[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4229 Introduced in Senate (IS)]

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118th CONGRESS
  2d Session
                                S. 4229

    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 net 
                  price and not the drug's list price.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 1, 2024

 Ms. Rosen (for herself 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 require that 
coinsurance for drugs under Medicare part D be based on the drug's net 
                  price and not the drug's list price.

    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 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) 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 net price of the drug.--
                    ``(A) In general.--For plan years beginning on or 
                after January 1, 2025, 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) 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).''.
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