summary
Introduced
09/25/2019
09/25/2019
In Committee
Crossed Over
Passed
Dead
12/31/2020
12/31/2020
Introduced Session
116th Congress
Bill Summary
An original bill to amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes. This bill alters several programs and requirements relating to the prices of prescription drugs under Medicare and Medicaid. Among other things, the bill requires drug manufacturers to issue rebates to the Centers for Medicare & Medicaid Services (CMS) for certain drugs covered under Medicare for which the average manufacturer price increases faster than inflation; requires drug manufacturers to issue rebates to the CMS for discarded amounts of certain single-dose drugs covered under Medicare, based on information reported by providers; reduces the annual out-of-pocket spending threshold, and eliminates beneficiary cost-sharing above this threshold, under the Medicare prescription drug benefit; requires the CMS to publish certain information, as reported by pharmacy benefit managers (PBMs), relating to drug discounts and rebates, and payments between PBMs, health plans, and pharmacies; requires pass-through pricing models, and prohibits spread-pricing, for payment arrangements with PBMs under Medicaid; and increases the maximum rebate payable by drug manufacturers under the Medicaid Drug Rebate Program.
AI Summary
This bill alters several programs and requirements relating to the prices of prescription drugs under Medicare and Medicaid. Among other things, the bill requires drug manufacturers to issue rebates to the Centers for Medicare & Medicaid Services (CMS) for certain drugs covered under Medicare for which the average manufacturer price increases faster than inflation; requires drug manufacturers to issue rebates to the CMS for discarded amounts of certain single-dose drugs covered under Medicare, based on information reported by providers; reduces the annual out-of-pocket spending threshold, and eliminates beneficiary cost-sharing above this threshold, under the Medicare prescription drug benefit; requires the CMS to publish certain information, as reported by pharmacy benefit managers (PBMs), relating to drug discounts and rebates, and payments between PBMs, health plans, and pharmacies; requires pass-through pricing models, and prohibits spread-pricing, for payment arrangements with PBMs under Medicaid; and increases the maximum rebate payable by drug manufacturers under the Medicaid Drug Rebate Program.
Sponsors (1)
Last Action
Placed on Senate Legislative Calendar under General Orders. Calendar No. 225. (on 09/25/2019)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.congress.gov/bill/116th-congress/senate-bill/2543/all-info |
| BillText | https://www.congress.gov/116/bills/s2543/BILLS-116s2543rs.pdf |
| Bill | https://www.congress.gov/116/bills/s2543/BILLS-116s2543rs.pdf.pdf |
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