This bill would change how some Medicare Part D drugs are priced at the pharmacy for people with long-term health conditions. Starting in 2027, for certain “chronic care drugs,” your share of the cost must be based on the drug’s net price—the price after rebates and other discounts—rather than a higher list price. If you’re paying costs before you meet your deductible, you would never pay more than that net price. After the deductible and before the out-of-pocket cap, any coinsurance must be a percentage of the net price. Plans can still use a flat copay instead of a percentage if they choose. The Department of Health and Human Services will put these changes in place through regulations.

These rules cover select drug groups often used for ongoing conditions, such as blood sugar regulators (not including insulin), inhaled anti-inflammatories and bronchodilators for lung conditions, anticoagulants, and some heart medicines, with room for updates as guidelines change. Low-income Medicare enrollees would also see aligned limits so they don’t pay more than the plan’s set cost for these drugs.

• Who is affected: People with Medicare Part D who use certain chronic care drugs, including categories like blood glucose regulators (not insulin), inhaled corticosteroids, bronchodilators, anticoagulants, and some cardiovascular and respiratory agents.
• What changes: Your cost is tied to the drug’s net price (after rebates). Before the deductible, you won’t pay above that net price. Between the deductible and the out-of-pocket cap, any percentage coinsurance is based on the net price. Plans may use a flat copay instead.
• When: Applies to plan years starting January 1, 2027.