Insulin Access for All Act of 2021
Bill: H.R.4158 | Sponsor: Rep. Rush, Bobby L. (D-IL)
Policy area: Health

Summary:
Insulin Access for All Act of 2021
This bill prohibits cost-sharing (e.g., copayments) under Medicaid and the Medicare prescription drug benefit for insulin and associated medical supplies.

To amend titles XVIII and XIX of the Social Security Act to eliminate 
 cost sharing with respect to coverage of insulin as a covered part D 
 drug under the Medicare program or as a covered outpatient drug under 
                         the Medicaid program.

    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 Access for All Act of 
2021''.

SEC. 2. ELIMINATING COST SHARING WITH RESPECT TO COVERAGE OF INSULIN AS 
              A COVERED PART D DRUG UNDER THE MEDICARE PROGRAM OR AS A 
              COVERED OUTPATIENT DRUG UNDER THE MEDICAID PROGRAM.

    (a) Medicare.--
            (1) Elimination of cost sharing for insulin and certain 
        associated medical supplies furnished to part d eligible 
        individuals.--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 certain covered part 
        d drugs.--The coverage does not impose any deductible, 
        copayment, coinsurance, or other cost sharing for insulin (as 
        described in subparagraph (B) of subsection (e)(1)) or medical 
        supplies associated with the injection of insulin (as described 
        in such subparagraph).''; and
                    (B) in subsection (c), by adding at the end the 
                following new paragraph:
            ``(4) Same elimination of cost sharing for certain covered 
        part d drugs.--The coverage is in accordance with subsection 
        (b)(8).''.
            (2) Elimination of cost sharing for insulin and certain 
        associated medical supplies furnished to part d eligible 
        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 certain 
                covered part d drugs.--Coverage that is in accordance 
                with section 1860D-2(b)(8).''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (D), by striking ``The 
                        substitution'' and inserting ``Subject to 
                        subparagraph (F), the substitution'';
                            (ii) in subparagraph (E), by inserting 
                        after ``Subject to'' the following: 
                        ``subparagraph (F) and''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(F) Elimination of cost sharing for certain 
                covered part d drugs.--Coverage that is in accordance 
                with section 1860D-2(b)(8).''.
            (3) Applicability.--The amendments made by this subsection 
        shall apply with respect to insulin, and medical supplies 
        associated with the injection of insulin, furnished on or after 
        January 1, 2022.
    (b) Medicaid.--
            (1) In general.--Section 1916 of the Social Security Act 
        (42 U.S.C. 1396o) is amended--
                    (A) in subsection (a)(2)--
                            (i) in subparagraph (H), by striking ``or'' 
                        at the end;
                            (ii) in subparagraph (I), by striking ``; 
                        and'' and inserting ``, or''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(J) insulin furnished as a covered outpatient 
                drug (as defined in section 1927(k)(2)) and medical 
                supplies associated with the injection of such insulin; 
                and''; and
                    (B) in subsection (b)(2)--
                            (i) in subparagraph (H), by striking ``or'' 
                        at the end;
                            (ii) in subparagraph (I), by striking ``; 
                        and'' and inserting ``, or''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(J) insulin furnished as a covered outpatient 
                drug (as defined in section 1927(k)(2)) and medical 
                supplies associated with the injection of such insulin; 
                and''.
            (2) Alternative cost sharing limitation.--Section 
        1916A(c)(2) of the Social Security Act (42 U.S.C. 1396o-
        1(c)(2)) is amended by adding at the end the following new 
        subparagraph:
                    ``(D) Nonapplicability of cost sharing to 
                insulin.--In no case may the cost sharing under 
                paragraph (1)(A) apply with respect to insulin 
                furnished as a covered outpatient drug (as defined in 
                section 1927(k)(2)) and medical supplies associated 
                with the injection of such insulin.''.
            (3) Effective date.--
                    (A) In general.--Subject to subparagraph (B), the 
                amendments made by this subsection shall apply with 
                respect to covered outpatient drugs furnished on or 
                after January 1, 2022.
                    (B) Exception for state legislation.--In the case 
                of a State plan under title XIX of the Social Security 
                Act (42 U.S.C. 1396 et seq.) that the Secretary of 
                Health and Human Services determines requires State 
                legislation in order for the respective plan to meet 
                any requirement imposed by amendments made by this 
                subsection, the respective plan shall not be regarded 
                as failing to comply with the requirements of such 
                title solely on the basis of its failure to meet such 
                an additional requirement before the first day of the 
                first calendar quarter beginning after the close of the 
                first regular session of the State legislature that 
                begins after the date of the enactment of this Act. For 
                purposes of the previous sentence, in the case of a 
                State that has a 2-year legislative session, each year 
                of the session shall be considered to be a separate 
                regular session of the State legislature.
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