Sec. 2. Requiring prescription drug refill notifications during emergencies

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Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1185 et seq.) is amended by adding at the end the following new section: A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, that provides benefits for prescription drugs under such plan or such coverage shall provide to each participant or beneficiary under such plan or such coverage who resides in an emergency area during an emergency period— not later than 5 business days after the date of the beginning of such period with respect to such area (or, the case of the emergency period described in section 2(d)(2) of the Emergency Advance Refill Notification Act of 2020, not later than 5 business days after the date of the enactment of this section), a notification (written in a manner that is clear and understandable to the average participant or beneficiary)— of whether such plan or coverage will waive, during such period with respect to such a participant or beneficiary, any time restrictions under such plan or coverage on any authorized refills for such drugs to enable such refills in advance of when such refills would otherwise have been permitted under such plan or coverage; and in the case that such plan or coverage will waive such restrictions during such period with respect to such a participant or beneficiary, that contains information on how such a participant or beneficiary may obtain such a refill; and in the case such plan or coverage elects to so waive such restrictions during such period with respect to such a participant or beneficiary after the notification described in paragraph

(1)has been provided with respect to such period, not later than 5 business days after such election, a notification of such election that contains the information described in subparagraph

(B)of such paragraph. For purposes of this section, an emergency area is a geographical area in which, and an emergency period is the period during which, there exists— an emergency or disaster declared by the President pursuant to the National Emergencies Act or the Robert T. Stafford Disaster Relief and Emergency Assistance Act; and a public health emergency declared by the Secretary pursuant to section 319 of the Public Health Service Act. . The table of contents of the Employee Retirement Income Security Act of 1974 is amended by inserting after the item relating to section 714 the following: Sec. 715. Additional market reforms. Sec. 716. Provision of prescription drug refill notifications during emergencies. . 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 new section: A group health plan, and a health insurance issuer offering group or individual health insurance coverage, that provides benefits for prescription drugs under such plan or such coverage shall provide to each participant, beneficiary, or enrollee enrolled under such plan or such coverage who resides in an emergency area during an emergency period— not later than 5 business days after the date of the beginning of such period with respect to such area (or, the case of the emergency period described in section 2(d)(2) of the Emergency Advance Refill Notification Act of 2020, not later than 5 business days after the date of the enactment of this section), a notification (written in a manner that is clear and understandable to the average participant, beneficiary, or enrollee)— of whether such plan or coverage will waive, during such period with respect to such a participant, beneficiary, or enrollee, any time restrictions under such plan or coverage on any authorized refills for such drugs to enable such refills in advance of when such refills would otherwise have been permitted under such plan or coverage; and in the case that such plan or coverage will waive such restrictions during such period with respect to such a participant, beneficiary, or enrollee, that contains information on how such a participant, beneficiary, or enrollee may obtain such a refill; and in the case such plan or coverage elects to so waive such restrictions during such period with respect to such a participant, beneficiary, or enrollee after the notification described in paragraph

(1)has been provided with respect to such period, not later than 5 business days after such election, a notification of such election that contains the information described in subparagraph

(B)of such paragraph. For purposes of this section, an emergency area is a geographical area in which, and an emergency period is the period during which, there exists— an emergency or disaster declared by the President pursuant to the National Emergencies Act or the Robert T. Stafford Disaster Relief and Emergency Assistance Act; and a public health emergency declared by the Secretary pursuant to section 319. . Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section: A group health plan that provides benefits for prescription drugs under such plan shall provide to each participant or beneficiary enrolled under such plan who resides in an emergency area during an emergency period, not later than 5 business days after the date of the beginning of such period with respect to such area (or, the case of the emergency period described in section 2(d)(2) of the Emergency Advance Refill Notification Act of 2020, not later than 5 business days after the date of the enactment of this section)— a notification (written in a manner that is clear and understandable to the average participant or beneficiary)— of whether such plan will waive, during such period with respect to such a participant or beneficiary, any time restrictions under such plan on any authorized refills for such drugs to enable such refills in advance of when such refills would otherwise have been permitted under such plan; and in the case that such plan will waive such restrictions during such period with respect to such a participant or beneficiary, that contains information on how such a participant or beneficiary may obtain such a refill; and in the case such plan elects to so waive such restrictions during such period with respect to such a participant or beneficiary after the notification described in paragraph

(1)has been provided with respect to such period, not later than 5 business days after such election, a notification of such election that contains the information described in subparagraph

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U.S. Code

Standards relating to benefits for mothers and newborns
§ 1185

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42 USC 300gg–11

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Sec. 2

Requiring prescription drug refill notifications during emergencies

U.S.C.§ 1185

Cite42 USC 300gg–11

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