To amend title XVIII of the Social Security Act to require that coinsurance for drugs under Medicare part D be based on the drug's net price and not the drug's list price.
About This Bill
Committee
Latest Action · May 1, 2024
Read twice and referred to the Committee on Finance.
This bill amends Medicare Part D prescription drug coverage rules to change how seniors' out-of-pocket costs are calculated. Currently, coinsurance amounts (the percentage of drug costs patients must pay) are based on a drug's list price, which is often much higher than the actual negotiated price insurers pay. The legislation requires that starting January 1, 2025, coinsurance be calculated using the drug's net price—the negotiated price after discounts and manufacturer rebates—when that net price is lower than the list price. This change would apply to most Medicare Part D beneficiaries in the coverage gap between their annual deductible and out-of-pocket spending limits. The bill could lower drug costs for seniors by ensuring they pay coinsurance based on what insurance plans actually pay rather than inflated list prices, though it excludes certain drug categories already subject to special pricing rules.
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