S. 2770: Share the Savings with Seniors Act

The Share the Savings with Seniors Act aims to amend Medicare Part D's coverage for chronic care drugs, ensuring that seniors have proper cost-sharing options. Here’s a breakdown of the key components of the bill:

Cost-Sharing for Chronic Care Drugs

Starting from January 1, 2027, the bill specifies how cost-sharing for chronic care drugs will be handled:

• For costs below the annual deductible, cost-sharing for these drugs must not exceed the net price of the drug.
• For costs above the annual deductible and below the out-of-pocket threshold, any coinsurance amounts must be based on a percentage of the net price of the drug.

Exceptions

There are exceptions in cases where cost-sharing is based on a fixed copayment that does not refer to the drug's price or benchmark price. This is important for plans that may offer more predictable payment structures.

Definitions

The bill also provides definitions for specific terms:

• Chronic care drug: Refers to prescribed drugs used in the management of chronic conditions, including but not limited to:
• Blood glucose regulators (excluding insulins)
• Anti-inflammatories and inhaled corticosteroids
• Bronchodilators
• Anticoagulants
• Cardiovascular agents
• Net price: Refers to the price after all concessions from manufacturers that are expected to be received by the plan or pharmacy benefit manager.

Coverage for Low-Income Individuals

The bill mandates that the copayment amounts for chronic care drugs furnished to low-income individuals must not exceed the respective cost-sharing under their specific prescription drug plans starting in 2027.

Regulations Implementation

To facilitate the implementation of these changes, the Secretary of Health and Human Services is authorized to initially apply the amendments through interim final regulations.

Relevant Companies

• PFE - Pfizer Inc.: As a major manufacturer of chronic care drugs, changes in Medicare reimbursement policies could directly affect their sales and pricing strategies for these drugs.
• ABBV - AbbVie Inc.: AbbVie produces a range of chronic medications, including those for conditions listed in the bill, which might influence their market approach if Medicare policies alter pricing models.
• JNJ - Johnson & Johnson: As a pharmaceutical company with chronic care drugs in its portfolio, the legislation could impact their market access and reimbursement dynamics.
• NVS - Novartis AG: Novartis develops various chronic disease treatments; thus, the bill may affect their pricing and medical plan negotiations.