[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2456 Introduced in Senate (IS)]
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118th CONGRESS
1st Session
S. 2456
To amend title XVIII of the Social Security Act to limit beneficiary
cost-sharing to the net price of covered part D drugs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 20, 2023
Mr. Casey (for himself and Mr. Cornyn) introduced the following bill;
which was read twice and referred to the Committee on Finance
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A BILL
To amend title XVIII of the Social Security Act to limit beneficiary
cost-sharing to the net price of covered part D drugs.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Protecting Seniors from High Drug
Costs Act''.
SEC. 2. PROTECTING SENIORS FROM EXCESSIVE COST-SHARING UNDER MEDICARE
PART D.
(a) In General.--Section 1860D-2 of the Social Security Act (42
U.S.C. 1395w-102) is amended--
(1) in subsection (b)--
(A) in paragraph (2)(A), in the matter preceding
clause (i), by striking ``and (9)'' and inserting ``,
(9), and (10)''; and
(B) by adding at the end the following new
paragraph:
``(10) Limiting cost-sharing to net price.--
``(A) In general.--For plan years beginning on or
after January 1, 2026, the cost-sharing (for costs
above the annual deductible specified in paragraph (1))
for a covered part D drug (other than a covered part D
drug described in paragraph (8) or (9)) shall not
exceed the applicable amount specified in subparagraph
(B).
``(B) Applicable amount specified.--The applicable
amount specified in this subparagraph, with respect to
a covered part D drug under a prescription drug plan or
an MA-PD plan, is the negotiated price of the covered
part D drug under the prescription drug plan or MA-PD
plan, net of any manufacturer-provided price
concessions (as defined under section 423.100 of title
42, Code of Federal Regulations (or any successor
regulation)), as reported for such drug in the Detailed
DIR Report (or any successor report) submitted by the
sponsor or organization offering the plan for the
previous plan year.
``(C) Enforcement.--
``(i) In general.--A PDP sponsor of a
prescription drug plan or an MA organization
offering an MA-PD plan that violates the
requirements under this paragraph, with respect
to a covered part D drug under such plan, may
be subject to a civil monetary penalty, as
determined appropriate by the Secretary.
``(ii) Application.--The provisions of
section 1128A (other than subsections (a) and
(b)) shall apply to a civil monetary penalty
under this subparagraph in the same manner as
such provisions apply to a penalty or
proceeding under section 1128A(a).''.
(2) in subsection (c), by adding at the end the following
new paragraph:
``(7) Limiting cost-sharing to net price.--The coverage is
provided in accordance with subsection (b)(10).''.
(b) Conforming Amendment to Cost-Sharing for Low-Income
Individuals.--Section 1860D-14(a)(1)(D)(iii) of the Social Security Act
(42 U.S.C. 1395w-114(a)(1)(D)(iii)) is amended by adding at the end the
following new sentence: ``For plan year 2026, and subsequent plan
years, the copayment amount applicable under this clause to a covered
part D drug dispensed to the individual may not exceed the applicable
amount specified in section 1860D-2(b)(10)(B) for the covered part D
drug under the prescription drug plan or MA-PD plan in which the
individual is enrolled.''.
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