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S. 2554 — what changed

Patient Right to Know Drug Prices Act

From Reported in Senate to Engrossed in Senate. 1 section amended and 1 added between Reported in Senate and Engrossed in Senate.

Sec. 2 Prohibition on limiting certain information on drug prices

added 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:

added “2729. Information on prescription drugs

added “(a) In general—A group health plan or a health insurance issuer offering group or individual health insurance coverage shall—

added “(1) not restrict, directly or indirectly, any pharmacy that dispenses a prescription drug to an enrollee in the plan or coverage from informing (or penalize such pharmacy for informing) an enrollee of any differential between the enrollee's out-of-pocket cost under the plan or coverage with respect to acquisition of the drug and the amount an individual would pay for acquisition of the drug without using any health plan or health insurance coverage; and

added “(2) ensure that any entity that provides pharmacy benefits management services under a contract with any such health plan or health insurance coverage does not, with respect to such plan or coverage, restrict, directly or indirectly, a pharmacy that dispenses a prescription drug from informing (or penalize such pharmacy for informing) an enrollee of any differential between the enrollee's out-of-pocket cost under the plan or coverage with respect to acquisition of the drug and the amount an individual would pay for acquisition of the drug without using any health plan or health insurance coverage.

added “(b) Definition—For purposes of this section, the term out-of-pocket cost, with respect to acquisition of a drug, means the amount to be paid by the enrollee under the plan or coverage, including any cost-sharing (including any deductible, copayment, or coinsurance) and, as determined by the Secretary, any other expenditure.”

(a)
removed Exchange plans— Section 1311(e) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(e)) is amended by adding at the end the following:

removed “(4) Information on prescription drugs—The Exchange shall require health plans seeking certification as qualified health plans to ensure that—

removed “(A) the health insurance issuer does not restrict any pharmacy that dispenses a prescription drug to an enrollee in the plan from informing (or penalize such pharmacy for informing) an enrollee of any differential between the price of the drug to the enrollee under the plan and the price the individual would pay for the drug if the enrollee obtained the drug without using any health insurance coverage; and

removed “(B) any entity that provides pharmacy benefits management services under a contract with any such health plan does not, with respect to such plan or any health benefits plan that the entity contracts with to provide pharmacy benefits management services and that is offered by an entity other than such sponsor or organization, restrict a pharmacy that dispenses a prescription drug from informing (or penalize such pharmacy for informing) an enrollee of any differential between the price of the drug to the enrollee under the plan and the price the individual would pay for the drug if the enrollee obtained the drug without using any health insurance coverage.”

(b)
removed Other health plans— The provisions of section 1311(e)(4) of the Patient Protection and Affordable Care Act (as added by subsection (a)) shall apply to all health insurance issuers with respect to health insurance coverage and to all group health plans (as such terms are defined in section 2791 of the Public Health Service Act (42 U.S.C. 300gg–91)).

Sec. 3 Modernizing the reporting of biological and biosimilar products

added

added Subtitle B of title XI of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173) is amended—

(1)
added in section 1111—
(A)
added by redesignating paragraphs (3) through (8) as paragraphs (6) through (11), respectively;
(B)
added by inserting after paragraph (2) the following:

added “(3) Biosimilar biological product—The term biosimilar biological product means a biological product for which an application under section 351(k) of the Public Health Service Act is approved.

added “(4) Biosimilar biological product applicant—The term biosimilar biological product applicant means a person who has filed or received approval for a biosimilar biological product under section 351(k) of the Public Health Service Act.

added “(5) Biosimilar biological product application—The term biosimilar biological product application means an application for licensure of a biological product under section 351(k) of the Public Health Service Act.”

(C)
added in paragraph (6), as so redesignated, by inserting “, or a biological product for which an application is approved under section 351(a) of the Public Health Service Act” before the period;
(D)
added in paragraph (7), as so redesignated—
(i)
added by striking “paragraph (3)” and inserting “paragraph (6)”;
(ii)
added by inserting “or a reference product in a biosimilar biological product application” after “ANDA”; and
(iii)
added by inserting “or under section 351(a) of the Public Health Service Act” before the period; and
(E)
added by adding at the end the following:

added “(12) Reference product—The term reference product means a brand name drug for which a license is in effect under section 351(a) of the Public Health Service Act.”

(2)
added in section 1112—
(A)
added in subsection (a)—
(i)
added in paragraph (1)—
(I)
added by inserting “or a biosimilar biological product applicant who has submitted a biosimilar biological product application for which a statement under section 351(l)(3)(B)(ii)(I) of the Public Health Service Act has been provided” after “Federal Food, Drug, and Cosmetic Act”; and
(II)
added by inserting “or the biosimilar biological product that is the subject of the biosimilar biological product application, as applicable” after “the ANDA”; and
(ii)
added in paragraph (2)—
(I)
added in the matter preceding subparagraph (A), by inserting “or a biosimilar biological product applicant” after “generic drug applicant”;
(II)
added in subparagraph (A)—
(aa)
added by striking “marketing” and inserting “marketing,”; and
(bb)
added by inserting “or the reference product in the biosimilar biological product application” before “involved”;
(III)
added in subparagraph (B), by inserting “or of the biosimilar biological product for which the biosimilar biological product application was submitted” after “submitted”; and
(IV)
added by amending subparagraph (C) to read as follows:

added “(C) as applicable—

added “(i) the 180-day period referred to in section 505(j)(5)(B)(iv) of the Federal Food, Drug, and Cosmetic Act as it applies to such ANDA or to any other ANDA based on the same brand name drug; or

added “(ii) the 1-year period referred to in section 351(k)(6)(A) of the Public Health Service Act as it applies to such biosimilar biological product application or to any other biosimilar biological product application based on the same brand name drug.”

(B)
added in subsection (b)—
(i)
added by amending paragraph (1) to read as follows:

added “(1) Requirement

added “(A) Generic drugs—A generic drug applicant that has submitted an ANDA containing a certification under section 505(j)(2)(A)(vii)(IV) of the Federal Food, Drug, and Cosmetic Act with respect to a listed drug and another generic drug applicant that has submitted an ANDA containing such a certification for the same listed drug shall each file the agreement in accordance with subsection (c). The agreement shall be filed prior to the date of the first commercial marketing of either of the generic drugs for which such ANDAs were submitted.

added “(B) Biosimilar biological products—A biosimilar biological product applicant that has submitted a biosimilar biological product application for which a statement under section 351(l)(3)(B)(ii)(I) of the Public Health Service Act has been provided with respect to a reference product and another biosimilar biological product applicant that has submitted a biosimilar biological product application for which such a statement for the same reference product has been provided shall each file the agreement in accordance with subsection (c). The agreement shall be filed prior to the date of the first commercial marketing of either of the biosimilar biological products for which such biosimilar biological product applications were submitted.”

(ii)
added in paragraph (2)—
(I)
added by striking “between two generic drug applicants is an agreement” and inserting “is, as applicable, an agreement between 2 generic drug applicants”; and
(II)
added by inserting “, or an agreement between 2 biosimilar biological product applicants regarding the 1-year period referred to in section 351(k)(6)(A) of the Public Health Service Act as it applies to the biosimilar biological product applications with which the agreement is concerned” before the period;
(3)
added in section 1115, by striking “or generic drug applicant” each place such term appears and inserting “, generic drug applicant, or biosimilar biological product applicant”; and
(4)
added in section 1117, by striking “, or any agreement between generic drug applicants” and inserting “or a biosimilar biological product applicant, any agreement between generic drug applicants, or any agreement between biosimilar biological product applicants”.