Protect Beneficiaries from Middlemen Act

House Votes

This bill would cap what you pay at the pharmacy for Medicare Part D drugs. After you meet your deductible and before you hit your yearly out‑of‑pocket limit, your monthly copay or coinsurance could not be higher than either the plan’s average net price for that drug (what the plan actually pays after rebates and discounts) or the pharmacy’s cash price if that’s lower . These limits would start for plan years beginning January 1, 2027.

People who get the low‑income subsidy would also have their copays capped the same way starting in 2027. A federal watchdog report is due by January 1, 2029 to check if plans are following the rules, how enforcement is working, and how to improve public awareness.

• Who is affected: People with Medicare Part D, including those with the low‑income subsidy; pharmacies and drug plans that set prices and collect rebates .
• What changes: Your share at the counter can’t exceed the plan’s average net price or the pharmacy’s cash price, whichever is lower.
• When: Applies to plan years starting January 1, 2027; compliance report due by January 1, 2029 .