‘‘(c) OUT-OF-NETWORK
PROVIDERS.—Nothing in 
this section requires a plan or issuer that has a network 
of providers to provide benefits for selected insulin prod-
ucts described in this section that are delivered by an out- 
of-network provider, or precludes a plan or issuer that has 
a network of providers from imposing higher cost-sharing 
than the levels specified in subsection (a) for selected insu-
lin products described in this section that are delivered 
by an out-of-network provider. 
‘‘(d) RULE OF CONSTRUCTION.—Subsection (a) shall 
not be construed to require coverage of, or prevent a group 
health plan or health insurance coverage from imposing 
cost-sharing other than the levels specified in subsection 
(a) on, insulin products that are not selected insulin prod-
ucts, to the extent that such coverage is not otherwise re-
quired and such cost-sharing is otherwise permitted under 
Federal and applicable State law. 
‘‘(e) APPLICATION
OF
COST-SHARING
TOWARDS 
DEDUCTIBLES
AND OUT-OF-POCKET MAXIMUMS.—Any 
cost-sharing payments made pursuant to subsection (a)(2) 
shall be counted toward any deductible or out-of-pocket 
maximum that applies under the plan or coverage.’’. 
(2) CLERICAL AMENDMENT.—The table of con-
tents in section 1 of the Employee Retirement In-
come Security Act of 1974 (29 U.S.C. 1001 et seq.) 
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is amended by inserting after the item relating to 
section 725 the following: 
‘‘Sec. 726. Requirements with respect to cost-sharing for certain insulin prod-
ucts.’’. 
(d) NO EFFECT ON OTHER COST-SHARING.—Section 
1302(d)(2) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18022(d)(2)) is amended by adding at the 
end the following new subparagraph: 
‘‘(D) SPECIAL RULE RELATING TO INSU-
LIN COVERAGE.—The exemption of coverage of 
selected insulin products (as defined in section 
2799A–11(b) of the Public Health Service Act) 
from the application of any deductible pursuant 
to section 2799A–11(a)(1) of such Act, section 
726(a)(1) of the Employee Retirement Income 
Security Act of 1974, or section 9826(a)(1) of 
the Internal Revenue Code of 1986 shall not be 
considered when determining the actuarial value 
of a qualified health plan under this sub-
section.’’. 
(e) COVERAGE
OF CERTAIN INSULIN PRODUCTS 
UNDER CATASTROPHIC PLANS.—Section 1302(e) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 
18022(e)) is amended by adding at the end the following: 
‘‘(4) COVERAGE
OF
CERTAIN
INSULIN
PROD-
UCTS.— 
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‘‘(A) IN GENERAL.—Notwithstanding para-
graph (1)(B)(i), a health plan described in 
paragraph (1) shall provide coverage of selected 
insulin products, in accordance with section 
2799A–11 of the Public Health Service Act, for 
a plan year before an enrolled individual has in-
curred cost-sharing expenses in an amount 
equal to the annual limitation in effect under 
subsection (c)(1) for the plan year. 
‘‘(B) TERMINOLOGY.—For purposes of 
subparagraph (A)— 
‘‘(i) the term ‘selected insulin prod-
ucts’ has the meaning given such term in 
section 2799A–11(b) of the Public Health 
Service Act; and 
‘‘(ii) the requirements of section 
2799A–11 of such Act shall be applied by 
deeming each reference in such section to 
‘individual health insurance coverage’ to be 
a reference to a plan described in para-
graph (1).’’. 
SEC. 3. APPROPRIATE COST-SHARING FOR CERTAIN INSU-
LIN PRODUCTS UNDER MEDICARE PART D. 
(a) IN GENERAL.—Section 1860D–2 of the Social 
Security Act (42 U.S.C. 1395w–102) is amended— 
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