To amend title XXVII of the Public Health Service Act to limit co-payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in a specialty drug tier to the dollar amount (or its equivalent) of such requirements applicable to prescription drugs in a non-preferred brand drug tier, and for other purposes.
Patients' Access to Treatments Act of 2012 - Amends the Public Health Service Act to prohibit a health plan offering group or individual health insurance that provides coverage for prescription drugs and uses a formulary or other tiered cost-sharing structure from imposing co-payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in a specialty drug tier that exceed the dollar amount of such requirements applicable to prescription drugs in a non-preferred brand drug tier.
Provides that if a formulary used by such a health plan contains more than one non-preferred brand drug tier, such prohibition shall be applied with respect to the non-preferred brand drug tier for which beneficiary cost-sharing is lowest.
Defines: (1) "non-preferred brand drug tier" as a category of drugs within a tier in such formulary for which beneficiary cost-sharing is greater than tiers for generic drugs or preferred brand drugs in the plan's formulary, that are prescription drugs, and that are not included within a specialty drug tier; and (2) "specialty drug tier" as a category of drugs within a tier in such formulary for which beneficiary cost-sharing is greater than tiers for generic drugs, preferred brand drugs, or non-preferred drugs in the plan's formulary and that are prescription drugs.
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
checking server…
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line