[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6965 Introduced in House (IH)]

<DOC>






118th CONGRESS
  2d Session
                                H. R. 6965

  To amend title XXVII of the Public Health Service Act, the Employee 
 Retirement Income Security Act of 1974, and the Internal Revenue Code 
  of 1986 to establish requirements with respect to cost sharing for 
epinephrine injectors under group health plans and group and individual 
                       health insurance coverage.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 11, 2024

 Mr. Frost (for himself and Ms. Matsui) introduced the following bill; 
  which was referred to the Committee on Energy and Commerce, and in 
  addition to the Committees on Ways and Means, and Education and the 
 Workforce, 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 XXVII of the Public Health Service Act, the Employee 
 Retirement Income Security Act of 1974, and the Internal Revenue Code 
  of 1986 to establish requirements with respect to cost sharing for 
epinephrine injectors under group health plans and group and individual 
                       health insurance coverage.

    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 ``Epinephrine's Pharma Inflated Price 
Ends Now Act'' or the ``EPIPEN Act''.

SEC. 2. REQUIREMENTS WITH RESPECT TO COST SHARING FOR EPINEPHRINE 
              INJECTORS.

    (a) PHSA.--Part D of title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg-111 et seq.) is amended by adding at the end the 
following new section:

``SEC. 2799A-11. REQUIREMENTS WITH RESPECT TO COST SHARING FOR 
              EPINEPHRINE INJECTORS.

    ``(a) In General.--A group health plan, and a health insurance 
issuer offering group or individual health insurance coverage, shall 
provide coverage of epinephrine injectors, and with respect to such 
injectors, may not--
            ``(1) apply any deductible; or
            ``(2) impose any cost sharing in excess of $60 per package 
        of 2 injectors (or the equivalent).
    ``(b) Application of Cost Sharing Toward Deductibles and Out-of-
Pocket Maximums.--Any cost-sharing payments made pursuant to subsection 
(a)(2) shall be counted toward any deductible or out-of-pocket maximum 
that applies under the plan or coverage.
    ``(c) Out-of-network Providers.--Nothing in this section requires a 
plan or issuer that has a network of providers to provide benefits for 
an epinephrine injector described in this section that is delivered by 
an out-of-network provider, or precludes a plan or issuer that has a 
network of providers from imposing higher cost sharing than the levels 
specified in subsection (a)(2) for an epinephrine injector described in 
this section that is delivered by an out-of-network provider.
    ``(d) Epinephrine Injector Defined.--In this section, the term 
`epinephrine injector' means an auto-injector approved by the Food and 
Drug Administration for the administration of epinephrine.''.
    (b) ERISA.--
            (1) In general.--Subpart B of part 7 of subtitle B of title 
        I of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1185 et seq.) is amended by adding at the end the 
        following new section:

``SEC. 726. REQUIREMENTS WITH RESPECT TO COST SHARING FOR EPINEPHRINE 
              INJECTORS.

    ``(a) In General.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, shall provide coverage 
of epinephrine injectors, and with respect to such injectors, may not--
            ``(1) apply any deductible; or
            ``(2) impose any cost sharing in excess of $60 per package 
        of 2 injectors (or the equivalent).
    ``(b) Application of Cost Sharing Toward Deductibles and Out-of-
Pocket Maximums.--Any cost-sharing payments made pursuant to subsection 
(a)(2) shall be counted toward any deductible or out-of-pocket maximum 
that applies under the plan or coverage.
    ``(c) Out-of-Network Providers.--Nothing in this section requires a 
plan or issuer that has a network of providers to provide benefits for 
an epinephrine injector described in this section that is delivered by 
an out-of-network provider, or precludes a plan or issuer that has a 
network of providers from imposing higher cost sharing than the levels 
specified in subsection (a)(2) for an epinephrine injector described in 
this section that is delivered by an out-of-network provider.
    ``(d) Epinephrine Injector Defined.--In this section, the term 
`epinephrine injector' means an auto-injector approved by the Food and 
Drug Administration for the administration of epinephrine.''.
            (2) Clerical amendment.--The table of contents in section 1 
        of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1001 et seq.) is amended by inserting after the item 
        relating to section 725 the following:

``Sec. 726. Requirements with respect to cost sharing for epinephrine 
                            injectors.''.
    (c) IRC.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986 is amended by adding at the end 
        the following new section:

``SEC. 9826. REQUIREMENTS WITH RESPECT TO COST SHARING FOR EPINEPHRINE 
              INJECTORS.

    ``(a) In General.--A group health plan shall provide coverage of 
epinephrine injectors, and with respect to such injectors, may not--
            ``(1) apply any deductible; or
            ``(2) impose any cost sharing in excess of $60 per package 
        of 2 injectors (or the equivalent).
    ``(b) Application of Cost Sharing Toward Deductibles and Out-of-
Pocket Maximums.--Any cost-sharing payments made pursuant to subsection 
(a)(2) shall be counted toward any deductible or out-of-pocket maximum 
that applies under the plan.
    ``(c) Out-of-Network Providers.--Nothing in this section requires a 
plan that has a network of providers to provide benefits for an 
epinephrine injector described in this section that is delivered by an 
out-of-network provider, or precludes a plan that has a network of 
providers from imposing higher cost sharing than the levels specified 
in subsection (a)(2) for an epinephrine injector described in this 
section that is delivered by an out-of-network provider.
    ``(d) Epinephrine Injector Defined.--In this section, the term 
`epinephrine injector' means an auto-injector approved by the Food and 
Drug Administration for the administration of epinephrine.''.
            (2) Clerical amendment.--The table of sections for 
        subchapter B of chapter 100 of the Internal Revenue Code of 
        1986 is amended by adding at the end the following new item:

``Sec. 9826. Requirements with respect to cost sharing for epinephrine 
                            injectors.''.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2025.
                                 <all>