Insulin Savings for Patients Act
Bill: H.R.6757 | Sponsor: Rep. Burgess, Michael C. (R-TX)
Policy area: Health

Summary:
Insulin Savings for Patients Act
This bill requires 100% of negotiated price concessions for covered insulin products under the Medicare prescription drug benefit to be reflected at the point of sale by 2024. The Government Accountability Office must annually report on the effects of the bill's implementation, including with respect to insulin prices.

To amend title XVIII of the Social Security Act to establish under the 
     Medicare prescription drug program a minimum amount of price 
 concessions for insulin to be passed through to beneficiaries at the 
                 point-of-sale, and for other purposes.

    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 ``Insulin Savings for Patients Act''.

SEC. 2. NEGOTIATED PRICE CONCESSIONS FOR INSULIN AT POINT-OF-SALE UNDER 
              PART D OF MEDICARE PROGRAM.

    (a) In General.--Section 1860D-2(d)(1) of the Social Security Act 
(42 U.S.C. 1395w-102(d)(1)) is amended--
            (1) in subparagraph (A), by striking ``Under'' and 
        inserting ``Subject to subparagraph (D), under''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Negotiated price concessions for insulin at 
                point-of-sale.--
                            ``(i) In general.--For drugs dispensed in 
                        plan year 2022 or a subsequent plan year, the 
                        minimum percentage described in clause (ii) for 
                        such plan year of price concessions negotiated 
                        between manufacturers and a prescription drug 
                        plan or MA-PD plan (or any entity that provides 
                        pharmacy benefits management services under a 
                        contract with any such prescription drug plan 
                        or MA-PD plan) and taken into account under 
                        subparagraph (B) in determining negotiated 
                        prices for the plan year for covered part D 
                        drugs that are insulin provided under such a 
                        plan shall be provided to enrollees of such a 
                        plan at pharmacies or by mail order service at 
                        the point-of-sale of such drugs.
                            ``(ii) Amount of price concession.--For 
                        purposes of clause (i), and subject to clause 
                        (iii), the minimum percentage described in this 
                        clause is--
                                    ``(I) for drugs dispensed in plan 
                                year 2022, 50 percent;
                                    ``(II) for drugs dispensed in plan 
                                year 2023, 75 percent; and
                                    ``(III) for drugs dispensed in plan 
                                year 2024 or a subsequent plan year, 
                                100 percent.
                            ``(iii) Modification of minimum 
                        percentage.--For plan years beginning on or 
                        after January 1, 2024, the Secretary may, 
                        through notice and comment rulemaking, specify 
                        a percentage other than the percentage 
                        described in clause (ii) for a plan year, 
                        except that in specifying such percentage the 
                        Secretary shall not specify a percentage that 
                        is less than 50 percent of the negotiated price 
                        concession for such plan year. Any percentage 
                        specified pursuant to the authority of the 
                        previous sentence for a plan year that would be 
                        less than the percentage otherwise described in 
                        clause (ii) for the plan year may only be 
                        applied if such reduction in percentage is 
                        justified as a benefit to individuals enrolled 
                        under this title.''.
    (b) Inclusion of Information in Bid Submission.--Section 1860D-
11(b)(2) of the Social Security Act (42 U.S.C. 1395w-11(b)(2)) is 
amended--
            (1) by redesignating subparagraph (F) as subparagraph (G); 
        and
            (2) by inserting after subparagraph (E) the following new 
        subparagraph:
                    ``(F) Point-of-sale price concessions for 
                insulin.--For plan years beginning on or after January 
                1, 2022, an estimate of the aggregate price concessions 
                for all insulin negotiated by the plan for such plan 
                year.''.
    (c) GAO Study and Report on Insulin Pricing.--Not later than 2 
years after the date of the enactment of this Act, and annually 
thereafter, the Comptroller General of the United States shall--
            (1) conduct a study on the effects of the implementation of 
        the requirement described in subparagraph (D) of section 1860D-
        2(d)(1) of the Social Security Act (42 U.S.C. 1395w-102(d)(1)), 
        as added by subsection (a), including an analysis of--
                    (A) trends in the list and net prices of insulin 
                for qualified prescription drug coverage offered by a 
                prescription drug plan under part D of the Social 
                Security Act or an MA-PD plan under part C of such 
                title;
                    (B) savings on insulin for individuals enrolled in 
                a prescription drug plan under part D of the Social 
                Security Act or an MA-PD plan under part C of such 
                title;
                    (C) trends in out-of-pocket costs for individuals 
                enrolled in such plans, as compared to individuals 
                enrolled in a group health plan (as defined in section 
                2791(a) of the Public Health Service Act (42 U.S.C. 
                300gg-91(a)), a State plan under title XIX of the 
                Social Security Act, or a qualified health plan offered 
                through an Exchange established under title I of the 
                Patient Protection and Affordable Care Act (42 U.S.C. 
                18001 et seq.); and
                    (D) approval and market entry of biosimilar insulin 
                under section 351(k) of the Public Health Service Act 
                (42 U.S.C. 262); and
            (2) submit to the Committee on Energy and Commerce and the 
        Committee on Ways and Means in the House of Representatives, 
        and the Committee on Finance in the Senate, a report on the 
        study conducted under paragraph (1), with recommendations on 
        how to enhance the access of individuals enrolled in a 
        prescription drug plan under part D of the Social Security Act 
        or an MA-PD plan under part C of such title to lower out-of-
        pocket costs for insulin.
    (d) Transparency.--Section 1860D-1(c)(3) of the Social Security Act 
(42 U.S.C. 1395w-101(c)(3)) is amended by adding at the end the 
following new subparagraph:
                    ``(C) Additional information.--For plan year 2022 
                and each subsequent plan year, such information 
                referred to in paragraph (2)(A) shall also include, for 
                a plan year, information regarding the requirement 
                described in subparagraph (D) of section 1860D-2(d)(1) 
                with respect to insulin negotiated by the plan for such 
                plan year.''.
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