118 S2456 IS: Protecting Seniors from High Drug Costs Act U.S. Senate 2023-07-20 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

II118th CONGRESS1st SessionS. 2456IN THE SENATE OF THE UNITED STATESJuly 20, 2023Mr. Casey (for himself and Mr. Cornyn) introduced the following bill; which was read twice and referred to the Committee on FinanceA BILLTo amend title XVIII of the Social Security Act to limit beneficiary cost-sharing to the net price of covered part D drugs.

1.

Short title

This Act may be cited as the Protecting Seniors from High Drug Costs Act.

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..