If passed, this bill would amend existing statutes in the Patient Protection and Affordable Care Act and the Public Health Service Act. Specifically, it would ensure that cost-sharing for prescription drugs does not exceed $250 per individual per month or $500 for families, a significant threshold aimed at alleviating the financial burden on insured individuals seeking necessary medications. The legislation is poised to enhance protections for patients by addressing the often exorbitant costs associated with prescription drug coverage.
Summary
House Bill 6347, referred to as the Capping Prescription Costs Act of 2023, aims to limit the cost-sharing required of individuals for prescription medications under qualified health plans. The primary goal of the bill is to establish a cap on out-of-pocket expenses associated with prescription drugs, which is intended to enhance affordability and accessibility for patients who rely on medication for health management. The proposed legislation sets specific limits on monthly cost-sharing beginning in 2025, emphasizing a consumer-focused approach to healthcare реформ.
Contention
Notably, the implementation of this bill is likely to spark discussions about the broader implications for health insurance providers and the pharmaceutical industry. Critics may argue that such caps could affect the pricing structures negotiated between insurers and pharmaceutical companies, leading to potential unintended consequences on drug availability or pricing strategies. Observers also point to the challenges of adjusting to consumer price index fluctuations, which will impact cost-sharing limits in subsequent years.
Saving Seniors Money on Prescriptions ActThis bill establishes reporting requirements for pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit and Medicare Advantage, particularly relating to the prices of prescription drugs.Specifically, PBMs must (1) disclose certain information underlying cost performance measurements (e.g., exclusions and terms), and (2) report to prescription drug plan (PDP) sponsors (and to the Centers for Medicare & Medicaid Services upon request) an itemized list of prescription drugs that were dispensed during the previous year and related data about costs, claims, affiliated pharmacies, and other specified information. PDP sponsors may audit PBMs to ensure compliance with this bill's requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations.In addition, the Government Accountability Office must study federal and state reporting requirements for health plans and PBMs with respect to prescription drug price transparency and recommend ways to streamline these requirements.