Bill > HR5197

This bill aims to limit cost-sharing for prescription drugs under Medicare Part D by introducing new restrictions on drug pricing starting in 2027. Specifically, the bill requires that cost-sharing for a month's supply of a covered prescription drug cannot exceed the drug's average net price (defined as the average amount paid for the drug, minus any rebates) or the pharmacy's applicable cash price (the price charged to uninsured patients). This means Medicare beneficiaries would pay no more than the actual lowest price of the drug, potentially reducing out-of-pocket expenses. The bill applies to drugs dispensed by pharmacies before a patient reaches their out-of-pocket spending threshold. It also includes a provision for low-income individuals to ensure their copayments align with these new pricing rules. Additionally, the bill requires the Government Accountability Office (GAO) to submit a report by January 1, 2029, analyzing compliance, enforcement, and potential improvements to the new drug pricing mechanism. The goal is to protect Medicare beneficiaries from excessive drug costs by limiting what they pay to the actual net price of medications.

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https://www.congress.gov/bill/119th-congress/house-bill/5197/all-info