I 
118TH CONGRESS 
1ST SESSION H. R. 3134 
To amend the Public Health Service Act to establish insulin assistance 
programs, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 9, 2023 
Ms. CRAIG (for herself and Mr. PHILLIPS) 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 provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend the Public Health Service Act to establish insulin 
assistance programs, 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 ‘‘Emergency Access to 
Insulin Act of 2023’’. 
SEC. 2. INSULIN ASSISTANCE PROGRAMS. 
(a) IN GENERAL.—Part B of title III of the Public 
Health Service Act (42 U.S.C. 243 et seq.) is amended 
by adding at the end the following: 
VerDate Sep 11 2014 
03:07 May 17, 2023
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3134.IH
H3134
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘SEC. 320C. INSULIN ASSISTANCE PROGRAMS. 
‘‘(a) ESTABLISHMENT OF PROGRAM OF GRANTS TO 
STATES, INDIAN
TRIBES, 
AND
TRIBAL
ORGANIZA-
TIONS.— 
‘‘(1) IN
GENERAL.—The Secretary shall, not 
later than 1 year after the date of enactment of this 
section, make grants to States, Indian tribes, and 
tribal organizations for the purpose of carrying out 
programs to assist eligible individuals in obtaining 
insulin in accordance with paragraph (4). 
‘‘(2) GRANT AND CONTRACT AUTHORITY FOR 
STATES, INDIAN
TRIBES, AND
TRIBAL
ORGANIZA-
TIONS.— 
‘‘(A) IN GENERAL.—A State, Indian tribe, 
or tribal organization receiving a grant under 
paragraph (1) may, subject to subparagraph 
(B), expend the grant to carry out the purpose 
described in such paragraph through grants or 
contracts to public or private entities, including 
local governments. 
‘‘(B) CERTAIN APPLICATIONS.—If a non-
profit private entity and a private entity that is 
not a nonprofit entity both submit applications 
to a State, Indian tribe, or tribal organization 
to receive an award of a grant or contract 
under subparagraph (A), the State, Indian 
VerDate Sep 11 2014 
03:07 May 17, 2023
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3134.IH
H3134
pbinns on DSKJLVW7X2PROD with $$_JOB
tribe, or tribal organization shall give priority to 
the application submitted by the nonprofit pri-
vate entity in any case in which the State, In-
dian tribe, or tribal organization determines 
that the quality of such application is equiva-
lent to the quality of the application submitted 
by the other private entity. 
‘‘(3) ALLOTMENT.—Each State, Indian tribe, 
or tribal organization that applies for a grant in ac-
cordance with subsection (e) shall receive a grant 
under this section in an amount that is equal to the 
sum of— 
‘‘(A) a minimum amount determined by 
the Secretary; and 
‘‘(B) an additional amount based on cri-
teria established by the Secretary, which may 
include the ability of the State, Indian tribe, or 
tribal organization to successfully assist individ-
uals in seeking eligibility for Federal or State- 
funded programs as described in paragraph 
(4)(A)(ii)(II). 
‘‘(4) PROGRAM COMPONENTS.— 
‘‘(A) IN GENERAL.—A State, Indian tribe, 
or tribal organization carrying out a program 
supported by a grant under this subsection— 
VerDate Sep 11 2014 
03:07 May 17, 2023
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3134.IH
H3134
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(i) shall use the grant funds to— 
‘‘(I) issue insulin cards to eligible 
individuals in accordance with sub-
paragraph (B); and 
‘‘(II) enter into agreements with 
pharmacies— 
‘‘(aa) for such pharmacies to 
fill prescriptions for individuals 
displaying valid insulin cards 
that are issued in accordance 
with subparagraph (B) at no cost 
to such individuals; and 
‘‘(bb) for the State, Indian 
tribe, or tribal organization to 
pay such pharmacies for insulin 
filled for a prescription described 
in item (aa); and 
‘‘(ii) may use the grant funds to— 
‘‘(I) purchase insulin; or 
‘‘(II) assist individuals in seeking 
eligibility for Federal or State-funded 
programs which may provide coverage 
for insulin or otherwise assist such in-
dividuals in obtaining insulin. 
‘‘(B) INSULIN CARDS.— 
VerDate Sep 11 2014 
03:07 May 17, 2023
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H3134.IH
H3134
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(i) APPLICATION.—An eligible indi-
vidual seeking an insulin card through a 
program supported by a grant under this 
subsection shall submit an application to 
the State, Indian tribe, or tribal organiza-
tion receiving the grant, at such time, in 
such manner, and containing such infor-
mation as the State, Indian tribe, or tribal 
organization may reasonably require for 
purposes of this subsection, including— 
‘‘(I) 
documentation 
indicating 
proof of— 
‘‘(aa) in the case of a grant 
awarded to a State, residency in 
the State; 
‘‘(bb) in the case of a grant 
awarded to an Indian tribe, mem-
bership in the Indian tribe; or 
‘‘(cc) in the case of a grant 
awarded to a tribal organization, 
membership in the Indian tribe 
or Indian community served by 
the tribal organization; 
‘‘(II) a prescription for insulin 
that is prescribed to the individual; 
VerDate Sep 11 2014 
03:07 May 17, 2023
Jkt 039200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H3134.IH
H3134
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(III) a statement that, to the 
best of the individual’s knowledge, the 
individual is an uninsured individual 
or an underinsured individual; and 
‘‘(IV) if the individual is an 
underinsured individual, the name of 
the high-deductible health plan in 
which the individual is enrolled and 
any unique identifier of the plan, such 
as a policy number. 
‘‘(ii) INITIAL CARD.— 
‘‘(I) IN GENERAL.—A State, In-
dian tribe, or tribal organization car-
rying out a program supported by a 
grant under this subsection shall issue 
an initial insulin card to each indi-
vidual that submits an application to 
the State, Indian tribe, or tribal orga-
nization meeting the requirements 
under clause (i). 
‘‘(II) TIMING.—A State, Indian 
tribe, or tribal organization that re-
ceives an application under clause (i) 
from an individual shall issue an ini-
tial insulin card to such individual not 
VerDate Sep 11 2014 
03:07 May 17, 2023
Jkt 039200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H3134.IH
H3134
pbinns on DSKJLVW7X2PROD with $$_JOB
later than 5 business days after re-
ceiving such application. 
‘‘(III) SUPPLY.—An initial insu-
lin card issued to an individual under 
this clause shall be valid for an ap-
proximate 7-day supply of insulin that 
is appropriate for the individual based 
on the prescription for the individual 
provided in the application under 
clause (i) and packaging and proc-
essing practices for insulin. 
‘‘(iii) 3-MONTH
CARDS.—Not later 
than 12 business days after an individual 
submits an application under clause (i) to 
a State, Indian tribe, or tribal organiza-
tion, the State, Indian tribe, or tribal orga-
nization shall— 
‘‘(I) determine whether the indi-
vidual is an eligible individual; and 
‘‘(II) if the individual is an eligi-
ble individual, issue the individual an 
insulin card that is valid for an ap-
proximate 90-day supply of insulin 
that is appropriate for the individual 
based on the prescription provided in 
VerDate Sep 11 2014 
03:07 May 17, 2023
Jkt 039200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H3134.IH
H3134
pbinns on DSKJLVW7X2PROD with $$_JOB
the application under clause (i) and 
packaging and processing practices 
for insulin. 
‘‘(iv) RENEWAL OF CARDS.— 
‘‘(I) 3-MONTH CARDS.—An eligi-
ble individual that is issued an insulin 
card under clause (iii) may apply to 
renew such card in accordance with a 
process established by the State, In-
dian tribe, or tribal organization. 
‘‘(II) 
LIMITATION.—An 
indi-
vidual that submits an application 
under clause (i) and is denied an insu-
lin card under clause (ii) or (iii) may 
not submit another application under 
clause (i) for the 1-year period begin-
ning on the date on which the indi-
vidual is denied such card. 
‘‘(b) REQUIREMENT OF MATCHING FUNDS.— 
‘‘(1) IN
GENERAL.—The Secretary may not 
make a grant under subsection (a) unless the State, 
Indian tribe, or tribal organization involved agrees, 
with respect to the costs to be incurred by the State, 
Indian tribe, or tribal organization in carrying out 
the purpose described in subsection (a)(1), to make 
VerDate Sep 11 2014 
03:07 May 17, 2023
Jkt 039200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H3134.IH
H3134
pbinns on DSKJLVW7X2PROD with $$_JOB
available non-Federal contributions (in cash or in 
kind under paragraph (2)) toward such costs in an 
amount equal to not less than $1 for each $3 of 
Federal funds provided in the grant. Such contribu-
tions may be made directly or through donations 
from public or private entities. 
‘‘(2) DETERMINATION
OF
AMOUNT
OF
NON- 
FEDERAL CONTRIBUTION.— 
‘‘(A) IN GENERAL.—Non-Federal contribu-
tions required in paragraph (1) may be in cash 
or in kind, fairly evaluated, including equipment 
or services (and excluding indirect or overhead 
costs). Amounts provided by the Federal Gov-
ernment, or services assisted or subsidized to 
any significant extent by the Federal Govern-
ment, may not be included in determining the 
amount of such non-Federal contributions. 
‘‘(B) 
MAINTENANCE
OF
EFFORT.—In 
making a determination of the amount of non- 
Federal contributions for purposes of paragraph 
(1), the Secretary may include only non-Federal 
contributions in excess of the average amount 
of non-Federal contributions made by the State, 
Indian tribe, or tribal organization involved to-
ward the purpose described in subsection (a)(1) 
VerDate Sep 11 2014 
03:07 May 17, 2023
Jkt 039200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H3134.IH
H3134
pbinns on DSKJLVW7X2PROD with $$_JOB
for the 2-year period preceding the first fiscal 
year for which the State, Indian tribe, or tribal 
organization is applying to receive a grant 
under subsection (a). 
‘‘(C) INCLUSION OF RELEVANT NON-FED-
ERAL
CONTRIBUTIONS
FOR
MEDICAID.—In 
making a determination of the amount of non- 
Federal contributions for purposes of paragraph 
(1), the Secretary shall, subject to subpara-
graphs (A) and (B) of this paragraph, include 
any non-Federal amounts expended pursuant to 
title XIX of the Social Security Act by the 
State, Indian tribe, or tribal organization re-
lated to insulin dispensed to individuals eligible 
for medical assistance under such title. 
‘‘(c) ADDITIONAL REQUIRED AGREEMENTS.— 
‘‘(1) STATEWIDE PROVISION OF SERVICES.— 
‘‘(A) IN
GENERAL.—The Secretary may 
not make a grant under subsection (a) unless 
the State, Indian tribe, or tribal organization 
involved agrees that services and activities 
under the grant will be made available through-
out the State (including availability to members 
of any Indian tribe or tribal organization in the 
State), Indian tribe, or tribal organization. 
VerDate Sep 11 2014 
03:07 May 17, 2023
Jkt 039200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H3134.IH
H3134
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(B) WAIVER.— 
‘‘(i) IN
GENERAL.—The Secretary 
may waive the requirement established in 
subparagraph (A) for a State, Indian tribe, 
or tribal organization if the Secretary de-
termines that compliance by the State, In-
dian tribe, or tribal organization with the 
requirement would result in an inefficient 
allocation of resources with respect to car-
rying out the purpose described in sub-
section (a)(1). 
‘‘(ii) INDIAN TRIBES AND TRIBAL OR-
GANIZATIONS.—If an Indian tribe or tribal 
organization is receiving a grant under 
subsection (a) and the State in which the 
tribe or organization is located is receiving 
a grant under subsection (a), the require-
ment under subparagraph (A) for the 
State regarding availability to the tribe or 
organization is deemed to have been 
waived under this subparagraph. 
‘‘(2) RELATIONSHIP TO ITEMS AND SERVICES 
UNDER OTHER PROGRAMS.— 
‘‘(A) IN
GENERAL.—The Secretary may 
not make a grant under subsection (a) unless 
VerDate Sep 11 2014 
03:07 May 17, 2023
Jkt 039200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H3134.IH
H3134
pbinns on DSKJLVW7X2PROD with $$_JOB
the State, Indian tribe, or tribal organization 
involved agrees that the grant will not be ex-
pended to make payment for any item or serv-
ice to the extent that payment has been made, 
or can reasonably be expected to be made, with 
respect to such item or service— 
‘‘(i) except as provided in subpara-
graph (B), under any State compensation 
program, under an insurance policy, or 
under any Federal or State health benefits 
program; or 
‘‘(ii) by an entity that provides health 
services on a prepaid basis. 
‘‘(B) EXCEPTION.—The requirement under 
subparagraph (A)(i) shall not apply with re-
spect to coverage under a high-deductible health 
plan. 
‘‘(3) LIMITATION
ON
ADMINISTRATIVE
EX-
PENSES.—The Secretary may not make a grant 
under subsection (a) unless the State, Indian tribe, 
or tribal organization involved agrees that not more 
than 10 percent of the grant will be expended for 
administrative expenses with respect to the grant. 
‘‘(4) RECORDS
AND
AUDITS.—The Secretary 
may not make a grant under subsection (a) unless 
VerDate Sep 11 2014 
03:07 May 17, 2023
Jkt 039200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H3134.IH
H3134
pbinns on DSKJLVW7X2PROD with $$_JOB
the State, Indian tribe, or tribal organization in-
volved agrees that— 
‘‘(A) the State, Indian tribe, or tribal orga-
nization will establish such fiscal control and 
fund accounting procedures as may be nec-
essary to ensure the proper disbursal of, and 
accounting for, amounts received by the State, 
Indian tribe, or tribal organization under such 
subsection; 
‘‘(B) the State, Indian tribe, or tribal orga-
nization will keep such records as the Secretary 
shall prescribe, including— 
‘‘(i) records that fully disclose— 
‘‘(I) the amount and disposition 
by the State, Indian tribe, or tribal 
organization of the proceeds of such 
grant; 
‘‘(II) the total cost of the project 
or undertaking intended to be carried 
out through the grant; and 
‘‘(III) the amount of that portion 
of the cost of the project or under-
taking supplied by sources other than 
the grant; and 
VerDate Sep 11 2014 
03:07 May 17, 2023
Jkt 039200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H3134.IH
H3134
pbinns on DSKJLVW7X2PROD with $$_JOB