EPI Act
Bill: S.1132 | Sponsor: Sen. Kennedy, John (R-LA)
Policy area: Health

Summary:
Ending Pricey Insulin Act or the EPI Act
This bill establishes a maximum out-of-pocket cost of $50 for a 30-day supply of insulin.
Specifically, no private or public health insurance plan may charge an enrollee more than $50 for a 30-day supply of insulin, regardless of the amount of insulin prescribed for that period. This includes any deductible, co-payment, coinsurance, or other cost-sharing requirement.
This $50 limit also applies to the cash price for insulin prescriptions for uninsured individuals.
The requirements of this bill apply beginning on January 1, 2022, irrespective of the date this bill is enacted.

To establish a cap on out-of-pocket costs for insulin.

    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 ``Ending Pricey Insulin Act'' or the 
``EPI Act''.

SEC. 2. CAPPING OUT-OF-POCKETS COST OF INSULIN.

    (a) Individuals Enrolled in Certain Health Plans.--Title XXVII of 
the Public Health Service Act (42 U.S.C. 300gg et seq.) is amended by 
inserting after section 2729 the following:

``SEC. 2729A. COVERAGE OF INSULIN DRUGS.

    ``Beginning with plan year 2022, a group health plan or health 
insurance issuer offering group or individual health insurance coverage 
that provides coverage for prescription insulin drugs may not impose 
any deductible, copayment, coinsurance, or other cost-sharing 
requirement with respect to such drugs that results in out-of-pocket 
costs to the enrollee that exceed $50 per prescription for a 30-day 
supply of covered prescription insulin drugs, regardless of the amount 
of insulin drugs needed to fill the enrollee's insulin 
prescriptions.''.
    (b) Individuals Enrolled in Other Coverage.--
            (1) Medicare, medicaid, and chip.--The Secretary of Health 
        and Human Services shall take such administrative action as is 
        necessary to ensure that in no event shall any State plan or 
        waiver under title XIX or XXI of the Social Security Act or 
        prescription drug plan under part D of title XVIII of such Act 
        or MA-PD plan under part C of such title of such Act that 
        provides coverage for prescription insulin drugs impose any 
        deductible, copayment, coinsurance, or other cost-sharing 
        requirement with respect to such drugs that results in out-of-
        pocket costs to an individual enrolled in such coverage that 
        exceeds $50 per prescription for a 30-day supply of covered 
        prescription insulin drugs, regardless of the amount of insulin 
        drugs needed to fill the enrollee's insulin prescriptions.
            (2) Veterans.--The Secretary of Veterans Affairs shall take 
        such administrative action as is necessary to ensure that 
        prescription insulin drugs written by eligible health care 
        providers for veterans do not impose any deductible, copayment, 
        coinsurance, or other cost-sharing requirement with respect to 
        such drugs that results in out-of-pocket costs to the veteran 
        that exceeds $50 per prescription for a 30-day supply of 
        covered prescription insulin drugs, regardless of the amount of 
        insulin drugs needed to fill the veteran's insulin 
        prescriptions. For purposes of the preceding sentence, the term 
        ``eligible health care provider'' means a health care provider 
        under section 1703(c) of title 38, United States Code, or an 
        eligible entity or provider under section 1703A(b) of such 
        title.
            (3) TRICARE.--The Secretary of Defense shall take such 
        administrative action as is necessary to ensure that 
        prescription insulin drugs written by health care providers for 
        enrollees in the TRICARE program under chapter 55 of title 10, 
        United States Code, do not impose any deductible, copayment, 
        coinsurance, or other cost-sharing requirement with respect to 
        such drugs that results in out-of-pocket costs to enrollees 
        that exceeds $50 per prescription for a 30-day supply of 
        covered prescription insulin drugs, regardless of the amount of 
        insulin drugs needed to fill the enrollee's insulin 
        prescriptions.

SEC. 3. CAP ON CASH PRICE FOR INSULIN FOR INDIVIDUALS WITHOUT HEALTH 
              INSURANCE.

    Beginning on January 1, 2022, in the case of an individual who is 
not enrolled in any public or private health plan, the cash price for a 
30-day supply of such individual's prescription insulin drugs, 
regardless of the amount of insulin drugs needed to fill the 
individual's insulin prescriptions, shall be not more than $50.

SEC. 4. RETROACTIVE EFFECT.

    In the event that this Act is enacted after January 1, 2022--
            (1) any out-of-pocket cost to an enrollee for insulin in 
        plan year 2022 or a subsequent plan year that is in excess of 
        the amount specified in section 2729A of the Public Health 
        Service Act (as added by section 2) shall be reimbursed by the 
        group health plan or health insurance issuer to the enrollee;
            (2) any amount paid by an uninsured individual for insulin 
        on or after January 1, 2022, that is in excess of the amount 
        specified in section 3 shall be reimbursed by the insulin 
        manufacturer to the individual; and
            (3) any amount paid by an enrollee or veteran for insulin 
        on or after January 1, 2022, that is in excess of the amount 
        specified in paragraph (1) (2), or (3), as applicable, of 
        section 2(b) shall be reimbursed by the Secretary of Health and 
        Human Services, the Secretary of Veterans Affairs, or the 
        Secretary of Defense, as applicable, to the enrollee or 
        veteran.
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