S. 2617: Reducing Drug Prices for Seniors Act.

This bill, titled the Reducing Drug Prices for Seniors Act, proposes changes to how coinsurance for prescription drugs under Medicare Part D is calculated. Here’s a breakdown of its key provisions:

Changes to Coinsurance Calculation

The bill amends the Social Security Act to require that the coinsurance amount for covered Part D drugs be based on the net price of the drug rather than its list price. This change is aimed at reducing out-of-pocket costs for seniors who are enrolled in Medicare.

Definition of Net Price

Under the proposed legislation, the term net price refers to the negotiated price of a covered Part D drug, minus any price concessions provided by the manufacturer. This price is reported by the insurance plans offering Medicare coverage and is documented in a report known as the Detailed DIR Report.

Implementation Timeline

The changes would take effect for plan years beginning on or after January 1, 2026. This means that starting in 2026, the new calculation method for coinsurance will be enforced.

Exclusions

It is noted that this new calculation method will not apply to certain covered Part D drugs that are specified under paragraphs 8 and 9 of the current guidelines, although the bill does not specify the exact drugs in this context.

Overall Goal

The overall goal of the bill is to lower out-of-pocket costs for seniors who use prescription drugs, thereby making medication more affordable for those enrolled in Medicare.

Relevant Companies

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