Bill > S2770

This bill amends Medicare Part D to establish new cost-sharing rules for "chronic care drugs" beginning in January 2027. Under the proposed changes, chronic care drugs would have cost-sharing limitations that ensure patients pay no more than the drug's net price (defined as the negotiated price minus manufacturer price concessions) before meeting their annual deductible. For costs above the deductible and below the out-of-pocket threshold, coinsurance would be calculated as a percentage of the drug's net price. The bill specifically defines chronic care drugs as medications in certain United States Pharmacopeia Convention categories, including drugs for blood glucose regulation, respiratory conditions, cardiovascular health, and anticoagulants. The legislation also ensures that low-income Medicare beneficiaries will have copayment protections for these chronic care drugs. An important exception allows prescription drug plans to maintain existing cost-sharing structures if their copayments are not directly tied to drug pricing metrics. The bill instructs the Department of Health and Human Services to implement these changes through interim final regulations, indicating a desire for relatively quick implementation of the new cost-sharing approach.

Budget and Finance

https://www.congress.gov/bill/119th-congress/senate-bill/2770/all-info