Bill > HR4299

This bill amends the Social Security Act to establish a new rebate system for selected drugs and biological products under Medicare Part B. The legislation introduces a mechanism where drug manufacturers must provide rebates for certain high-cost drugs, primarily focusing on cancer and complex therapies. When a selected drug is prescribed, instead of using the traditional Average Sales Price plus 6% (ASP+6) payment method, the bill establishes a new Maximum Fair Price (MFP) calculation that reduces patient coinsurance. Manufacturers will be required to report quarterly on the number of drug units used and provide rebates based on the difference between the traditional ASP+6 payment amount and the new MFP payment amount. These rebates will be deposited into the Federal Supplementary Medical Insurance Trust Fund, with the goal of lowering out-of-pocket costs for Medicare patients. The bill includes provisions for civil monetary penalties if manufacturers fail to comply with the new rebate requirements and makes several technical amendments to existing Medicare payment regulations to implement this new system. Ultimately, the legislation aims to make high-cost drugs more affordable for patients while maintaining a sustainable framework for drug manufacturers.

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https://www.congress.gov/bill/119th-congress/house-bill/4299/all-info