Bill > HR1244

This bill aims to reduce drug prices for seniors by changing how Medicare Part D calculates coinsurance for prescription drugs. Specifically, starting in 2026, the bill would require that coinsurance be calculated based on a drug's actual acquisition cost rather than its wholesale acquisition cost, but only when the actual acquisition cost is lower. The "actual acquisition cost" is defined as the negotiated price of a drug under a prescription drug plan, minus any manufacturer price concessions, as reported in the Detailed DIR (Direct and Indirect Remuneration) Report. This change means that seniors would potentially pay lower out-of-pocket costs for prescription drugs, as the coinsurance would be based on the lower, more accurate price of the medication. The bill applies to drugs included on a plan's formulary and subject to coinsurance, with some exceptions for certain types of drugs. By linking coinsurance to the actual cost of drugs, the legislation seeks to make prescription medications more affordable for Medicare Part D beneficiaries.

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https://www.congress.gov/bill/119th-congress/house-bill/1244/all-info