Us Congress 2025-2026 Regular Session

Us Congress Senate Bill SB1186 Compare Versions

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Old	New	Differences
1	1	II
2	2	119THCONGRESS
3	3	1
4	4	STSESSION S. 1186
5	5	To amend title XVIII of the Social Security Act to apply prescription drug
6	6	inflation rebates to drugs furnished in the commercial market and to
7	7	change the base year for rebate calculations.
8	8	IN THE SENATE OF THE UNITED STATES
9	9	MARCH27, 2025
10	10	Ms. C
11	11	ORTEZMASTO(for herself, Ms. KLOBUCHAR, Mr. WYDEN, Ms. BALD-
12	12	WIN, Mr. REED, Ms. SMITH, Mr. BLUMENTHAL, Mr. KING, Mr. WELCH,
13	13	Mr. H
14	14	ICKENLOOPER, Ms. SLOTKIN, and Mr. GALLEGO) introduced the
15	15	following bill; which was read twice and referred to the Committee on Fi-
16	16	nance
17	17	A BILL
18	18	To amend title XVIII of the Social Security Act to apply
19	19	prescription drug inflation rebates to drugs furnished
20	20	in the commercial market and to change the base year
21	21	for rebate calculations.
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 ‘‘Lower Drug Costs for 4
26	26	Families Act’’. 5
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29	29	•S 1186 IS
30	30	SEC. 2. APPLICATION OF PRESCRIPTION DRUG INFLATION 1
31	31	REBATES TO DRUGS FURNISHED IN THE 2
32	32	COMMERCIAL MARKET. 3
33	33	(a) P
34	34	ARTB DRUGS.— 4
35	35	(1) A
36	36	PPLICATION OF PRESCRIPTION DRUG IN -5
37	37	FLATION REBATES TO DRUGS FURNISHED IN THE 6
38	38	COMMERCIAL MARKET .—Section 1847A(i) of the So-7
39	39	cial Security Act (42 U.S.C. 1395w–3a(i)) is amend-8
40	40	ed— 9
41	41	(A) in paragraph (1)(A)(i), by striking 10
42	42	‘‘units’’ and inserting ‘‘billing units’’; 11
43	43	(B) in paragraph (2)(A), by striking ‘‘for 12
44	44	which payment is made under this part’’ and 13
45	45	inserting ‘‘that would be payable under this 14
46	46	part if such drug were furnished to an indi-15
47	47	vidual enrolled under this part’’; and 16
48	48	(C) in paragraph (3)— 17
49	49	(i) in subparagraph (A)(i), by striking 18
50	50	‘‘units’’ and inserting ‘‘billing units’’; and 19
51	51	(ii) by striking subparagraph (B) and 20
52	52	inserting the following: 21
53	53	‘‘(B) T
54	54	OTAL NUMBER OF BILLING 22
55	55	UNITS.—For purposes of subparagraph (A)(i), 23
56	56	the total number of billing units with respect to 24
57	57	a part B rebatable drug is determined as fol-25
58	58	lows: 26
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61	61	•S 1186 IS
62	62	‘‘(i) Determine the total number of 1
63	63	units equal to— 2
64	64	‘‘(I) the total number of units, as 3
65	65	reported under subsection (c)(1)(B) 4
66	66	for each National Drug Code of such 5
67	67	drug during the calendar quarter that 6
68	68	is two calendar quarters prior to the 7
69	69	calendar quarter as described in sub-8
70	70	paragraph (A), minus 9
71	71	‘‘(II) the total number of units 10
72	72	with respect to each National Drug 11
73	73	Code of such drug for which payment 12
74	74	was made under a State plan under 13
75	75	title XIX (or waiver of such plan), as 14
76	76	reported by States under section 15
77	77	1927(b)(2)(A) for the rebate period 16
78	78	that is the same calendar quarter as 17
79	79	described in subclause (I). 18
80	80	‘‘(ii) Convert the units determined 19
81	81	under clause (i) to billing units for the bill-20
82	82	ing and payment code of such drug, using 21
83	83	a methodology similar to the methodology 22
84	84	used under this section, by dividing the 23
85	85	units determined under clause (i) for each 24
86	86	National Drug Code of such drug by the 25
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89	89	•S 1186 IS
90	90	billing unit for the billing and payment 1
91	91	code of such drug. 2
92	92	‘‘(iii) Compute the sum of the billing 3
93	93	units for each National Drug Code of such 4
94	94	drug in clause (ii).’’. 5
95	95	(2) C
96	96	HANGE OF BASE YEAR FOR REBATE CAL -6
97	97	CULATION.—Section 1847A(i) of the Social Security 7
98	98	Act (42 U.S.C. 1395w–3a(i)) is amended— 8
99	99	(A) in paragraph (3)— 9
100	100	(i) in subparagraph (D), by striking 10
101	101	‘‘July 1, 2021’’ and inserting ‘‘July 1, 11
102	102	2016’’; and 12
103	103	(ii) in subparagraph (E), by striking 13
104	104	‘‘January 2021’’ and inserting ‘‘January 14
105	105	2016’’; and 15
106	106	(B) in paragraph (4)— 16
107	107	(i) in subparagraph (A)— 17
108	108	(I) by striking ‘‘December 1, 18
109	109	2020’’ and inserting ‘‘December 31, 19
110	110	2015’’; and 20
111	111	(II) by striking ‘‘January 2021’’ 21
112	112	and inserting ‘‘January 2016’’; 22
113	113	(ii) in subparagraph (B), by striking 23
114	114	‘‘December 1, 2020’’ and inserting ‘‘De-24
115	115	cember 31, 2015’’; and 25
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118	118	•S 1186 IS
119	119	(iii) in subparagraph (C), by striking 1
120	120	‘‘January 2021’’ and inserting ‘‘January 2
121	121	2016’’. 3
122	122	(3) E
123	123	FFECTIVE DATE.—The amendments made 4
124	124	by this subsection shall apply with respect to cal-5
125	125	endar quarters beginning on or after January 1, 6
126	126	2026. 7
127	127	(b) C
128	128	OVEREDPARTD DRUGS.— 8
129	129	(1) A
130	130	PPLICATION OF PRESCRIPTION DRUG IN -9
131	131	FLATION REBATES TO DRUGS FURNISHED IN THE 10
132	132	COMMERCIAL MARKET .—Section 1860D–14B of the 11
133	133	Social Security Act (42 U.S.C. 1395w–114b) is 12
134	134	amended— 13
135	135	(A) in subsection (b)— 14
136	136	(i) in paragraph (1)— 15
137	137	(I) in subparagraph (A)(i), by 16
138	138	striking ‘‘the total number of units’’ 17
139	139	and all that follows through the semi-18
140	140	colon and inserting the following: ‘‘the 19
141	141	total number of units that are used to 20
142	142	calculate the average manufacturer 21
143	143	price of such dosage form and 22
144	144	strength with respect to such part D 23
145	145	rebatable drug, as reported by the 24
146	146	manufacturer of such drug under sec-25
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149	149	•S 1186 IS
150	150	tion 1927 for each month, with re-1
151	151	spect to such period;’’; and 2
152	152	(II) by striking subparagraph (B) 3
153	153	and inserting the following: 4
154	154	‘‘(B) E
155	155	XCLUDED UNITS.—For purposes of 5
156	156	subparagraph (A)(i), the Secretary shall exclude 6
157	157	from the total number of units for a dosage 7
158	158	form and strength with respect to a part D 8
159	159	rebatable drug, with respect to an applicable pe-9
160	160	riod, the following: 10
161	161	‘‘(i) Units of each dosage form and 11
162	162	strength of such part D rebatable drug for 12
163	163	which payment was made under a State 13
164	164	plan under title XIX (or waiver of such 14
165	165	plan), as reported by States under section 15
166	166	1927(b)(2)(A). 16
167	167	‘‘(ii) Units of each dosage form and 17
168	168	strength of such part D rebatable drug for 18
169	169	which a rebate is paid under section 19
170	170	1847A(i). 20
171	171	‘‘(iii) Beginning with plan year 2026, 21
172	172	units of each dosage form and strength of 22
173	173	such part D rebatable drug for which the 23
174	174	manufacturer provides a discount under 24
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177	177	•S 1186 IS
178	178	the program under section 340B of the 1
179	179	Public Health Service Act.’’; and 2
180	180	(ii) in paragraph (6), by striking ‘‘
181	181	IN-3
182	182	FORMATION.—The Secretary’’ and all that 4
183	183	follows through ‘‘rebatable covered part D 5
184	184	drug dispensed’’ and inserting the fol-6
185	185	lowing: ‘‘AMP
186	186	REPORTS.—The Secretary 7
187	187	shall provide for a method and process 8
188	188	under which, in the case of a manufacturer 9
189	189	of a part D rebatable drug that submits 10
190	190	revisions to information submitted under 11
191	191	section 1927 by the manufacturer with re-12
192	192	spect to such drug’’; and 13
193	193	(B) by striking subsection (d) and insert-14
194	194	ing the following: 15
195	195	‘‘(d) I
196	196	NFORMATION.—For purposes of carrying out 16
197	197	this section, the Secretary shall use information submitted 17
198	198	by manufacturers under section 1927(b)(3) and informa-18
199	199	tion submitted by States under section 1927(b)(2)(A).’’. 19
200	200	(2) C
201	201	HANGE OF BASE YEAR FOR REBATE CAL -20
202	202	CULATION.—Section 1860D–14B of the Social Secu-21
203	203	rity Act (42 U.S.C. 1395w–114b) is amended— 22
204	204	(A) in subsection (b)(5)— 23
205	205	(i) in subparagraph (A)— 24
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208	208	•S 1186 IS
209	209	(I) by striking ‘‘October 1, 2021’’ 1
210	210	and inserting ‘‘October 1, 2016’’; and 2
211	211	(II) by striking ‘‘January 2021’’ 3
212	212	and inserting ‘‘January 2016’’; and 4
213	213	(ii) in subparagraph (C), by striking 5
214	214	‘‘January 2021’’ and inserting ‘‘January 6
215	215	2016’’; and 7
216	216	(B) in subsection (g)— 8
217	217	(i) in paragraph (3)— 9
218	218	(I) by striking ‘‘January 1, 10
219	219	2021’’ and inserting ‘‘January 1, 11
220	220	2016’’; and 12
221	221	(II) by striking ‘‘October 1, 13
222	222	2021’’ and inserting ‘‘October 1, 14
223	223	2016’’; and 15
224	224	(ii) in paragraph (4), by striking 16
225	225	‘‘January 2021’’ and inserting ‘‘January 17
226	226	2016’’. 18
227	227	(3) E
228	228	FFECTIVE DATE.—The amendments made 19
229	229	by this subsection shall take apply with respect to 20
230	230	applicable periods (as defined in section 1860D– 21
231	231	14B(g)(7) of the Social Security Act (42 U.S.C. 22
232	232	1395w–114b(g)(7))) beginning on or after October 23
233	233	1, 2025. 24
234	234	Æ
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