I 
116TH CONGRESS 
1ST SESSION H. R. 2757 
To amend title XVIII of the Social Security Act to provide for adjustments 
to the Medicare part D cost-sharing reductions for low-income individuals. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2019 
Mr. CUNNINGHAM (for himself, Mr. BILIRAKIS, and Mr. EVANS) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committee on Ways and Means, 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 com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for adjustments to the Medicare part D cost-sharing 
reductions for low-income individuals. 
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 ‘‘Creating Lower cost 
Alternative for Your prescription drugs Act’’ or the 
‘‘CLAY Act’’. 
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SEC. 2. ADJUSTMENTS TO MEDICARE PART D COST-SHAR-
ING REDUCTIONS FOR LOW-INCOME INDIVID-
UALS. 
Section 1860D–14(a) of the Social Security Act (42 
U.S.C. 1395w–114(a)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (D)— 
(i) in clause (ii)— 
(I) by striking ‘‘that does not ex-
ceed $1 for’’ and all that follows 
through the period at the end and in-
serting ‘‘that does not exceed— 
‘‘(I) for plan years before plan 
year 2021— 
‘‘(aa) for a generic drug or a 
preferred drug that is a multiple 
source drug (as defined in section 
1927(k)(7)(A)(i)), $1 or, if less, 
the copayment amount applicable 
to an individual under clause 
(iii); and 
‘‘(bb) for any other drug, $3 
or, if less, the copayment amount 
applicable to an individual under 
clause (iii); and’’; and 
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(II) by adding at the end the fol-
lowing new subclauses: 
‘‘(II) for plan year 2021— 
‘‘(aa) for a generic drug, $0; 
and 
‘‘(bb) for any other drug, 
the dollar amount applied under 
this clause (after application of 
paragraph (4)(A)) for plan year 
2020 for a drug described in sub-
clause (I)(bb); and 
‘‘(III) for a subsequent year, the 
dollar amount applied under this 
clause for the previous year for the 
drug, increased by the annual percent-
age increase in the consumer price 
index (all items; U.S. city average) as 
of September of such previous year.’’; 
and 
(ii) in clause (iii)— 
(I) by striking ‘‘does not exceed 
the 
copayment 
amount 
specified 
under’’ and inserting ‘‘does not ex-
ceed— 
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‘‘(I) for plan years beginning be-
fore plan year 2021, the copayment 
amount specified under’’; 
(II) by striking the period at the 
end and inserting ‘‘; and’’; and 
(III) by adding at the end the 
following new subclause: 
‘‘(II) for plan year 2021 and 
each subsequent plan year the copay-
ment amount applied under clause (ii) 
for the drug and year involved.’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(F) ROUNDING.—Any amount established 
under clause (ii) of subparagraph (D), including 
as applied under clause (iii) of such subpara-
graph or paragraph (2)(E), that is based on an 
increase of $3, that is not a multiple of 5 cents 
or 10 cents, respectively, shall be rounded to 
the nearest multiple of 5 cents or 10 cents, re-
spectively.’’; 
(2) in paragraph (2)— 
(A) in subparagraph (C), by inserting ‘‘and 
subparagraph (E)’’ before the period; 
(B) in subparagraph (D)— 
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(i) by striking ‘‘of coinsurance of’’ and 
inserting ‘‘of— 
‘‘(I) for plan years before plan 
year 2021, coinsurance of’’; 
(ii) by striking the period at the end 
and inserting ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing new subclause: 
‘‘(II) for plan year 2021 and 
each subsequent plan year, a copay-
ment amount that does not exceed the 
copayment 
amount 
applied 
under 
paragraph (1)(D)(ii) for the drug and 
year involved.’’; and 
(C) in subparagraph (E)— 
(i) by striking ‘‘subsection (c), the 
substitution for’’ and inserting ‘‘subsection 
(c)— 
‘‘(i) for plan years before plan year 
2021, the substitution for’’; 
(ii) by striking the period at the end 
and inserting ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing new clause: 
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‘‘(ii) for plan year 2021 and each sub-
sequent plan year, the elimination of any 
cost-sharing 
imposed 
under 
section 
1860D–2(b)(4)(A).’’; and 
(3) in paragraph (4)(A)(ii), by inserting ‘‘(be-
fore 2021)’’ after ‘‘subsequent year’’. 
Æ 
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