I 
118TH CONGRESS 
1ST SESSION H. R. 4895 
To amend title XI of the Social Security Act to expand the drug price 
negotiation program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 26, 2023 
Mr. PALLONE (for himself, Mr. NEAL, and Mr. SCOTT of Virginia) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committees on Ways and Means, and 
Education and the Workforce, for a period to be subsequently determined 
by the Speaker, in each case for consideration of such provisions as fall 
within the jurisdiction of the committee concerned 
A BILL 
To amend title XI of the Social Security Act to expand 
the drug price negotiation program, and for other purposes. 
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 ‘‘Lowering Drug Costs 
for American Families Act’’. 
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SEC. 2. EXPANDING THE DRUG PRICE NEGOTIATION PRO-
GRAM. 
(a) INCREASING THE NUMBER OF DRUGS SUBJECT 
TO NEGOTIATION.—Section 1192(a)(4) of the Social Se-
curity Act (42 U.S.C. 1320f–1(a)(4)) is amended by strik-
ing ‘‘20’’ each place it appears and inserting ‘‘50’’ in each 
such place. 
(b) EXPANSION OF DEFINITION OF MAXIMUM FAIR 
PRICE ELIGIBLE INDIVIDUAL.—Section 1191(c)(2) of the 
Social Security Act (42 U.S.C. 1320f–1(c)(2)) is amend-
ed— 
(1) in subparagraph (A), by inserting ‘‘, or a 
participant, beneficiary, or enrollee who is enrolled 
under a group health plan or health insurance cov-
erage offered in the group or individual market (as 
such terms are defined in section 2791 of the Public 
Health Service Act) with respect to which there is in 
effect an agreement with the Secretary under section 
1197 with respect to such selected drug as so fur-
nished or dispensed’’ after ‘‘such selected drug’’; and 
(2) in subparagraph (B), by inserting ‘‘, or a 
participant, beneficiary, or enrollee who is enrolled 
under a group health plan or health insurance cov-
erage offered in the group or individual market (as 
such terms are defined in section 2791 of the Public 
Health Service Act) with respect to which there is in 
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effect an agreement with the Secretary under section 
1197 with respect to such selected drug as so fur-
nished or administered’’ after ‘‘such selected drug’’. 
(c) APPLICATION OF ADMINISTRATIVE PROCEDURES 
TO NEW MAXIMUM FAIR PRICE ELIGIBLE INDIVID-
UALS.—Section 1196(a)(3) of the Social Security Act (42 
U.S.C. 1320f–5(a)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (B), by striking the period 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(C) maximum fair price eligible individ-
uals not described in subparagraph (A) or 
(B).’’. 
(d) HEALTH INSURER AGREEMENTS.—Part E of 
title XI of the Social Security Act (42 U.S.C. 1320f et 
seq.) is amended— 
(1) by redesignating sections 1197 and 1198 as 
sections 1198 and 1199, respectively; and 
(2) by inserting after section 1196 the following 
new section: 
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‘‘SEC. 
1197. 
VOLUNTARY 
PARTICIPATION 
BY 
OTHER 
HEALTH PLANS. 
‘‘(a) AGREEMENT TO PARTICIPATE UNDER PRO-
GRAM.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
under the program under this part the Secretary 
shall be treated as having in effect an agreement 
with a group health plan or health insurance issuer 
offering group or individual health insurance cov-
erage (as such terms are defined in section 2791 of 
the Public Health Service Act), with respect to a 
price applicability period and a selected drug with 
respect to such period— 
‘‘(A) in the case such selected drug fur-
nished or dispensed at a pharmacy or by mail 
order service if coverage is provided under such 
plan or coverage during such period for such se-
lected drug as so furnished or dispensed; and 
‘‘(B) in the case such selected drug fur-
nished or administered by a hospital, physician, 
or other provider of services or supplier if cov-
erage is provided under such plan or coverage 
during such period for such selected drug as so 
furnished or administered. 
‘‘(2) OPTING OUT OF AGREEMENT.—The Sec-
retary shall not be treated as having in effect an 
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agreement under the program under this part with 
a group health plan or health insurance issuer offer-
ing group or individual health insurance coverage 
with respect to a price applicability period and a se-
lected drug with respect to such period if such a 
plan or issuer affirmatively elects, through a process 
specified by the Secretary, not to participate under 
the program with respect to such period and drug. 
‘‘(b) PUBLICATION OF ELECTION.—With respect to 
each price applicability period and each selected drug with 
respect to such period, the Secretary and the Secretary 
of Labor and the Secretary of the Treasury, as applicable, 
shall make public a list of each group health plan and each 
health insurance issuer offering group or individual health 
insurance coverage, with respect to which coverage is pro-
vided under such plan or coverage for such drug, that has 
elected under subsection (a) not to participate under the 
program with respect to such period and drug.’’. 
(e) APPLICATION TO GROUP HEALTH PLANS AND 
HEALTH INSURANCE COVERAGE.— 
(1) PHSA.—Part D of title XXVII of the Pub-
lic Health Service Act (42 U.S.C. 300gg–111 et 
seq.) is amended by adding at the end the following 
new section: 
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‘‘SEC. 2799A–11. DRUG PRICE NEGOTIATION PROGRAM AND 
APPLICATION OF MAXIMUM FAIR PRICES. 
‘‘(a) IN GENERAL.—In the case of a group health 
plan or health insurance issuer offering group or indi-
vidual health insurance coverage that is treated under sec-
tion 1197 of the Social Security Act as having in effect 
an agreement with the Secretary under the Drug Price 
Negotiation Program under part E of title XI of such Act, 
with respect to a price applicability period (as defined in 
section 1191(b) of such Act) and a selected drug (as de-
fined in section 1192(c) of such Act) with respect to such 
period for which coverage is provided under such plan or 
coverage— 
‘‘(1) the provisions of such part shall apply— 
‘‘(A) in the case the drug is furnished or 
dispensed at a pharmacy or by a mail order 
service, to such plan or coverage, and to the 
participants, beneficiaries, and enrollees en-
rolled under such plan or coverage, during such 
period, with respect to such selected drug, in 
the same manner as such provisions apply to 
prescription drug plans and MA–PD plans, and 
to participants, beneficiaries, and enrollees en-
rolled under such prescription drug plans and 
MA–PD plans during such period; and 
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‘‘(B) in the case the drug is furnished or 
administered by a hospital, physician, or other 
provider of services or supplier, to such plan or 
coverage, and to the participants, beneficiaries, 
and enrollees enrolled under such plan or cov-
erage, and to hospitals, physicians, and other 
providers of services and suppliers during such 
period, with respect to such drug in the same 
manner as such provisions apply to the Sec-
retary, to participants, beneficiaries, and enroll-
ees entitled to benefits under part A of title 
XVIII or enrolled under part B of such title, 
and to hospitals, physicians, and other pro-
viders and suppliers participating under title 
XVIII during such period; 
‘‘(2) the plan or issuer shall apply any cost- 
sharing responsibilities under such plan or coverage, 
with respect to such selected drug, by substituting 
an amount not more than the maximum fair price 
negotiated under such part E of title XI for such 
drug in lieu of the drug price upon which the cost- 
sharing would have otherwise applied, and such cost- 
sharing responsibilities with respect to such selected 
drug may not exceed such maximum fair price; and 
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‘‘(3) the Secretary shall apply the provisions of 
such part E to such plan, issuer, and coverage, such 
participants, beneficiaries, and enrollees so enrolled 
in such plans and coverage, and such hospitals, phy-
sicians, and other providers and suppliers partici-
pating in such plans and coverage. 
‘‘(b) NOTIFICATION REGARDING NONPARTICIPATION 
IN DRUG PRICE NEGOTIATION PROGRAM.—A group 
health plan or a health insurance issuer offering group or 
individual health insurance coverage shall publicly dis-
close, in a manner and in accordance with a process speci-
fied by the Secretary, any election made under section 
1197 of the Social Security Act by such plan or issuer 
to not participate in the Drug Price Negotiation Program 
under part E of title XI of such Act with respect to a 
selected drug (as defined in section 1192(c) of such Act) 
for which coverage is provided under such plan or coverage 
before the beginning of the plan year for which such elec-
tion was made.’’. 
(2) ERISA.— 
(A) IN GENERAL.—Subpart B of part 7 of 
subtitle B of title I of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1181 
et seq.) is amended by adding at the end the 
following new section: 
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‘‘SEC. 726. DRUG PRICE NEGOTIATION PROGRAM AND AP-
PLICATION OF MAXIMUM FAIR PRICES. 
‘‘(a) IN GENERAL.—In the case of a group health 
plan or health insurance issuer offering group health in-
surance coverage that is treated under section 1197 of the 
Social Security Act as having in effect an agreement with 
the Secretary of Health and Human Services under the 
Drug Price Negotiation Program under part E of title XI 
of such Act, with respect to a price applicability period 
(as defined in section 1191(b) of such Act) and a selected 
drug (as defined in section 1192(c) of such Act) with re-
spect to such period for which coverage is provided under 
such plan or coverage— 
‘‘(1) the provisions of such part shall apply, as 
applicable— 
‘‘(A) in the case the drug is furnished or 
dispensed at a pharmacy or by a mail order 
service, to such plan or coverage, and to the 
participants and beneficiaries enrolled under 
such plan or coverage, during such period, with 
respect to such selected drug, in the same man-
ner as such provisions apply to prescription 
drug plans and MA–PD plans, and to partici-
pants and beneficiaries enrolled under such pre-
scription drug plans and MA–PD plans during 
such period; and 
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‘‘(B) in the case the drug is furnished or 
administered by a hospital, physician, or other 
provider of services or supplier, to the group 
health plan or coverage offered by an issuer, to 
the participants and beneficiaries enrolled 
under such plans or coverage, and to hospitals, 
physicians, and other providers of services and 
suppliers during such period, with respect to 
such drug in the same manner as such provi-
sions apply to the Secretary of Health and 
Human Services, to participants and bene-
ficiaries entitled to benefits under part A of 
title XVIII or enrolled under part B of such 
title, and to hospitals, physicians, and other 
providers and suppliers participating under title 
XVIII during such period; 
‘‘(2) the plan or issuer shall apply any cost- 
sharing responsibilities under such plan or coverage, 
with respect to such selected drug, by substituting 
an amount not more than the maximum fair price 
negotiated under such part E of title XI for such 
drug in lieu of the drug price upon which the cost- 
sharing would have otherwise applied, and such cost- 
sharing responsibilities with respect to such selected 
drug may not exceed such maximum fair price; and 
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