
04:25 Aug 10, 2020
Jkt 099200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H7722.IH
H7722
kjohnson on DSK79L0C42PROD with BILLS
‘‘(A) are charges associated with the trans-
actions, with respect to an insulin drug, be-
tween wholesalers, distributors, retailers, and 
pharmacies; and 
‘‘(B) may not exceed 10 percent of the av-
erage net price of such an insulin drug. 
‘‘(2) REPORTING REQUIREMENT FOR PLANS.— 
In the case that a health insurance issuer offering 
group or individual health insurance coverage 
charges a participant, beneficiary, or enrollee for av-
erage charges for distribution and dispensing pursu-
ant to subsection (a)(1), the health insurance issuer 
shall submit to the Inspector General of the Depart-
ment of Health and Human Services information 
with respect to such charges and the amount of the 
charges. 
‘‘(3) REPORT
TO
CONGRESS
BY
INSPECTOR 
GENERAL.—Beginning January 1, 2022, and annu-
ally thereafter, the Inspector General shall review 
the charges described in paragraph (2) and submit 
to Congress a report on such on review. 
‘‘(d) DEFINITIONS.—In this section: 
‘‘(1) INSULIN.— 
‘‘(A) IN
GENERAL.—The term ‘insulin’ 
means a prescription drug containing insulin 
VerDate Sep 11 2014 
04:25 Aug 10, 2020
Jkt 099200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H7722.IH
H7722
kjohnson on DSK79L0C42PROD with BILLS
that is approved by the Food and Drug Admin-
istration to improve glycemic control in patients 
with diabetes mellitus (and may include any 
medical supplies included with such drug or as-
sociated with the injection of such drug). 
‘‘(B) EXCLUSION.—Such term does not in-
clude any medical supplies that provides for the 
monitoring of insulin levels. 
‘‘(2) LIST PRICE.—The term ‘list price’ has the 
meaning given the term wholesale acquisition cost in 
section 1847A(c)(6)(B) of the Social Security Act. 
‘‘(3) NET PRICE.—The term ‘net price’ means, 
with respect to prescription drug coverage under 
group or individual health insurance coverage of-
fered by a health insurance issuer, the list price of 
the drug net all rebates, discounts, concessions, and 
other adjustments applied to the cost paid by the 
health insurance issuer, or by any other entity that 
provides pharmacy benefit management services 
under a contract with any such health insurance 
issuer, regardless of whether such adjustments are 
prospective or retrospective. 
‘‘(4) PRESCRIPTION
DRUG.—The term ‘pre-
scription drug’ mean a drug, as defined in section 
201(g) of the Federal Food, Drug, and Cosmetic 
VerDate Sep 11 2014 
04:25 Aug 10, 2020
Jkt 099200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H7722.IH
H7722
kjohnson on DSK79L0C42PROD with BILLS
Act, that is subject to section 503(b)(1) of such 
Act.’’. 
(2) APPLICATION TO ERISA PLANS.—Subpart A 
of part 7 of the Employee Retirement Income Secu-
rity Act of 1974 (29 U.S.C. 1185 et seq.) is amend-
ed by adding at the end the following new section 
(and amending the table of contents accordingly): 
‘‘SEC. 704. NET PRICE FOR INSULIN DRUGS. 
‘‘(a) AVAILABILITY OF NET PRICE.—With respect to 
plan years beginning on and after January 1, 2021, a 
group health plan shall provide a participant, beneficiary, 
or enrollee who has diabetes access to an insulin drug at— 
‘‘(1) the lesser of— 
‘‘(A) the 10 percent of the average net 
price for such drug published pursuant to sec-
tion 2(a) of Matt’s Act, plus the average 
charges for distribution and dispensing de-
scribed in subsection (c) for such drug; 
‘‘(B) the coinsurance amount for an insu-
lin drug under the group health plan which 
such an individual is a participant, beneficiary, 
or enrollee would otherwise be responsible not-
withstanding this section; or 
‘‘(C) $20; or 
VerDate Sep 11 2014 
04:25 Aug 10, 2020
Jkt 099200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H7722.IH
H7722
kjohnson on DSK79L0C42PROD with BILLS
‘‘(2) $0, in the case such a participant, bene-
ficiary, or enrollee is enrolled in a high deductible 
health plan (as defined in section 223(c)(2) of the 
Internal Revenue Code of 1986). 
‘‘(b) WAIVER OF DEDUCTIBLE.—In applying sub-
section (a), such a participant, beneficiary, or enrollee 
shall have access to an insulin drug without regard to a 
deductible. 
‘‘(c) CHARGES
FOR
DISTRIBUTING
AND
DIS-
PENSING.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a), charges for distribution and dispensing de-
scribed in this subsection— 
‘‘(A) are charges associated with the trans-
actions, with respect to an insulin drug, be-
tween wholesalers, distributors, retailers, and 
pharmacies; and 
‘‘(B) may not exceed 10 percent of the av-
erage net price of such an insulin drug. 
‘‘(2) REPORTING REQUIREMENT FOR PLANS.— 
In the case that a group health plan charges a par-
ticipant, beneficiary, or enrollee for average charges 
for distribution and dispensing pursuant to sub-
section (a)(1), the group health plan shall submit to 
the Inspector General of the Department of Health 
VerDate Sep 11 2014 
04:25 Aug 10, 2020
Jkt 099200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H7722.IH
H7722
kjohnson on DSK79L0C42PROD with BILLS