[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2474 Introduced in Senate (IS)]
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118th CONGRESS
1st Session
S. 2474
To amend title XVIII of the Social Security Act to ensure appropriate
cost-sharing for chronic care drugs under Medicare part D.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 25, 2023
Mr. Cornyn (for himself, Mr. Carper, Mr. Tillis, and Mr. Brown)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to ensure appropriate
cost-sharing for chronic care drugs under Medicare part D.
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 ``Share the Savings with Seniors
Act''.
SEC. 2. APPROPRIATE COST-SHARING FOR CHRONIC CARE DRUGS 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 (1)(A), in the matter preceding
clause (i), by striking ``and (9)'' and inserting ``,
(9), and (10)'';
(B) in paragraph (2)(A), in the matter preceding
clause (i), by striking ``and (9)'' and inserting ``,
(9), and (10)''; and
(C) by adding at the end the following new
paragraph:
``(10) Cost-sharing for chronic care drugs.--
``(A) In general.--For plan years beginning on or
after January 1, 2025, in the case of a chronic care
drug, the following shall apply:
``(i) For costs below the annual deductible
specified in paragraph (1), cost-sharing for
such drug shall not exceed the net price of
such drug.
``(ii) Subject to subparagraph (B), for
costs above the annual deductible specified in
paragraph (1) and below the out-of-pocket
threshold specified in paragraph (4), any
coinsurance amount for such drug shall be based
on a percentage of the net price of such drug.
``(B) Exception.--The requirement under
subparagraph (A)(ii) shall not apply to a chronic care
drug under a prescription drug plan if the cost-sharing
amount for such drug under such plan is based on a
copayment that is not tied to a percentage of a drug
price (such as the negotiated price, list price, or
wholesale acquisition cost), a drug benchmark price
(such as the average wholesale price), or a drug cost.
``(C) Definitions.--In this paragraph:
``(i) Chronic care drug.--The term `chronic
care drug' means a covered part D drug that is
included under any of the following United
States Pharmacopeia Convention (USP) categories
and classes of drugs, as included in the most
recent version of the USP Medicare Model
Guidelines:
``(I) Blood glucose regulators,
other than insulins.
``(II) Anti-inflammatories, inhaled
corticosteroids.
``(III) Bronchodilators,
anticholinergic.
``(IV) Bronchodilators,
sympathomimetic.
``(V) Respiratory tract agents,
other.
``(VI) Anticoagulants.
``(VII) Cardiovascular agents,
other.
``(VIII) Any category or class
identified by the Secretary or USP as a
successor to the categories and classes
described in subclauses (I) through
(VII) based on the most recent USP
Medicare Model Guidelines at the time
of such identification.
``(ii) Net price.--The term `net price'
means the negotiated price of the drug net of
all price concessions originating from
manufacturers that are received or expected to
be received by the plan or pharmacy benefit
manager on behalf of the plan for such product
and that are not already reflected in the
negotiated price.''; and
(2) in subsection (c), by adding at the end the following
new paragraph:
``(7) Cost-sharing for covered chronic care drugs.--The
coverage is provided in accordance with subsection (b)(10).''.
(b) Conforming Amendments 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 2025 and subsequent plan years,
the copayment amount applicable under the first sentence of this
subclause for a chronic drug (as defined in section 1860D-2(b)(10)(B))
furnished to the individual may not exceed the applicable cost-sharing
for such drug under the prescription drug plan or MA-PD plan in which
the individual is enrolled.''.
(c) Regulations.--Notwithstanding any other provision of law, the
Secretary of Health and Human Services shall initially implement the
amendments made by this section through interim final regulations.
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