I
119THCONGRESS
1
STSESSION H. R. 1244
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 actual acquisi-
tion cost and not the drug’s wholesale acquisition cost.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY12, 2025
Mr. D
AVISof North Carolina (for himself and Mr. PFLUGER) introduced the
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned
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 actual acquisition cost and not the
drug’s wholesale acquisition cost.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Reducing Drug Prices 4
for Seniors Act’’. 5
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SEC. 2. REQUIRING THAT COINSURANCE FOR DRUGS 1
UNDER MEDICARE PART D BE BASED ON THE 2
DRUG’S ACTUAL ACQUISITION COST AND NOT 3
THE DRUG’S WHOLESALE ACQUISITION COST. 4
Section 1860D–2 of the Social Security Act (42 5
U.S.C. 1395w–102) is amended— 6
(1) in subsection (b)— 7
(A) in paragraph (2)(A), in the matter 8
preceding clause (i), by striking ‘‘and (9)’’ and 9
inserting ‘‘, (9), and (10)’’; and 10
(B) by adding at the end the following new 11
paragraph: 12
‘‘(10) R
EQUIREMENT THAT COINSURANCE FOR 13
COVERED PART D DRUGS BE BASED ON THE ACTUAL 14
ACQUISITION COST OF THE DRUG .— 15
‘‘(A) I
N GENERAL.—For plan years begin-16
ning on or after January 1, 2026, for costs 17
above the annual deductible specified in para-18
graph (1) and below the annual out-of-pocket 19
threshold specified in paragraph (4), any coin-20
surance amount for a covered part D drug (in-21
sofar as such covered part D drug is included 22
on the formulary and subject to coinsurance 23
rather than a copayment) shall be calculated 24
based on the actual acquisition cost (and not 25
the wholesale acquisition cost) of such covered 26
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part D drug if such actual acquisition cost is 1
lower than the wholesale acquisition cost of 2
such covered part D drug. The preceding sen-3
tence shall not apply to a covered part D drug 4
described in paragraph (8) or (9). 5
‘‘(B) A
CTUAL ACQUISITION COST DE -6
FINED.—In this paragraph, the term ‘actual ac-7
quisition cost’ means, with respect to a covered 8
part D drug, the negotiated price of the covered 9
part D drug under the prescription drug plan 10
or MA–PD plan, net of any manufacturer-pro-11
vided price concessions (as defined under sec-12
tion 423.100 of title 42, Code of Federal Regu-13
lations (or any successor regulation)), as re-14
ported for such drug in the Detailed DIR Re-15
port (or any successor report) submitted by the 16
sponsor or organization offering the plan for 17
the previous plan year.’’; and 18
(2) in subsection (c), by adding at the end the 19
following new paragraph: 20
‘‘(7) R
EQUIREMENT THAT COINSURANCE FOR 21
COVERED PART D DRUGS BE BASED ON THE NET 22
PRICE OF THE DRUG .—The coverage is provided in 23
accordance with subsection (b)(10).’’. 24
Æ
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