Bill Summary
The Prescription Drug Rebate Reform Act of 2019 is a proposed bill in the United States that aims to address the issue of high prescription drug prices and out-of-pocket costs for consumers. It requires group health plans and health insurance issuers to set coinsurance obligations for prescription drugs based on the net price of the drug, rather than the list price. This means that consumers will not have to pay a percentage of the list price, which is often inflated, but only the actual cost of the drug. The bill also allows for copayments for prescription drugs as long as they are not tied to a percentage of the drug's cost. The bill defines key terms such as coinsurance, deductible, list price, and net price, and applies to plan years starting on or after January 1, 2021.
Possible Impacts
1. This legislation could potentially benefit people by reducing their out-of-pocket costs for prescription drugs, making them more affordable and accessible.
2. It may also affect pharmaceutical companies, as they may have to adjust their pricing strategies in order to comply with the new cost-sharing requirements.
3. Health insurance companies may also be impacted, as they will need to adjust their coverage plans and premiums in order to comply with the new law.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3805 Introduced in House (IH)]
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116th CONGRESS
1st Session
H. R. 3805
To reform prescription drug pricing and reduce out-of-pocket costs by
ensuring consumers benefit from negotiated rebates.
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IN THE HOUSE OF REPRESENTATIVES
July 17, 2019
Mr. Gallagher introduced the following bill; which was referred to the
Committee on Energy and Commerce
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A BILL
To reform prescription drug pricing and reduce out-of-pocket costs by
ensuring consumers benefit from negotiated rebates.
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 ``Prescription Drug Rebate Reform Act
of 2019''.
SEC. 2. COST-SHARING WITH RESPECT TO PRESCRIPTION DRUGS.
(a) In General.--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:
``SEC. 2729A. COST-SHARING WITH RESPECT TO PRESCRIPTION DRUGS.
``(a) In General.--A group health plan or health insurance issuer
offering group or individual health insurance coverage shall set any
coinsurance obligation an enrollee has with respect to a prescription
drug covered by the plan or coverage based on the net price of the
drug, such that no payment by the enrollee with respect to the drug is
based on a percentage of the list price of a drug.
``(b) Applicability.--Subsection (a)--
``(1) shall apply with respect to a prescription drug
benefit when the enrollee is required to pay a deductible with
respect to such benefits and--
``(A) has not yet satisfied the deductible under
the plan or coverage; or
``(B) has another coinsurance obligation with
respect to such benefits under the plan or coverage;
and
``(2) shall not apply if, with respect to the dispensed
quantity of a prescription drug, the net price and list price
are the same, or are different by not more than 1 cent.
``(c) Copayments.--Nothing in this section prevents a group health
plan or health insurance issuer from requiring a copayment for any
prescription drug if such copayment is not tied to a percent of the
specified cost of the drug.
``(d) Definitions.--In this section--
``(1) the term `coinsurance' means, with respect to
prescription drug coverage under a group health plan or group
or individual health insurance coverage, a payment obligation
of an enrollee in such health plan or health insurance coverage
that is based on a portion or percentage of the specified cost
of a prescription drug, which may be up to 100 percent of that
cost;
``(2) the term `deductible' means the payment obligation of
an enrollee in a group health plan or group or individual
health insurance coverage before the group health plan or group
or individual health insurance coverage will pay any portion of
the cost of prescription drug coverage;
``(3) the term `list price' has the meaning given the term
`wholesale acquisition cost' in section 1847A(c)(6)(B) of the
Social Security Act;
``(4) the term `net price' means, with respect to
prescription drug coverage under a group health plan or group
or individual health insurance coverage, the list price of the
drug net all rebates, discounts, concessions, and other
adjustments applied to the cost paid by the group health plan
or health insurance issuer, or by any other entity that
provides pharmacy benefit management services under a contract
with any such group health plan or health insurance issuer,
regardless of whether such adjustments are prospective or
retrospective; and
``(5) the term `prescription drug' mean a drug, as defined
in section 201(g) of the Federal Food, Drug, and Cosmetic Act,
that is subject to section 503(b)(1) of such Act.''.
(b) Effective Date.--Section 2729A of the Public Health Service
Act, as added by subsection (a), shall apply with respect to plan years
beginning on or after January 1, 2021.
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