Patients' Access to Treatments Act of 2012 - Amends the Public Health Service Act to prohibit a health plan offering group or individual health insurance that provides coverage for prescription drugs and uses a formulary or other tiered cost-sharing structure from imposing co-payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in a specialty drug tier that exceed the dollar amount of such requirements applicable to prescription drugs in a non-preferred brand drug tier.
Provides that if a formulary used by such a health plan contains more than one non-preferred brand drug tier, such prohibition shall be applied with respect to the non-preferred brand drug tier for which beneficiary cost-sharing is lowest.
Defines: (1) "non-preferred brand drug tier" as a category of drugs 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, that are prescription drugs, and that are not included within a specialty drug tier; and (2) "specialty drug tier" as a category of drugs 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 that are prescription drugs.
[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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Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
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