I 
114TH CONGRESS 
1ST SESSION H. R. 1600 
To amend title XXVII of the Public Health Service Act to limit co-payment, 
coinsurance, or other cost-sharing requirements applicable to prescription 
drugs in a specialty drug tier to the dollar amount (or its equivalent) 
of such requirements applicable to prescription drugs in a non-preferred 
brand drug tier, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 25, 2015 
Mr. MCKINLEY (for himself, Mrs. CAPPS, Mr. HECK of Nevada, Mr. JOHNSON 
of Georgia, Mr. HARPER, Mr. DAVID SCOTT of Georgia, Mr. YOUNG of 
Alaska, Ms. MICHELLE
LUJAN
GRISHAM
of New Mexico, Mr. 
FITZPATRICK, Mr. PRICE of North Carolina, Ms. ESHOO, Mr. CART-
WRIGHT, Mr. HIGGINS, Mr. TONKO, Mr. RYAN of Ohio, Ms. PINGREE, 
Ms. TSONGAS, Ms. CLARK of Massachusetts, Ms. TITUS, Mr. SCHIFF, 
Ms. BROWNLEY of California, Ms. GABBARD, Mr. KEATING, Mr. ISRAEL, 
Ms. NORTON, Mr. CARSON of Indiana, Mr. BUTTERFIELD, Mr. DEFAZIO, 
Mr. THOMPSON of Mississippi, Mr. BLUMENAUER, Mr. GARAMENDI, Mr. 
HASTINGS, Mr. PETERS, Mr. WALZ, Ms. SLAUGHTER, Mr. MCGOVERN, 
Mr. NOLAN, Mr. QUIGLEY, Mr. JOLLY, Mr. FARR, Mrs. DAVIS of Cali-
fornia, Mr. SMITH of New Jersey, Mr. LANGEVIN, Mr. SEAN PATRICK 
MALONEY of New York, Mr. LOEBSACK, Mr. PAYNE, Mr. NADLER, Mr. 
COHEN, Mr. BEYER, Mr. DOGGETT, and Mr. RANGEL) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce 
A BILL 
To amend title XXVII of the Public Health Service Act 
to limit co-payment, coinsurance, or other cost-sharing 
requirements applicable to prescription drugs in a spe-
cialty drug tier to the dollar amount (or its equivalent) 
of such requirements applicable to prescription drugs 
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in a non-preferred brand drug tier, and for other pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Patients’ Access to 
Treatments Act of 2015’’. 
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). 
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‘‘(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-
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 
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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 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, 
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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 
to plan years beginning on or after the date of the enact-
ment of this Act. 
Æ 
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