The Fairness for Patient Medications Act would cap what patients pay out-of-pocket for drugs that receive substantial manufacturer rebates. Starting in January 2025, health insurance plans would limit patient cost-sharing on these "highly rebated drugs" to one-twelfth of the plan's annual net price per 30-day supply, meaning patients would pay based on what the plan actually pays after rebates rather than the list price. The bill defines highly rebated drugs as those receiving rebates and price reductions exceeding 50 percent of total spending, which the Secretary of Health and Human Services would certify annually starting April 1, 2024. The legislation also requires that when insurance plans newly add previously excluded drugs to their coverage, any manufacturer rebates must be passed to patients at the pharmacy counter or take the form of flat fees unrelated to sales volume, preventing plans from hiding savings from patients. This bill affects patients with commercial health insurance, insurance plans, and pharmacy benefit managers that negotiate drug prices on behalf of insurers.
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