Title: CLAY Act
Policy area: Health

Summary:
Creating Lower cost Alternative for Your prescription drugs Act or the CLAY Act
This bill eliminates co-payments for generic drugs for low-income individuals who receive subsidies under the Medicare prescription drug benefit.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2757 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 2757

    To amend title XVIII of the Social Security Act to provide for 
  adjustments to the Medicare part D cost-sharing reductions for low-
                          income individuals.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 15, 2019

 Mr. Cunningham (for himself, Mr. Bilirakis, and Mr. Evans) introduced 
 the following bill; which was referred to the Committee on Energy and 
  Commerce, and in addition to the Committee on Ways and Means, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to provide for 
  adjustments to the Medicare part D cost-sharing reductions for low-
                          income individuals.

    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 ``Creating Lower cost Alternative for 
Your prescription drugs Act'' or the ``CLAY Act''.

SEC. 2. ADJUSTMENTS TO MEDICARE PART D COST-SHARING REDUCTIONS FOR LOW-
              INCOME INDIVIDUALS.

    Section 1860D-14(a) of the Social Security Act (42 U.S.C. 1395w-
114(a)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (D)--
                            (i) in clause (ii)--
                                    (I) by striking ``that does not 
                                exceed $1 for'' and all that follows 
                                through the period at the end and 
                                inserting ``that does not exceed--
                                    ``(I) for plan years before plan 
                                year 2021--
                                            ``(aa) for a generic drug 
                                        or a preferred drug that is a 
                                        multiple source drug (as 
                                        defined in section 
                                        1927(k)(7)(A)(i)), $1 or, if 
                                        less, the copayment amount 
                                        applicable to an individual 
                                        under clause (iii); and
                                            ``(bb) for any other drug, 
                                        $3 or, if less, the copayment 
                                        amount applicable to an 
                                        individual under clause (iii); 
                                        and''; and
                                    (II) by adding at the end the 
                                following new subclauses:
                                    ``(II) for plan year 2021--
                                            ``(aa) for a generic drug, 
                                        $0; and
                                            ``(bb) for any other drug, 
                                        the dollar amount applied under 
                                        this clause (after application 
                                        of paragraph (4)(A)) for plan 
                                        year 2020 for a drug described 
                                        in subclause (I)(bb); and
                                    ``(III) for a subsequent year, the 
                                dollar amount applied under this clause 
                                for the previous year for the drug, 
                                increased by the annual percentage 
                                increase in the consumer price index 
                                (all items; U.S. city average) as of 
                                September of such previous year.''; and
                            (ii) in clause (iii)--
                                    (I) by striking ``does not exceed 
                                the copayment amount specified under'' 
                                and inserting ``does not exceed--
                                    ``(I) for plan years beginning 
                                before plan year 2021, the copayment 
                                amount specified under'';
                                    (II) by striking the period at the 
                                end and inserting ``; and''; and
                                    (III) by adding at the end the 
                                following new subclause:
                                    ``(II) for plan year 2021 and each 
                                subsequent plan year the copayment 
                                amount applied under clause (ii) for 
                                the drug and year involved.''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(F) Rounding.--Any amount established under 
                clause (ii) of subparagraph (D), including as applied 
                under clause (iii) of such subparagraph or paragraph 
                (2)(E), that is based on an increase of $3, that is not 
                a multiple of 5 cents or 10 cents, respectively, shall 
                be rounded to the nearest multiple of 5 cents or 10 
                cents, respectively.'';
            (2) in paragraph (2)--
                    (A) in subparagraph (C), by inserting ``and 
                subparagraph (E)'' before the period;
                    (B) in subparagraph (D)--
                            (i) by striking ``of coinsurance of'' and 
                        inserting ``of--
                                    ``(I) for plan years before plan 
                                year 2021, coinsurance of'';
                            (ii) by striking the period at the end and 
                        inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new subclause:
                                    ``(II) for plan year 2021 and each 
                                subsequent plan year, a copayment 
                                amount that does not exceed the 
                                copayment amount applied under 
                                paragraph (1)(D)(ii) for the drug and 
                                year involved.''; and
                    (C) in subparagraph (E)--
                            (i) by striking ``subsection (c), the 
                        substitution for'' and inserting ``subsection 
                        (c)--
                            ``(i) for plan years before plan year 2021, 
                        the substitution for'';
                            (ii) by striking the period at the end and 
                        inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(ii) for plan year 2021 and each 
                        subsequent plan year, the elimination of any 
                        cost-sharing imposed under section 1860D-
                        2(b)(4)(A).''; and
            (3) in paragraph (4)(A)(ii), by inserting ``(before 2021)'' 
        after ``subsequent year''.
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