Amends title XVIII of the Social Security Act to require that coinsurance for drugs under Medicare Part D be based on the drug’s net price rather than the list price.
Applies to plan years beginning on or after January 1, 2025.
Coinsurance amounts for covered Part D drugs (included on the formulary and subject to coinsurance rather than a copayment) will be calculated based on the net price if it is lower than the list price.
The requirement does not apply to covered Part D drugs described in paragraphs (8) or (9) of the legislation.
Defines “net price” as the negotiated price of the covered Part D drug under the prescription drug plan or MA-PD plan, net of any manufacturer-provided price concessions, as reported in the Detailed DIR Report (or any successor report) submitted by the sponsor or organization offering the plan for the previous plan year.