Protecting Patient Access to Cancer and Complex Therapies Act
Sponsored By: Representative Murphy, Gregory F. [R-NC-3]
Introduced
Summary
Creates a mandatory quarterly manufacturer rebate tied to negotiated maximum fair prices for certain Medicare Part B drugs. It would change how Part B payments and coinsurance are calculated so beneficiaries pay based on the negotiated MFP+6 price and manufacturers refund the difference to Medicare.
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- Patients and families: Coinsurance for designated "selected drugs" would be calculated around the negotiated MFP+6 price, with coinsurance amounts defined as 20% of the payment amount, which can lower out-of-pocket costs when the negotiated price is below current pricing.
- Manufacturers: Makers of selected drugs would owe a quarterly rebate equal to the per-unit difference between the current ASP+6 price and the MFP+6 price times units. Manufacturers must pay within 30 days of each quarterly report and face civil money penalties for noncompliance.
- Medicare program and state programs: Rebates are deposited into the Federal Supplementary Medical Insurance Trust Fund and the bill aligns Part B payment and cost-sharing rules across outpatient settings. It also excludes these MFP rebates from average sales price calculations to keep them separate from ASP-based pricing.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 2 benefits, 0 costs, 0 mixed.
Lower Medicare coinsurance on negotiated Part B drugs
If enacted, some Medicare Part B drugs with a negotiated fair price would use a new coinsurance rule during the drug’s initial price period. Your coinsurance would be 20% of 106% of that fair price, converted to a percent of the usual Part B payment. If an inflation-based coinsurance would be lower, you would pay the lower amount. Medicare would pay the rest, and provider payments would adjust to match. The same method could apply in hospital outpatient and ambulatory surgery settings when the drug is billed on its own.
Drug makers would owe new Medicare rebates
The bill would make drug makers pay a quarterly rebate for selected Part B drugs with a negotiated fair price. The rebate per unit would equal the gap between the usual Part B rate and the fair‑price rate, including coinsurance, times the number of units. Medicare would report the units and amounts within six months after each quarter, and companies would have 30 days to pay. The money would go to the Medicare Supplementary Medical Insurance Trust Fund and would be on top of other required rebates. These payments would not be counted when calculating a drug’s average sales price, and civil money penalties would apply for nonpayment.
Sponsors & CoSponsors
Sponsor
Murphy, Gregory F. [R-NC-3]
NC • R
Cosponsors
Gray
CA • D
Sponsored 7/7/2025
Rep. Dunn, Neal P. [R-FL-2]
FL • R
Sponsored 7/7/2025
Rep. Carter, Earl L. "Buddy" [R-GA-1]
GA • R
Sponsored 7/29/2025
Joyce (PA)
PA • R
Sponsored 9/4/2025
Rep. Miller, Carol D. [R-WV-1]
WV • R
Sponsored 10/8/2025
Rep. Harris, Andy [R-MD-1]
MD • R
Sponsored 10/24/2025
Kean
NJ • R
Sponsored 10/24/2025
Rep. Miller, Max L. [R-OH-7]
OH • R
Sponsored 10/28/2025
Rep. Miller-Meeks, Mariannette [R-IA-1]
IA • R
Sponsored 10/28/2025
Kustoff
TN • R
Sponsored 10/28/2025
Balderson
OH • R
Sponsored 10/31/2025
Rep. Kennedy, Mike [R-UT-3]
UT • R
Sponsored 11/12/2025
Rep. Fitzpatrick, Brian K. [R-PA-1]
PA • R
Sponsored 12/16/2025
Kelly (PA)
PA • R
Sponsored 1/8/2026
Davis (NC)
NC • D
Sponsored 1/12/2026
Rep. Moore, Blake D. [R-UT-1]
UT • R
Sponsored 2/2/2026
Rep. Suozzi, Thomas R. [D-NY-3]
NY • D
Sponsored 2/2/2026
Pfluger
TX • R
Sponsored 2/2/2026
Gonzalez, V.
TX • D
Sponsored 2/4/2026
Peters
CA • D
Sponsored 4/2/2026
Cuellar
TX • D
Sponsored 4/9/2026
Bilirakis
FL • R
Sponsored 4/9/2026
Rep. Moran, Nathaniel [R-TX-1]
TX • R
Sponsored 4/9/2026
Rep. Gooden, Lance [R-TX-5]
TX • R
Sponsored 4/9/2026
Rep. Moskowitz, Jared [D-FL-23]
FL • D
Sponsored 4/16/2026
Rep. Tenney, Claudia [R-NY-24]
NY • R
Sponsored 4/22/2026
Rep. Sorensen, Eric [D-IL-17]
IL • D
Sponsored 4/27/2026
Crenshaw
TX • R
Sponsored 4/27/2026
Rep. Carey, Mike [R-OH-15]
OH • R
Sponsored 4/27/2026
Rep. Harrigan, Pat [R-NC-10]
NC • R
Sponsored 4/29/2026
Roll Call Votes
No roll call votes available for this bill.
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