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).