119-S2617

Bill is currently in: Senate
Path to Law
House Senate President

119th CONGRESS

1st Session

S. 2617

1. Short title
2. Requiring that coinsurance for drugs under Medicare part D be based on the drug's net price and not the drug's list price

1. Short title

This Act may be cited as the "Reducing Drug Prices for Seniors Act.".

2. Requiring that coinsurance for drugs under Medicare part D be based on the drug's net price and not the drug's list price

Section 1860D–2 of the Social Security Act (42 U.S.C. 1395w–102) is amended—

(1) Requirement that coinsurance for covered part D drugs be based on the net price of the drug - 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) Requirement that coinsurance for covered part D drugs be based on the net price of the drug - by adding at the end the following new paragraph:

(10) Requirement that coinsurance for covered part D drugs be based on the net price 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 net price (and not the list price) of such covered part D drug if such net price is lower than the list price 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) Net price defined - In this paragraph, the term "net price" 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.

(2) Requirement that coinsurance for covered part D drugs be based on the net price of the drug - 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).