Ensuring Seniors’ Access to COVID Treatments Act
Bill: H.R.975 | Sponsor: Rep. Casten, Sean (D-IL)
Policy area: Health

Summary:
Ensuring Seniors' Access to COVID Treatments Act
This bill requires prescription drug plans under Medicare and Medicare Advantage to cover drugs that are approved to treat COVID-19 (i.e., coronavirus disease 2019) without cost-sharing during the public health emergency.

To amend title XVIII of the Social Security Act to require coverage 
  under Medicare PDPs and MA-PD plans, without the imposition of cost 
 sharing or utilization management requirements, of drugs intended to 
               treat COVID-19 during certain emergencies.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ensuring Seniors' Access to COVID 
Treatments Act''.

SEC. 2. REQUIRING COVERAGE UNDER MEDICARE PDPS AND MA-PD PLANS, WITHOUT 
              THE IMPOSITION OF COST SHARING OR UTILIZATION MANAGEMENT 
              REQUIREMENTS, OF DRUGS INTENDED TO TREAT COVID-19 DURING 
              CERTAIN EMERGENCIES.

    (a) Coverage Requirement.--
            (1) In general.--Section 1860D-4(b)(3) of the Social 
        Security Act (42 U.S.C. 1395w-104(b)(3)) is amended by adding 
        at the end the following new subparagraph:
                    ``(I) Required inclusion of drugs intended to treat 
                covid-19.--
                            ``(i) In general.--Notwithstanding any 
                        other provision of law, a PDP sponsor offering 
                        a prescription drug plan shall, with respect to 
                        a plan year, any portion of which occurs during 
                        the period described in clause (ii), be 
                        required to--
                                    ``(I) include in any formulary--
                                            ``(aa) all covered part D 
                                        drugs with a medically accepted 
                                        indication (as defined in 
                                        section 1860D-2(e)(4)) to treat 
                                        COVID-19 that are marketed in 
                                        the United States; and
                                            ``(bb) all drugs authorized 
                                        under section 564 or 564A of 
                                        the Federal Food Drug and 
                                        Cosmetic Act to treat COVID-19; 
                                        and
                                    ``(II) not impose any prior 
                                authorization or other utilization 
                                management requirement with respect to 
                                such drugs described in item (aa) or 
                                (bb) of subclause (I) (other than such 
                                a requirement that limits the quantity 
                                of drugs due to safety).
                            ``(ii) Period described.--For purposes of 
                        clause (i), the period described in this clause 
                        is the period during which there exists the 
                        public health emergency declared by the 
                        Secretary pursuant to section 319 of the Public 
                        Health Service Act on January 31, 2020, 
                        entitled `Determination that a Public Health 
                        Emergency Exists Nationwide as the Result of 
                        the 2019 Novel Coronavirus' (including any 
                        renewal of such declaration pursuant to such 
                        section).''.
    (b) Elimination of Cost Sharing.--
            (1) Elimination of cost sharing for drugs intended to treat 
        covid-19 under standard and alternative prescription drug 
        coverage.--Section 1860D-2 of the Social Security Act (42 
        U.S.C. 1395w-102) is amended--
                    (A) in subsection (b)--
                            (i) in paragraph (1)(A), by striking ``The 
                        coverage'' and inserting ``Subject to paragraph 
                        (8), the coverage'';
                            (ii) in paragraph (2)--
                                    (I) in subparagraph (A), by 
                                inserting after ``Subject to 
                                subparagraphs (C) and (D)'' the 
                                following: ``and paragraph (8)'';
                                    (II) in subparagraph (C)(i), by 
                                striking ``paragraph (4)'' and 
                                inserting ``paragraphs (4) and (8)''; 
                                and
                                    (III) in subparagraph (D)(i), by 
                                striking ``paragraph (4)'' and 
                                inserting ``paragraphs (4) and (8)'';
                            (iii) in paragraph (4)(A)(i), by striking 
                        ``The coverage'' and inserting ``Subject to 
                        paragraph (8), the coverage''; and
                            (iv) by adding at the end the following new 
                        paragraph:
            ``(8) Elimination of cost-sharing for drugs intended to 
        treat covid-19.--The coverage does not impose any deductible, 
        copayment, coinsurance, or other cost-sharing requirement for 
        drugs described in section 1860D-4(b)(3)(I)(i)(I) with respect 
        to a plan year, any portion of which occurs during the period 
        during which there exists the public health emergency declared 
        by the Secretary pursuant to section 319 of the Public Health 
        Service Act on January 31, 2020, entitled `Determination that a 
        Public Health Emergency Exists Nationwide as the Result of the 
        2019 Novel Coronavirus' (including any renewal of such 
        declaration pursuant to such section).''; and
                    (B) in subsection (c), by adding at the end the 
                following new paragraph:
            ``(4) Same elimination of cost-sharing for drugs intended 
        to treat covid-19.--The coverage is in accordance with 
        subsection (b)(8).''.
            (2) Elimination of cost sharing for drugs intended to treat 
        covid-19 dispensed to individuals who are subsidy eligible 
        individuals.--Section 1860D-14(a) of the Social Security Act 
        (42 U.S.C. 1395w-114(a)) is amended--
                    (A) in paragraph (1)--
                            (i) in subparagraph (D)--
                                    (I) in clause (ii), by striking 
                                ``In the case of'' and inserting 
                                ``Subject to subparagraph (F), in the 
                                case of''; and
                                    (II) in clause (iii), by striking 
                                ``In the case of'' and inserting 
                                ``Subject to subparagraph (F), in the 
                                case of''; and
                            (ii) by adding at the end the following new 
                        subparagraph:
                    ``(F) Elimination of cost-sharing for drugs 
                intended to treat covid-19.--Coverage that is in 
                accordance with section 1860D-2(b)(8).''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (B), by striking ``A 
                        reduction'' and inserting ``Subject to 
                        subparagraph (F), a reduction'';
                            (ii) in subparagraph (D), by striking ``The 
                        substitution'' and inserting ``Subject to 
                        subparagraph (F), the substitution'';
                            (iii) in subparagraph (E), by inserting 
                        after ``Subject to'' the following: 
                        ``subparagraph (F) and''; and
                            (iv) by adding at the end the following new 
                        subparagraph:
                    ``(F) Elimination of cost-sharing for drugs 
                intended to treat covid-19.--Coverage that is in 
                accordance with section 1860D-2(b)(8).''.
    (c) Implementation.--Notwithstanding any other provision of law, 
the Secretary of Health and Human Services may implement the amendments 
made by this section by program instruction or otherwise.
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