Us Congress 2025-2026 Regular Session

Us Congress House Bill HB1244 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	I
2	2	119THCONGRESS
3	3	1
4	4	STSESSION H. R. 1244
5	5	To amend title XVIII of the Social Security Act to require that coinsurance
6	6	for drugs under Medicare part D be based on the drug’s actual acquisi-
7	7	tion cost and not the drug’s wholesale acquisition cost.
8	8	IN THE HOUSE OF REPRESENTATIVES
9	9	FEBRUARY12, 2025
10	10	Mr. D
11	11	AVISof North Carolina (for himself and Mr. PFLUGER) introduced the
12	12	following bill; which was referred to the Committee on Energy and Com-
13	13	merce, and in addition to the Committee on Ways and Means, for a pe-
14	14	riod to be subsequently determined by the Speaker, in each case for con-
15	15	sideration of such provisions as fall within the jurisdiction of the com-
16	16	mittee concerned
17	17	A BILL
18	18	To amend title XVIII of the Social Security Act to require
19	19	that coinsurance for drugs under Medicare part D be
20	20	based on the drug’s actual acquisition cost and not the
21	21	drug’s wholesale acquisition cost.
22	22	Be it enacted by the Senate and House of Representa-1
23	23	tives of the United States of America in Congress assembled, 2
24	24	SECTION 1. SHORT TITLE. 3
25	25	This Act may be cited as the ‘‘Reducing Drug Prices 4
26	26	for Seniors Act’’. 5
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29	29	•HR 1244 IH
30	30	SEC. 2. REQUIRING THAT COINSURANCE FOR DRUGS 1
31	31	UNDER MEDICARE PART D BE BASED ON THE 2
32	32	DRUG’S ACTUAL ACQUISITION COST AND NOT 3
33	33	THE DRUG’S WHOLESALE ACQUISITION COST. 4
34	34	Section 1860D–2 of the Social Security Act (42 5
35	35	U.S.C. 1395w–102) is amended— 6
36	36	(1) in subsection (b)— 7
37	37	(A) in paragraph (2)(A), in the matter 8
38	38	preceding clause (i), by striking ‘‘and (9)’’ and 9
39	39	inserting ‘‘, (9), and (10)’’; and 10
40	40	(B) by adding at the end the following new 11
41	41	paragraph: 12
42	42	‘‘(10) R
43	43	EQUIREMENT THAT COINSURANCE FOR 13
44	44	COVERED PART D DRUGS BE BASED ON THE ACTUAL 14
45	45	ACQUISITION COST OF THE DRUG .— 15
46	46	‘‘(A) I
47	47	N GENERAL.—For plan years begin-16
48	48	ning on or after January 1, 2026, for costs 17
49	49	above the annual deductible specified in para-18
50	50	graph (1) and below the annual out-of-pocket 19
51	51	threshold specified in paragraph (4), any coin-20
52	52	surance amount for a covered part D drug (in-21
53	53	sofar as such covered part D drug is included 22
54	54	on the formulary and subject to coinsurance 23
55	55	rather than a copayment) shall be calculated 24
56	56	based on the actual acquisition cost (and not 25
57	57	the wholesale acquisition cost) of such covered 26
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60	60	•HR 1244 IH
61	61	part D drug if such actual acquisition cost is 1
62	62	lower than the wholesale acquisition cost of 2
63	63	such covered part D drug. The preceding sen-3
64	64	tence shall not apply to a covered part D drug 4
65	65	described in paragraph (8) or (9). 5
66	66	‘‘(B) A
67	67	CTUAL ACQUISITION COST DE -6
68	68	FINED.—In this paragraph, the term ‘actual ac-7
69	69	quisition cost’ means, with respect to a covered 8
70	70	part D drug, the negotiated price of the covered 9
71	71	part D drug under the prescription drug plan 10
72	72	or MA–PD plan, net of any manufacturer-pro-11
73	73	vided price concessions (as defined under sec-12
74	74	tion 423.100 of title 42, Code of Federal Regu-13
75	75	lations (or any successor regulation)), as re-14
76	76	ported for such drug in the Detailed DIR Re-15
77	77	port (or any successor report) submitted by the 16
78	78	sponsor or organization offering the plan for 17
79	79	the previous plan year.’’; and 18
80	80	(2) in subsection (c), by adding at the end the 19
81	81	following new paragraph: 20
82	82	‘‘(7) R
83	83	EQUIREMENT THAT COINSURANCE FOR 21
84	84	COVERED PART D DRUGS BE BASED ON THE NET 22
85	85	PRICE OF THE DRUG .—The coverage is provided in 23
86	86	accordance with subsection (b)(10).’’. 24
87	87	Æ
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