[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4209 Introduced in House (IH)]

112th CONGRESS
  2d Session
                                H. R. 4209

   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.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 19, 2012

   Mr. McKinley (for himself, Mrs. Capps, Mr. Young of Florida, Mr. 
Cuellar, and Mr. Frank of Massachusetts) 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.

    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 ``Patients' Access to Treatments Act 
of 2012''.

SEC. 2. CO-PAYMENT, COINSURANCE, AND OTHER 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:

``SEC. 2719B. CO-PAYMENT, COINSURANCE, AND OTHER 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 co-payment, coinsurance, or 
other cost-sharing requirements applicable to prescription drugs in a 
specialty drug tier that exceed the dollar amount (or its equivalent) 
of co-payment, coinsurance, or other 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 `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).
            ``(2) 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 tier in such formulary for which 
                beneficiary cost-sharing is greater than tiers for 
                generic drugs or preferred brand drugs in the plan's 
                formulary;
                    ``(B) that are prescription drugs; and
                    ``(C) that are not included within a specialty drug 
                tier.
            ``(3) 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 tier in such formulary for which 
                beneficiary cost-sharing is greater than 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.
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