Protect Beneficiaries from Middlemen Act
Sponsored By: Representative Malliotakis
Introduced
Summary
This bill would cap Medicare Part D cost sharing so a beneficiary's copay for a drug between the deductible and the out-of-pocket threshold cannot exceed the drug's average net price for the plan year or, if lower, the pharmacy's cash price. Effective for plan years beginning January 1, 2027, it defines both "cash price" and "average net price," aligns the copayment rules in Part D plan language, and requires the Government Accountability Office to report by January 1, 2029 on compliance, enforcement, and disclosure.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Cap Medicare Part D drug copays
For plan years starting on or after January 1, 2027, Medicare Part D plans would cap what you pay for each month’s supply of a covered drug. After the deductible and before your out-of-pocket limit, your copay would be no more than the lower of two amounts. One is the plan’s average net price for that drug for the year (including your cost sharing, minus rebates). The other is the pharmacy’s cash price for that month’s supply. People with the low-income subsidy would get the same cap; GAO would report on compliance by January 1, 2029.
Sponsors & CoSponsors
Sponsor
Malliotakis
NY • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
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