[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 460 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 460

   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

                            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.

    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 2013''.

SEC. 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:

``SEC. 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.
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