119-hr1244

[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) .''.
 <all>