[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 4924 Introduced in Senate (IS)]
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119th CONGRESS
2d Session
S. 4924
To preserve patient access to health care providers and prescription
drug coverage under Medicare and individual market plans.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 24, 2026
Ms. Rosen (for herself and Mr. Curtis) introduced the following bill;
which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To preserve patient access to health care providers and prescription
drug coverage under Medicare and individual market plans.
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 ``Preserving Patient Access Act''.
SEC. 2. PRESERVING PATIENT ACCESS TO HEALTH CARE PROVIDERS AND
PRESCRIPTION DRUG COVERAGE UNDER MEDICARE AND INDIVIDUAL
MARKET PLANS.
(a) Medicare.--
(1) Medicare advantage plans.--Section 1851(e)(4) of the
Social Security Act (42 U.S.C. 1395w-21(e)(4)) is amended--
(A) in subparagraph (C)(ii), by striking ``or'' at
the end;
(B) by redesignating subparagraph (D) as
subparagraph (E); and
(C) by inserting after subparagraph (C) the
following new subparagraph:
``(D) a health care provider with whom the
individual has had an in-person or telehealth visit,
within the preceding 2 year period, and who was listed
as an in-network provider under the plan during the
annual, coordinated election period described in
paragraph (3) for the plan year becomes an out-of-
network provider under the plan.''.
(2) Prescription drug plans and ma-pd plans.--Section
1860D-1(b)(3) of the Social Security Act (42 U.S.C. 1395w-
101(b)(3)) is amended by adding at the end the following new
subparagraph:
``(F) Mid-year negative formulary changes.--
``(i) In general.--In the case where a
prescription drug plan or MA-PD plan implements
a negative formulary change with respect to a
covered part D drug dispensed to the part D
eligible individual within the previous 6-month
period, for which the plan provided coverage,
and for which approval or licensure under
section 505 of the Federal Food, Drug, and
Cosmetic Act or section 351 of the Public
Health Service Act is still in effect.
``(ii) Negative formulary change.--In this
subparagraph, the term `negative formulary
change' has the meaning given such term in
section 423.100 of title 42, Code of Federal
Regulations (or successor regulations).''.
(3) Effective date.--The amendments made by this subsection
shall apply with respect to plan years beginning on or after
January 1, 2027.
(b) Individual Market Plans.--
(1) In general.--Section 2702(b)(2) of the Public Health
Service Act (42 U.S.C. 300gg-1(b)(2)) is amended--
(A) by inserting ``and, as applicable, for mid-plan
year changes to provider networks or formularies
described in subparagraph (B)'' before the period at
the end;
(B) by striking ``A health'' and inserting the
following:
``(A) In general.--A health''; and
(C) by adding at the end the following:
``(B) Special enrollment period for individual
market plans.--
``(i) In general.--A health insurance
issuer offering individual health insurance
coverage shall establish a special enrollment
period under which any individual may enroll in
the coverage during a plan year if the
individual, during the same plan year, is
enrolled in other individual health insurance
coverage (referred to in this subparagraph as
the `initial plan') and--
``(I) a provider with whom the
individual had an in-person or
telehealth visit within the preceding
2-year period, and who was listed as an
in-network provider under the initial
plan during the most recent open
enrollment period, becomes an out-of-
network provider under the initial
plan; or
``(II) the initial plan implements
a negative formulary change with
respect to a prescription drug
dispensed or administered to the
individual within the previous 6-month
period, for which the initial plan
provided benefits, and for which
approval or licensure under section 505
of the Federal Food, Drug, and Cosmetic
Act or section 351 of this Act is still
in effect.
``(ii) Negative formulary change.--In this
subparagraph, the term `negative formulary
change' has the meaning given such term in
section 423.100 of title 42, Code of Federal
Regulations (or successor regulations), except
that, for purposes of this subparagraph, the
term `a drug covered by the initial plan' shall
be substituted for the term `a covered Part D
drug'.''.
(2) Exchanges.--Section 1311(c)(6)(C) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)(C))
is amended by inserting ``, section 2702(b)(1)(B),'' after ``of
1986''.
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