H.R. 460House113th Congress (2013-2015)In Committee

Patients' Access to Treatments Act of 2013

Introduced February 4, 2013

Legislative Activity

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HouseCommittee Latest Action

Referred to the Subcommittee on Health.

February 8, 2013

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HouseIntro Referral

Introduced in House

February 4, 2013

HouseIntro Referral

Referred to the House Committee on Energy and Commerce.

February 4, 2013

HouseCommittee

Referred to the Subcommittee on Health.

February 8, 2013

Floor Debate

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What members said about H.R. 460 on the floor

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Lois Capps
Rep. Lois CappsD-CA-24 · Mar 4, 2014

Mr. Speaker, Friday, February 28, 2014 was Rare Disease Day. And that is why I rise to let Americans know the importance of research, recognition and advocacy that is critical for individuals facing…

Bill Text

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Introduced in HouseIssued February 4, 2013

I

113th CONGRESS

1st Session

H. R. 460

IN THE HOUSE OF REPRESENTATIVES

February 4, 2013

Mr. McKinley (for himself, Mrs. Capps, Mrs. Capito, Mr. Young of Florida, Mr. Moran, Mr. Wolf, Mr. Tonko, Mr. Runyan, Mr. Conyers, Ms. Bonamici, Mr. Cicilline, Mr. DeFazio, Mr. Michaud, Mr. Farr, Ms. Pingree of Maine, Mr. Rangel, and Mr. Crenshaw) introduced the following bill; which was referred to the Committee on Energy and Commerce

A BILL

To amend title XXVII of the Public Health Service Act to limit co-payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in a specialty drug tier to the dollar amount (or its equivalent) of such requirements applicable to prescription drugs in a non-preferred brand drug tier, and for other purposes.

1.

Short title

This Act may be cited as the Patients’ Access to Treatments Act of 2013.

2.

Cost-sharing requirements applicable to prescription drugs in a specialty drug tier

(a)

In general

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

2719B.

Cost-sharing requirements applicable to prescription drugs in a specialty drug tier

(a)

Requirement

A group health plan, or a health insurance issuer offering group or individual health insurance, that provides coverage for prescription drugs and uses a formulary or other tiered cost-sharing structure shall not impose cost-sharing requirements applicable to prescription drugs in a specialty drug tier that exceed the dollar amount (or its equivalent) of cost-sharing requirements applicable to prescription drugs in a non-preferred brand drug tier (or prescription drugs in a brand drug tier if there is no non-preferred brand drug tier).

(b)

Special rule

If a formulary used by a group health plan or a health insurance issuer offering group or individual health insurance contains more than one non-preferred brand drug tier, then the requirements of subsection (a) shall be applied with respect to the non-preferred brand drug tier for which beneficiary cost-sharing is lowest.

(c)

Definitions

In this section:

(1)

The term cost-sharing includes co-payment and coinsurance.

(2)

The term drug tier means, with respect to a group health plan or health insurance issuer offering group or individual health insurance coverage that uses a formulary or other cost-sharing structure, a category of drugs—

(A)

within such formulary or structure for which the total dollar amount of cost-sharing requirements for any drug does not vary by more than ten percent from the total dollar amount of cost-sharing requirements for any other drug; and

(B)

that are prescription drugs.

(3)

The term non-preferred brand drug tier means, with respect to a group health plan or health insurance issuer offering group or individual health insurance coverage that uses a formulary or other tiered cost-sharing structure, a category of drugs—

(A)

within a drug tier in such formulary or structure for which beneficiary cost-sharing is greater than drug tiers for generic drugs or preferred brand drugs in the formulary or structure;

(B)

that are prescription drugs; and

(C)

that are not included within a specialty drug tier.

(4)

The term prescription drug means—

(A)

a drug subject to section 503(b)(1) of the Federal Food, Drug, or Cosmetic Act; and

(B)

includes a drug described in subparagraph (A) that is a biological product (as defined in section 351(i) of this Act).

(5)

The term specialty drug tier means, with respect to a group health plan or health insurance issuer offering group or individual health insurance coverage that uses a formulary or other tiered cost-sharing structure, a category of drugs—

(A)

within a drug tier in such formulary or structure for which beneficiary cost-sharing is greater than drug tiers for generic drugs, preferred brand drugs, or non-preferred drugs in the plan’s formulary; and

(B)

that are prescription drugs.

.

(b)

Effective date

Section 2719B of the Public Health Service Act, as added by subsection (a), applies to plan years beginning on or after the date of the enactment of this Act.