Title: Prescription Drug Rebate Reform Act of 2019
Policy area: Health

Summary:
Prescription Drug Rebate Reform Act of 2019
This bill requires private health insurance plans to set any coinsurance rate for a covered prescription drug based on the net price of the drug (the price after accounting for rebates and discounts provided by the drug manufacturer) and not the list price (the initial wholesale price set by the drug manufacturer). This requirement applies when a plan holder has an unmet deductible or other coinsurance obligation for prescription drug benefits under the plan.  The bill does not prohibit a plan from requiring a copayment provided that such copayment is not based on the cost of the drug.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3805 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 3805

 To reform prescription drug pricing and reduce out-of-pocket costs by 
          ensuring consumers benefit from negotiated rebates.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 17, 2019

Mr. Gallagher introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To reform prescription drug pricing and reduce out-of-pocket costs by 
          ensuring consumers benefit from negotiated rebates.

    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 ``Prescription Drug Rebate Reform Act 
of 2019''.

SEC. 2. COST-SHARING WITH RESPECT TO PRESCRIPTION DRUGS.

    (a) In General.--Subpart II of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-11 et seq.) is amended by adding at 
the end the following:

``SEC. 2729A. COST-SHARING WITH RESPECT TO PRESCRIPTION DRUGS.

    ``(a) In General.--A group health plan or health insurance issuer 
offering group or individual health insurance coverage shall set any 
coinsurance obligation an enrollee has with respect to a prescription 
drug covered by the plan or coverage based on the net price of the 
drug, such that no payment by the enrollee with respect to the drug is 
based on a percentage of the list price of a drug.
    ``(b) Applicability.--Subsection (a)--
            ``(1) shall apply with respect to a prescription drug 
        benefit when the enrollee is required to pay a deductible with 
        respect to such benefits and--
                    ``(A) has not yet satisfied the deductible under 
                the plan or coverage; or
                    ``(B) has another coinsurance obligation with 
                respect to such benefits under the plan or coverage; 
                and
            ``(2) shall not apply if, with respect to the dispensed 
        quantity of a prescription drug, the net price and list price 
        are the same, or are different by not more than 1 cent.
    ``(c) Copayments.--Nothing in this section prevents a group health 
plan or health insurance issuer from requiring a copayment for any 
prescription drug if such copayment is not tied to a percent of the 
specified cost of the drug.
    ``(d) Definitions.--In this section--
            ``(1) the term `coinsurance' means, with respect to 
        prescription drug coverage under a group health plan or group 
        or individual health insurance coverage, a payment obligation 
        of an enrollee in such health plan or health insurance coverage 
        that is based on a portion or percentage of the specified cost 
        of a prescription drug, which may be up to 100 percent of that 
        cost;
            ``(2) the term `deductible' means the payment obligation of 
        an enrollee in a group health plan or group or individual 
        health insurance coverage before the group health plan or group 
        or individual health insurance coverage will pay any portion of 
        the cost of prescription drug coverage;
            ``(3) the term `list price' has the meaning given the term 
        `wholesale acquisition cost' in section 1847A(c)(6)(B) of the 
        Social Security Act;
            ``(4) the term `net price' means, with respect to 
        prescription drug coverage under a group health plan or group 
        or individual health insurance coverage, the list price of the 
        drug net all rebates, discounts, concessions, and other 
        adjustments applied to the cost paid by the group health plan 
        or health insurance issuer, or by any other entity that 
        provides pharmacy benefit management services under a contract 
        with any such group health plan or health insurance issuer, 
        regardless of whether such adjustments are prospective or 
        retrospective; and
            ``(5) the term `prescription drug' mean a drug, as defined 
        in section 201(g) of the Federal Food, Drug, and Cosmetic Act, 
        that is subject to section 503(b)(1) of such Act.''.
    (b) Effective Date.--Section 2729A of the Public Health Service 
Act, as added by subsection (a), shall apply with respect to plan years 
beginning on or after January 1, 2021.
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