Protecting Seniors from High Drug Costs Act

Protecting Seniors from High Drug Costs Act

This bill limits cost-sharing for covered drugs under the Medicare prescription drug benefit to the negotiated price of the drug, net any manufacturer price concessions. Prescription drug plan sponsors are subject to civil penalties for violations.

[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2456 Introduced in Senate (IS)]

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118th CONGRESS
  1st Session
                                S. 2456

 To amend title XVIII of the Social Security Act to limit beneficiary 
         cost-sharing to the net price of covered part D drugs.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 20, 2023

 Mr. Casey (for himself and Mr. Cornyn) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to limit beneficiary 
         cost-sharing to the net price of covered part D drugs.

    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 ``Protecting Seniors from High Drug 
Costs Act''.

SEC. 2. PROTECTING SENIORS FROM EXCESSIVE COST-SHARING UNDER MEDICARE 
              PART D.

    (a) In General.--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) Limiting cost-sharing to net price.--
                    ``(A) In general.--For plan years beginning on or 
                after January 1, 2026, the cost-sharing (for costs 
                above the annual deductible specified in paragraph (1)) 
                for a covered part D drug (other than a covered part D 
                drug described in paragraph (8) or (9)) shall not 
                exceed the applicable amount specified in subparagraph 
                (B).
                    ``(B) Applicable amount specified.--The applicable 
                amount specified in this subparagraph, with respect to 
                a covered part D drug under a prescription drug plan or 
                an MA-PD plan, is 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.
                    ``(C) Enforcement.--
                            ``(i) In general.--A PDP sponsor of a 
                        prescription drug plan or an MA organization 
                        offering an MA-PD plan that violates the 
                        requirements under this paragraph, with respect 
                        to a covered part D drug under such plan, may 
                        be subject to a civil monetary penalty, as 
                        determined appropriate by the Secretary.
                            ``(ii) Application.--The provisions of 
                        section 1128A (other than subsections (a) and 
                        (b)) shall apply to a civil monetary penalty 
                        under this subparagraph in the same manner as 
                        such provisions apply to a penalty or 
                        proceeding under section 1128A(a).''.
            (2) in subsection (c), by adding at the end the following 
        new paragraph:
            ``(7) Limiting cost-sharing to net price.--The coverage is 
        provided in accordance with subsection (b)(10).''.
    (b) Conforming Amendment to Cost-Sharing for Low-Income 
Individuals.--Section 1860D-14(a)(1)(D)(iii) of the Social Security Act 
(42 U.S.C. 1395w-114(a)(1)(D)(iii)) is amended by adding at the end the 
following new sentence: ``For plan year 2026, and subsequent plan 
years, the copayment amount applicable under this clause to a covered 
part D drug dispensed to the individual may not exceed the applicable 
amount specified in section 1860D-2(b)(10)(B) for the covered part D 
drug under the prescription drug plan or MA-PD plan in which the 
individual is enrolled.''.
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