HR 1244
Reducing Drug Prices for Seniors Act
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Bill overview
This bill aims to lower prescription drug costs for seniors enrolled in Medicare Part D. It changes the way coinsurance is calculated for covered drugs, requiring that it be based on the actual acquisition cost paid by the drug plan, rather than the traditional wholesale acquisition cost. This change would result in lower out-of-pocket expenses for seniors when filling prescriptions. The bill takes effect starting in 2026.
Key provisions
- Requires coinsurance to be based on the actual acquisition cost of drugs.
- Defines ‘actual acquisition cost’ as the negotiated price paid by the prescription drug plan, minus manufacturer concessions.
- The change applies to drugs included on the plan’s formulary and subject to coinsurance.
- The change does not apply to certain drugs specified in the bill.
- The provision takes effect for plan years beginning January 1, 2026.
Who is affected
- Seniors enrolled in Medicare Part D
- Medicare Part D plans
- Pharmaceutical manufacturers
- Prescription drug sponsors
Notable changes
- Shifts the basis for calculating coinsurance from wholesale acquisition cost to actual acquisition cost.
- Incorporates manufacturer price concessions into the definition of actual acquisition cost.
Sponsors
Official sponsors from legislative records.
Primary sponsor
Cosponsors
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119th CONGRESS — 1st Session
H. R. 1244
IN THE HOUSE OF REPRESENTATIVES
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.
This Act may be cited as the Reducing Drug Prices for Seniors Act
.
Section 1860D–2 of the Social Security Act (42 U.S.C. 1395w–102) is amended—
in subsection (b)—
in paragraph (2)(A), in the matter preceding clause (i), by striking and (9)
and inserting , (9), and (10)
; and
by adding at the end the following new paragraph:
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).
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.
in subsection (c), by adding at the end the following new paragraph:
The coverage is provided in accordance with subsection (b)(10).