[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8987 Introduced in House (IH)]
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118th CONGRESS
2d Session
H. R. 8987
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 ensure cost sharing for a drug does not exceed the
nationwide average of consumer purchase prices for such drug.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 10, 2024
Ms. Porter (for herself, Ms. DeLauro, Mr. Grijalva, Mr. Cohen, and Ms.
Omar) 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 ensure cost sharing for a drug does not exceed the
nationwide average of consumer purchase prices for such drug.
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 ``Lowest Price for Patients Act of
2024''.
SEC. 2. ENSURING COST SHARING FOR A DRUG DOES NOT EXCEED THE NATIONWIDE
AVERAGE OF CONSUMER PURCHASE PRICES FOR SUCH DRUG.
(a) PHSA.--Subpart II of part A of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-11 et seq.) is amended by adding at the
end the following new section:
``SEC. 2730. LIMITATION ON COST SHARING FOR DRUGS.
``(a) In General.--For plan years beginning on or after the date of
the enactment of this section, a group health plan, and a health
insurance issuer offering group or individual health insurance
coverage, may not impose cost sharing (including deductibles,
coinsurance, and copayments) with respect to a covered outpatient drug
for which benefits are available under such plan or coverage dispensed
by an in-network pharmacy in an amount that exceeds the nationwide
average of consumer purchase prices for such drug for the 1-year period
ending on the first day of such plan year (as determined using
information from the survey described in section 1927(f)(1)(A)(i) of
the Social Security Act).
``(b) Clarification on Application to Pharmacy Benefit Managers.--A
group health plan, and a health insurance issuer offering group or
individual health insurance coverage, shall ensure that any pharmacy
benefit manager providing services under the plan or coverage complies
with subsection (a) in the same manner as such subsection applies with
respect to such plan or issuer.
``(c) Definitions.--In this section:
``(1) Covered outpatient drug.--The term `covered
outpatient drug' has the meaning given such term in section
1927(k) of the Social Security Act.
``(2) In-network pharmacy.--The term `in-network pharmacy'
means, with respect to a group health plan or group or
individual health insurance coverage and a drug, a pharmacy
with a contractual relationship in effect for dispensing such
drug under such plan or coverage.''.
(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. LIMITATION ON COST SHARING FOR DRUGS.
``(a) In General.--For plan years beginning on or after the date of
the enactment of this section, a group health plan, and a health
insurance issuer offering group coverage, may not impose cost sharing
(including deductibles, coinsurance, and copayments) with respect to a
covered outpatient drug for which benefits are available under such
plan or coverage dispensed by an in-network pharmacy in an amount that
exceeds the nationwide average of consumer purchase prices for such
drug for the 1-year period ending on the first day of such plan year
(as determined using information from the survey described in section
1927(f)(1)(A)(i) of the Social Security Act).
``(b) Clarification on Application to Pharmacy Benefit Managers.--A
group health plan, and a health insurance issuer offering group health
insurance coverage, shall ensure that any pharmacy benefit manager
providing services under the plan or coverage complies with subsection
(a) in the same manner as such subsection applies with respect to such
plan or issuer.
``(c) Definitions.--In this section:
``(1) Covered outpatient drug.--The term `covered
outpatient drug' has the meaning given such term in section
1927(k) of the Social Security Act.
``(2) In-network pharmacy.--The term `in-network pharmacy'
means, with respect to a group health plan or group health
insurance coverage and a drug, a pharmacy with a contractual
relationship in effect for dispensing such drug under such plan
or coverage.''.
(2) Clerical amendment.--The table of contents in section 1
of such Act is amended by inserting after the item relating to
section 715 the following new item:
``Sec. 726. Limitation on cost sharing for drugs.''.
(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. LIMITATION ON COST SHARING FOR DRUGS.
``(a) In General.--For plan years beginning on or after the date of
the enactment of this section, a group health plan may not impose cost
sharing (including deductibles, coinsurance, and copayments) with
respect to a covered outpatient drug for which benefits are available
under such plan dispensed by an in-network pharmacy in an amount that
exceeds the nationwide average of consumer purchase prices for such
drug for the 1-year period ending on the first day of such plan year
(as determined using information from the survey described in section
1927(f)(1)(A)(i) of the Social Security Act).
``(b) Clarification on Application to Pharmacy Benefit Managers.--A
group health plan shall ensure that any pharmacy benefit manager
providing services under the plan complies with subsection (a) in the
same manner as such subsection applies with respect to such plan.
``(c) Definitions.--In this section:
``(1) Covered outpatient drug.--The term `covered
outpatient drug' has the meaning given such term in section
1927(k) of the Social Security Act.
``(2) In-network pharmacy.--The term `in-network pharmacy'
means, with respect to a group health plan and a drug, a
pharmacy with a contractual relationship in effect for
dispensing such drug under such plan.''.
(2) Clerical amendment.--The table of sections for such
subchapter is amended by adding at the end the following new
item:
``Sec. 9826. Limitation on cost sharing for drugs.''.
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