H.R. 1244

119th CONGRESS 1st Session

To amend title XVIII of the Social Security Act to require that coinsurance for drugs under Medicare part D be based on the drug’s actual acquisition cost and not the drug’s wholesale acquisition cost.

IN THE HOUSE OF REPRESENTATIVES · February 12, 2025 · Sponsor: Mr. Davis of North Carolina

Table of contents

• H.R. 1244
  • SEC. 1. Short title
  • SEC. 2. Requiring that coinsurance for drugs under Medicare part D be based on the drug's actual acquisition cost and not the drug's wholesale acquisition cost

SEC. 1. Short title

• This Act may be cited as the Reducing Drug Prices for Seniors Act.

SEC. 2. Requiring that coinsurance for drugs under Medicare part D be based on the drug's actual acquisition cost and not the drug's wholesale acquisition cost

• Section 1860D–2 of the Social Security Act () is amended— 42 U.S.C. 1395w–102
  • in subsection (b)—
    • in paragraph (2)(A), in the matter preceding clause (i), by striking and (9)and inserting , (9), and (10); and
      • (10) Requirement that coinsurance for covered part D drugs be based on the actual acquisition cost of the drug
        • (A) In general
          • For plan years beginning on or after January 1, 2026, for costs above the annual deductible specified in paragraph (1) and below the annual out-of-pocket threshold specified in paragraph (4), any coinsurance amount for a covered part D drug (insofar as such covered part D drug is included on the formulary and subject to coinsurance rather than a copayment) shall be calculated based on the actual acquisition cost (and not the wholesale acquisition cost) of such covered part D drug if such actual acquisition cost is lower than the wholesale acquisition cost of such covered part D drug. The preceding sentence shall not apply to a covered part D drug described in paragraph (8) or (9).
        • (B) Actual acquisition cost defined
          • In this paragraph, the term means, with respect to a covered part D drug, 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 defined under section 423.100 of title 42, Code of Federal Regulations (or any successor regulation)), as reported for such drug in the Detailed DIR Report (or any successor report) submitted by the sponsor or organization offering the plan for the previous plan year. actual acquisition cost
    • by adding at the end the following new paragraph:
    • (7) Requirement that coinsurance for covered part D drugs be based on the net price of the drug
      • The coverage is provided in accordance with subsection (b)(10).
  • in subsection (c), by adding at the end the following new paragraph: