I 
116TH CONGRESS 
1ST SESSION H. R. 3805 
To reform prescription drug pricing and reduce out-of-pocket costs by 
ensuring consumers benefit from negotiated rebates. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 17, 2019 
Mr. GALLAGHER introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To reform prescription drug pricing and reduce out-of-pocket 
costs by ensuring consumers benefit from negotiated rebates. 
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 ‘‘Prescription Drug Re-
bate Reform Act of 2019’’. 
SEC. 2. COST-SHARING WITH RESPECT TO PRESCRIPTION 
DRUGS. 
(a) IN GENERAL.—Subpart II of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 
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300gg–11 et seq.) is amended by adding at the end the 
following: 
‘‘SEC. 2729A. COST-SHARING WITH RESPECT TO PRESCRIP-
TION DRUGS. 
‘‘(a) IN GENERAL.—A group health plan or health 
insurance issuer offering group or individual health insur-
ance coverage shall set any coinsurance obligation an en-
rollee has with respect to a prescription drug covered by 
the plan or coverage based on the net price of the drug, 
such that no payment by the enrollee with respect to the 
drug is based on a percentage of the list price of a drug. 
‘‘(b) APPLICABILITY.—Subsection (a)— 
‘‘(1) shall apply with respect to a prescription 
drug benefit when the enrollee is required to pay a 
deductible with respect to such benefits and— 
‘‘(A) has not yet satisfied the deductible 
under the plan or coverage; or 
‘‘(B) has another coinsurance obligation 
with respect to such benefits under the plan or 
coverage; and 
‘‘(2) shall not apply if, with respect to the dis-
pensed quantity of a prescription drug, the net price 
and list price are the same, or are different by not 
more than 1 cent. 
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‘‘(c) COPAYMENTS.—Nothing in this section prevents 
a group health plan or health insurance issuer from re-
quiring a copayment for any prescription drug if such co-
payment is not tied to a percent of the specified cost of 
the drug. 
‘‘(d) DEFINITIONS.—In this section— 
‘‘(1) the term ‘coinsurance’ means, with respect 
to prescription drug coverage under a group health 
plan or group or individual health insurance cov-
erage, a payment obligation of an enrollee in such 
health plan or health insurance coverage that is 
based on a portion or percentage of the specified 
cost of a prescription drug, which may be up to 100 
percent of that cost; 
‘‘(2) the term ‘deductible’ means the payment 
obligation of an enrollee in a group health plan or 
group or individual health insurance coverage before 
the group health plan or group or individual health 
insurance coverage will pay any portion of the cost 
of prescription drug coverage; 
‘‘(3) the term ‘list price’ has the meaning given 
the term ‘wholesale acquisition cost’ in section 
1847A(c)(6)(B) of the Social Security Act; 
‘‘(4) the term ‘net price’ means, with respect to 
prescription drug coverage under a group health 
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plan or group or individual health insurance cov-
erage, the list price of the drug net all rebates, dis-
counts, concessions, and other adjustments applied 
to the cost paid by the group health plan or health 
insurance issuer, or by any other entity that pro-
vides pharmacy benefit management services under 
a contract with any such group health plan or health 
insurance issuer, regardless of whether such adjust-
ments are prospective or retrospective; and 
‘‘(5) the term ‘prescription drug’ mean a drug, 
as defined in section 201(g) of the Federal Food, 
Drug, and Cosmetic Act, that is subject to section 
503(b)(1) of such Act.’’. 
(b) EFFECTIVE DATE.—Section 2729A of the Public 
Health Service Act, as added by subsection (a), shall apply 
with respect to plan years beginning on or after January 
1, 2021. 
Æ 
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