[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3466 Introduced in Senate (IS)]
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116th CONGRESS
2d Session
S. 3466
To amend title XVIII of the Social Security Act to eliminate cost
sharing for biosimilar biological products furnished under part B of
the Medicare program during the first 5 years such products are
marketed.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 12, 2020
Ms. McSally (for herself and Mr. Jones) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to eliminate cost
sharing for biosimilar biological products furnished under part B of
the Medicare program during the first 5 years such products are
marketed.
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 ``Acting to Cancel Copays and Ensure
Substantial Savings for Biosimilars Act of 2020'' or the ``ACCESS for
Biosimilars Act of 2020''.
SEC. 2. ELIMINATING COST SHARING FOR BIOSIMILAR BIOLOGICAL PRODUCTS
FURNISHED UNDER PART B OF THE MEDICARE PROGRAM.
Section 1833 of the Social Security Act (42 U.S.C. 1395l) is
amended--
(1) in subsection (a)(1)(S), by inserting ``(or, in the
case of such a biological that is a specified biosimilar
biological product (as defined in subsection (cc)) furnished
during a year (beginning with 2021) to an individual who is a
cost-sharing reduction eligible individual (as defined in such
subsection) with respect to such year, 100 percent)'' after
``80 percent''; and
(2) by adding at the end the following new subsection:
``(cc) Specified Biosimilar Biological Product Reduced Cost-Sharing
Provisions.--
``(1) Definitions.--
``(A) Cost-sharing reduction eligible individual
defined.--For purposes of subsection (a)(1)(S) and with
respect to a year, the term `cost-sharing reduction
eligible individual' means an individual who, as of
January 1 of such year--
``(i) is enrolled under this part; and
``(ii) does not have qualifying coverage
(as defined in subparagraph (B)).
``(B) Qualifying coverage.--
``(i) In general.--For purposes of
subparagraph (A), the term `qualifying
coverage' means, with respect to an individual,
coverage--
``(I) under--
``(aa) a group health plan
or health insurance coverage
(as such terms are defined in
section 2791 of the Public
Health Service Act);
``(bb) a Federal health
care program (as defined in
section 1128B(f)), other than
the program established under
this title;
``(cc) the health insurance
program under chapter 89 of
title 5, United States Code;
``(dd) a medicare
supplemental policy under
section 1882; or
``(ee) an MA or MA-PD plan;
and
``(II) that meets--
``(aa) in the case of
coverage described in any of
items (aa) through (dd) of
subclause (I), the condition
described in clause (ii); and
``(bb) in the case of
coverage described in item (ee)
of subclause (I), the condition
described in clause (iii).
``(ii) Condition for coverage other than
part c coverage.--For purposes of clause
(i)(II)(aa), the condition described in this
clause, with respect to an individual enrolled
in coverage described in any of items (aa)
through (dd) of clause (i)(I) during a year, is
that such coverage provides for the payment of
all cost sharing owed by such individual under
this part (or, if applicable, under an MA or
MA-PD plan) with respect to a specified
biosimilar biological product (as defined in
subparagraph (C)) furnished under this part
(or, if applicable, under an MA or MA-PD plan)
during such year, not taking into account the
application of any deductible under such
coverage.
``(iii) Condition for part c coverage.--For
purposes of clause (i)(II)(bb), the condition
described in this clause, with respect to an
individual enrolled in an MA or MA-PD plan
during a year, is that such plan provides for
no cost sharing for such individual with
respect to a specified biological biosimilar
product (as defined in subparagraph (C))
furnished under such plan during such year.
``(C) Specified biosimilar biological product.--For
purposes of subsection (a)(1)(S), the term `specified
biosimilar biological product' means a biosimilar
biological product (as defined in subsection (c)(6) of
section 1847A)--
``(i) for which the payment amount
determined under subsection (b)(8) of such
section for such product is less than the
payment amount determined under subsection
(b)(4) of such section for the reference
biological product (as defined in subsection
(c)(6) of such section); and
``(ii) that is furnished during the 5-year
period beginning on the later of--
``(I) January 1, 2021; or
``(II) the date on which the
biosimilar biological product is first
marketed.
``(2) Determinations.--The Secretary shall establish a
process--
``(A) for determining whether an individual is a
cost-sharing reduction eligible individual for a year;
and
``(B) for notifying MA organizations of such a
determination made with respect to an individual
enrolled under an MA plan or MA-PD plan offered by such
organization during such year.''.
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