Sponsors (31)
Introduced July 7, 2025 by Gregory Francis Murphy · Last progress July 7, 2025
The bill reduces out‑of‑pocket costs for some Medicare Part B drug users and boosts Medicare funding and transparency, at the risk of prompting manufacturer price responses, leaving percentage‑based cost sharing that can still be burdensome, and adding administrative complexity for providers and state programs.
Medicare beneficiaries who use the selected Part B drugs will generally pay lower coinsurance because coinsurance is set at 20% of the manufacturer flash price (MFP) + $6, which can reduce out‑of‑pocket costs when MFP is below current prices.
Medicare (Part B) funding is increased because manufacturers must remit quarterly rebates into the Medicare Supplementary Medical Insurance Trust Fund, which could help support Part B services and relieve pressure on taxpayers or premiums.
Manufacturers, hospitals, and health systems gain greater price transparency because HHS must report quarterly utilization and per‑unit rebate calculations, improving oversight and accountability.
Manufacturers face new required quarterly rebates payable within 30 days, which could prompt them to raise list prices or restrict supply to offset costs, potentially increasing costs for patients and taxpayers indirectly.
Some Medicare beneficiaries may still face high out‑of‑pocket costs because the policy uses percentage‑based coinsurance (20% of MFP+6) rather than a fixed dollar cap, so savings are limited if MFP is not substantially lower than current prices.
The rule adds administrative and operational burdens for Medicare contractors, manufacturers, and providers due to new reporting, payment, and cross‑reference requirements, creating short‑term disruption and potential billing errors.
Based on analysis of 2 sections of legislative text.
Modifies Medicare Part B rules to require quarterly manufacturer rebates tied to negotiated maximum fair prices, changes beneficiary coinsurance to an MFP+6 rule, and mandates HHS reporting.
Changes how Medicare Part B pays for and recoups money on selected drugs and biologics that are subject to a negotiated maximum fair price (MFP). The HHS Secretary must report quarterly on utilization and calculated rebates for each selected product, manufacturers must remit a per-unit quarterly rebate within 30 days of receiving that report, and beneficiary coinsurance for those drugs is set to an MFP+6 percent rule with a provision to use a lesser inflation-adjusted coinsurance when applicable. The amendments are technical changes to existing Part B payment and rebate rules: they remove a carve-out from the ASP+6 payment rule, add explicit quarterly reporting and rebate collection requirements, and clarify how beneficiary cost-sharing interacts with inflation rebates. Reporting timelines and manufacturer payment deadlines are specified (Secretary: within six months after each quarter; manufacturers: 30 days after receiving the report).