Sponsors (47)
Official title: To amend title XVIII of the Social Security Act to provide for a rebate by manufacturers for selected drugs and biological products subject to maximum fair price negotiation.
Introduced July 7, 2025 by Gregory Francis Murphy · Last progress July 7, 2025
The bill redirects manufacturer rebates to shore up Medicare Part B finances and standardize payment—lowering some patient costs and simplifying administration—while creating incentives that may raise drug list prices, leave some beneficiaries with high coinsurance, and increase compliance costs.
Medicare program and taxpayers: additional manufacturer rebate revenue is redirected into the Medicare Part B trust fund, lowering federal program net costs and helping support Part B solvency.
Medicare beneficiaries: out-of-pocket coinsurance for selected Part B drugs may fall because coinsurance is tied to MFP+6, potentially reducing patient drug costs for those receiving affected therapies.
Hospitals, health systems, and CMS: aligning Part B payment methodology by removing a carve-out increases payment consistency across drugs and reduces special-case complexity for administration.
Patients with chronic conditions and Medicare beneficiaries: manufacturers' obligation to remit sizable quarterly rebates could incentivize higher list prices, reduce product availability, or delay new drug introductions that affect access.
Medicare beneficiaries: some will still face coinsurance calculated at 20% of MFP+6, which can remain high for expensive therapies and may not eliminate substantial out-of-pocket spending.
Manufacturers, hospitals/health systems, and federal administrators: increased reporting and enforcement requirements raise compliance and administrative costs for industry and agencies, which could be passed on to payors or consumers.
Based on analysis of 2 sections of legislative text.
Subjects MFP-selected Part B drugs to standard ASP+6 payment, requires quarterly manufacturer rebates and reporting, and ties beneficiary coinsurance to MFP+6 with a cap.
Changes Medicare Part B payment rules for drugs and biologics designated as “selected” under the Maximum Fair Price (MFP) program by eliminating a special payment exception, subjecting those products to the standard ASP+6 payment methodology, and creating a new quarterly manufacturer rebate and reporting requirement tied to MFP pricing. The bill also sets beneficiary coinsurance rules for those products based on an “MFP+6” benchmark with an inflation-rebate-related cap. The law requires the Secretary to report quarterly units furnished and per-unit rebate amounts to manufacturers, who must remit the reported rebates within 30 days; it layers these rebates on top of other statutory rebates and changes how beneficiary cost-sharing is calculated for affected Part B drugs and biologics.