S 2199 — Insulin Price Reduction Act

Summary

Insulin Price Reduction Act This bill prohibits health insurance plan issuers and pharmacy benefits managers (PBMs) from receiving rebates or discounts for insulin from manufacturers who certify that its current insulin list price has been reduced to an amount no greater than what the list price was for the same insulin on July 1, 2006. This restriction does not apply to discounts provided to insurance plan holders at retail sale or to flat-rate fees for service paid to PBMs. Further, insurance plans are prohibited from applying a deductible to insulin that has received such price certification. A manufacturer may certify insulin prices by submitting to the Department of Health and Human Services data about the list price of any insulin the manufacturer has produced since January 1, 2000, and by setting the current list price for an insulin product at the 2006 rate. To remain certified, a manufacturer may not increase the list price of insulin by more than the annual increase in the medical care consumer price index. A manufacturer may certify the price of an insulin product for which it did not have a list price in 2006 by reducing the list price of such insulin to the weighted average list price in 2006 of specified insulin categories. This bill also applies to Medicare prescription drug benefits. The bill sets the rebate for insulin under Medicaid based on the average manufacturer price of insulin during the last fiscal quarter of 2019, increasing by the medical care consumer price index thereafter.

Bill Text

• Introduced Introduced in Senate Current html July 22, 2019

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill introduces new protections regarding insulin pricing, including limitations on rebates and cost-sharing for certified insulin.

• 42 U.S.C. 300gg-11 et seq.

  SEC. 2729A. INSULIN PRICE PROTECTIONS.

  Adds a new section to establish insulin price protections.

• 42 U.S.C. 300gg-11 et seq.

  (a) Contracting Requirements.--(1) In general.--(A) Requirement.--Except as provided in subparagraph (B), a group health plan or a health insurance issuer offering group or individual health insurance coverage shall not, and shall ensure that any entity that provides pharmacy benefits management services under a contract with any such health plan or health insurance coverage does not, directly or indirectly, receive from a manufacturer of certified insulin a rebate, reduction in price, or other remuneration with respect to such insulin received by an enrollee in the plan or coverage.

  Prohibits health plans from receiving rebates or other remuneration from insulin manufacturers.

• 42 U.S.C. 300gg-11 et seq.

  (B) Exception.--The requirement under subparagraph (A) shall not apply to--(i) any such reduction in price that is reflected at the point of sale to the enrollee; or (ii) any remuneration that is a flat fee-based service fee...

  Allows specific exceptions for price reductions at point of sale and service fees under certain conditions.

• 42 U.S.C. 300gg-11 et seq.

  (b) Deductible Limitation.--A group health plan or a health insurance issuer offering group or individual health insurance coverage shall not apply any deductible amount that otherwise is applicable to prescription drugs with respect to coverage of certified insulin under such plan or coverage, during the period described in subsection (a)(2).

  Removes deductibles for certified insulin to improve access.

• 42 U.S.C. 300gg-11 et seq.

  (c) Hold Harmless.--In the first 2 plan years during which paragraph (1) applies with respect to an insulin certified under section 5(b) of the Insulin Price Reduction Act...

  Provides protections against changes that would disadvantage patients regarding insulin coverage in the first two years.

• 42 U.S.C. 300gg-11 et seq.

  (d) Definitions.--In this section--(1) the term `certified insulin' means, with respect to a year, insulin that has been certified under section 5(b) of the Insulin Price Reduction Act for the year;...

  Defines key terms used in the insulin price protections.

• 42 U.S.C. 1395w-104

  (o) Limitation on Rebates, Price Reductions, or Other Remuneration for Certified Insulin.--(1) Limitation.--(A) In general.--Subject to subparagraphs (B) and (C), for plan year 2022 and subsequent plan years...

  Establishes similar protections under Medicare Part D regarding rebates and price reductions for certified insulin.

• 42 U.S.C. 1395w-104

  (B) Exception.--The requirement under subparagraph (A) shall not apply to--(i) any such reduction in price that is reflected at the point of sale to the beneficiary; or (ii) any remuneration that is a flat fee-based service fee...

  Provides exceptions similar to those for group health plans.

• 42 U.S.C. 1396r-8(c)

  (5) Special rule for determining minimum basic rebates for insulin.--(A) In general.--In determining the amount of the rebate specified in this subsection for a dosage form and strength of a covered outpatient drug described in subparagraph (B)...

  Establishes special rules for minimum rebate amounts for insulin in Medicaid programs.

Action History

1. July 22, 2019

   Introduced in Senate

2. July 22, 2019

   Read twice and referred to the Committee on Finance.

Sponsors

• Jeanne Shaheen · Primary

Subjects