Bill Details
HR.1244 - 119th Congress
Status
Latest action
2025-02-12 - Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced Date
2025-02-12
Policy Area
Health
Committees
View committees (2)
Cosponsors
View cosponsors (2)
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AI Summary This summary was generated by AI from the bill text. AI can get information wrong.
This bill would change how Medicare Part D calculates the amount seniors pay for some prescription drugs. Instead of basing coinsurance on a drug’s higher wholesale price, it would require plans to use the drug’s lower actual cost to the plan when that cost is lower. The goal is to make cost-sharing more accurate and, in some cases, lower what Medicare drug plan members pay. The change would start for plan years beginning on or after January 1, 2026.
- The new rule would apply to covered Part D drugs that are paid for with coinsurance, not a fixed copayment, and only during the part of the year after the deductible is met but before the out-of-pocket limit is reached.
- “Actual acquisition cost” would mean the plan’s negotiated price for the drug after subtracting manufacturer discounts or other price concessions.
- The bill says this lower-cost method would be used only when the actual acquisition cost is less than the wholesale acquisition cost.
- Some drugs would be excluded from this change, including drugs already covered under certain existing Medicare Part D rules.
Official Summaries
Reducing Drug Prices for Seniors Act
This bill requires the coinsurance amount for covered drugs under the Medicare prescription drug benefit to be based on the actual acquisition cost of the drug (i.e., the negotiated price under the prescription drug plan net of any manufacturer price concessions), rather than the wholesale acquisition cost of the drug, if the actual acquisition cost is lower.
Current Full Text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1244 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 1244
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
actual acquisition cost and not the drug's wholesale acquisition cost.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 12, 2025
Mr. Davis of North Carolina (for himself and Mr. Pfluger) introduced
the following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
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
actual acquisition cost and not the drug's wholesale acquisition cost.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Reducing Drug Prices for Seniors
Act''.
SEC. 2. REQUIRING THAT COINSURANCE FOR DRUGS UNDER MEDICARE PART D BE
BASED ON THE DRUG'S ACTUAL ACQUISITION COST AND NOT THE
DRUG'S WHOLESALE ACQUISITION COST.
Section 1860D-2 of the Social Security Act (42 U.S.C. 1395w-102) is
amended--
(1) in subsection (b)--
(A) in paragraph (2)(A), in the matter preceding
clause (i), by striking ``and (9)'' and inserting ``,
(9), and (10)''; and
(B) by adding at the end the following new
paragraph:
``(10) Requirement that coinsurance for covered part d
drugs be based on the actual acquisition cost of the drug.--
``(A) In general.--For plan years beginning on or
after January 1, 2026, for costs above the annual
deductible specified in paragraph (1) and below the
annual out-of-pocket threshold specified in paragraph
(4), any coinsurance amount for a covered part D drug
(insofar as such covered part D drug is included on the
formulary and subject to coinsurance rather than a
copayment) shall be calculated based on the actual
acquisition cost (and not the wholesale acquisition
cost) of such covered part D drug if such actual
acquisition cost is lower than the wholesale
acquisition cost of such covered part D drug. The
preceding sentence shall not apply to a covered part D
drug described in paragraph (8) or (9).
``(B) Actual acquisition cost defined.--In this
paragraph, the term `actual acquisition cost' means,
with respect to a covered part D drug, the negotiated
price of the covered part D drug under the prescription
drug plan or MA-PD plan, net of any manufacturer-
provided price concessions (as defined under section
423.100 of title 42, Code of Federal Regulations (or
any successor regulation)), as reported for such drug
in the Detailed DIR Report (or any successor report)
submitted by the sponsor or organization offering the
plan for the previous plan year.''; and
(2) in subsection (c), by adding at the end the following
new paragraph:
``(7) Requirement that coinsurance for covered part d drugs
be based on the net price of the drug.--The coverage is
provided in accordance with subsection (b)(10).''.
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