Lowest Price for Patients Act of 2024

[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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