Us Congress 2025-2026 Regular Session

Us Congress Senate Bill SB1186

Introduced
3/27/25  

Caption

Lower Drug Costs for Families Act This bill applies certain Medicare prescription drug rebate requirements to prescription drugs that are available under private health insurance. Current law requires drug manufacturers to issue rebates to the Centers for Medicare & Medicaid Services for brand-name drugs without generic equivalents under Medicare that (1) cost $100 or more per year per individual, and (2) for which prices increase faster than inflation. Manufacturers that fail to comply are subject to civil penalties. The bill applies these requirements to prescription drugs that are available in the commercial market under private health insurance. It also indexes rebate calculations to drug prices in 2016 (as opposed to 2021).

Impact

If enacted, SB1186 will significantly affect state laws governing prescription drug pricing by establishing inflation adjustments and rebates related to drug costs that would apply universally. This change is intended to create a more equitable pricing structure for consumers, aligning private market prices more closely with what the government pays for prescription drugs under federal programs. The provided amendments are meant to enhance the transparency of drug pricing and foster competition among pharmaceutical companies.

Summary

SB1186, titled the 'Lower Drug Costs for Families Act,' aims to amend title XVIII of the Social Security Act to extend prescription drug inflation rebates to drugs provided in the commercial market. This legislative initiative targets the rising costs of prescription medications by ensuring that rebates are applied not only in government programs but also in the broader market where families procure their medications. By revising the calculation base year for these rebates to an earlier date, the bill is designed to generate more significant financial relief for consumers by potentially lowering the prices imposed by manufacturers.

Contention

Despite its promises of lowering drug costs, SB1186 has sparked debate among stakeholders. Proponents argue that applying inflation rebates to the commercial market is a necessary step toward making prescription medications more affordable and accessible for families. Conversely, opponents express concern that such comprehensive regulatory changes might discourage pharmaceutical innovation and lead to supply chain issues. Subsequently, discussions also revolve around how transitioning to earlier rebate calculation years may impact the financial dynamics for pharmaceutical companies, potentially leading to higher retail prices if producers adjust to maintain profit margins.

Congress_id

119-S-1186

Policy_area

Health

Introduced_date

2025-03-27

Companion Bills

US HB2554

Related Lower Drug Costs for Families Act This bill applies certain Medicare prescription drug rebate requirements to prescription drugs that are available under private health insurance. Current law requires drug manufacturers to issue rebates to the Centers for Medicare & Medicaid Services for brand-name drugs without generic equivalents under Medicare that (1) cost $100 or more per year per individual, and (2) for which prices increase faster than inflation. Manufacturers that fail to comply are subject to civil penalties. The bill applies these requirements to prescription drugs that are available in the commercial market under private health insurance. It also indexes rebate calculations to drug prices in 2016 (as opposed to 2021).

Previously Filed As

US HB133

Mandating Exclusive Review of Individual Treatments (MERIT) Act This bill specifies that coverage determinations for drugs and biologics under Medicare must be made with respect to each drug or biologic, rather than with respect to a class of drugs or biologics.

US SB1450

Cutting Medicare Prescription Drug Prices in Half Act

US HB10409

To address the high costs of health care services, prescription drugs, and health insurance coverage in the United States, and for other purposes.

US HB167

Patient Access to Urgent-Use Pharmacy Compounding Act of 2023 This bill relaxes certain requirements for compounding drugs that are facing shortages. Drug compounding is the process of mixing or otherwise altering drugs to create a medication. Currently, the Food and Drug Administration (FDA) allows for drug compounding subject to certain requirements. Generally, a licensed pharmacist or physician not registered with the FDA may only compound drugs in limited quantities for prescriptions for a specific individual patient. On the other hand, an FDA-registered outsourcing facility may compound drugs in bulk for use in medical facilities but is subject to additional requirements. This bill allows a compounder not registered with the FDA to compound drugs in limited quantities for an urgent medical need not involving a specific patient if, among other requirements (1) the prescriber certifies that the prescriber is unable, despite reasonable attempts, to obtain certain related drugs with the same active ingredient and route of administration; (2) the compounded drug meets certain labeling requirements, including an indication that the compounded drug is provided only for urgent administration to a patient; and (3) the compounder requests and maintains certain records about patients receiving the compounded drug. Furthermore, a restriction against an unregistered compounder regularly compounding (or compounding inordinate amounts of) what is essentially a copy of a commercially available drug shall not apply if the drug is on a shortage list maintained by the FDA or the American Society of Hospital Pharmacists.

US HB4881

To amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program.

US HB4028

Territories Medicare Prescription Drug Assistance Equality Act of 2023

US SB1218

Fair Prescription Drug Prices for Americans Act

US SB1139

Lower Drug Costs for Families Act

US HB3093

Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2023

US SB4349

A bill to require private health plans to provide for secure electronic transmission of prior authorization requests for prescription drugs.

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