II 

117TH CONGRESS 

2D SESSION S. 4011 

To amend title XVIII of the Social Security Act to provide for a cap on 

beneficiary liability under part D of the Medicare program, and for 

other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 6, 2022 

Mr. WARNOCK 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 provide 

for a cap on beneficiary liability under part D of the 

Medicare program, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Capping Drug Costs 

5 for Seniors Act of 2022’’. 

6 SEC. 2. MEDICARE PART D BENEFIT REDESIGN. 

7 (a) BENEFIT STRUCTURE REDESIGN.—Section 

8 1860D–2(b) of the Social Security Act (42 U.S.C. 1395w– 

9 102(b)) is amended— 


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1 (1) in paragraph (2)— 

2 (A) in subparagraph (A), in the matter 

3 preceding clause (i), by inserting ‘‘for a year 

4 preceding 2025 and for costs above the annual 

5 deductible specified in paragraph (1) and up to 

6 the annual out-of-pocket threshold specified in 

7 paragraph (4)(B) for 2025 and each subsequent 

8 year’’ after ‘‘paragraph (3)’’; 

9 (B) in subparagraph (C)— 

10 (i) in clause (i), in the matter pre11 ceding subclause (I), by inserting ‘‘for a 

12 year preceding 2025,’’ after ‘‘paragraph 

13 (4),’’; and 

14 (ii) in clause (ii)(III), by striking 

15 ‘‘2020 and each subsequent year’’ and in16 serting ‘‘each of years 2020 through 

17 2024,’’; and 

18 (C) in subparagraph (D)— 

19 (i) in clause (i)— 

20 (I) in the matter preceding sub21 clause (I), by inserting ‘‘for a year 

22 preceding 2025,’’ after ‘‘paragraph 

23 (4),’’; and 

24 (II) in subclause (I)(bb), by 

25 striking ‘‘a year after 2018’’ and inVerDate Sep 11 2014 04:58 Apr 07, 2022 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4011.IS S4011

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1 serting ‘‘each of years 2018 through 

2 2024’’; and 

3 (ii) in clause (ii)(V), by striking 

4 ‘‘2019 and each subsequent year’’ and in5 serting ‘‘each of years 2019 through 

6 2024’’; 

7 (2) in paragraph (3)(A)— 

8 (A) in the matter preceding clause (i), by 

9 inserting ‘‘for a year preceding 2025,’’ after 

10 ‘‘and (4),’’; and 

11 (B) in clause (ii), by striking ‘‘for a subse12 quent year’’ and inserting ‘‘for each of years 

13 2007 through 2024’’; and 

14 (3) in paragraph (4)— 

15 (A) in subparagraph (A)— 

16 (i) in clause (i)— 

17 (I) by redesignating subclauses 

18 (I) and (II) as items (aa) and (bb), 

19 respectively, and moving the margin 

20 of each such redesignated item 2 ems 

21 to the right; 

22 (II) in the matter preceding item 

23 (aa), as redesignated by subclause (I), 

24 by striking ‘‘is equal to the greater 

25 of—’’ and inserting ‘‘is equal to— 


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1 ‘‘(I) for a year preceding 2025, 

2 the greater of—’’; 

3 (III) by striking the period at the 

4 end of item (bb), as redesignated by 

5 subclause (I), and inserting ‘‘; and’’; 

6 and 

7 (IV) by adding at the end the fol8 lowing: 

9 ‘‘(II) for 2025 and each suc10 ceeding year, $0.’’; and 

11 (ii) in clause (ii)— 

12 (I) by striking ‘‘clause (i)(I)’’ and 

13 inserting ‘‘clause (i)(I)(aa)’’; and 

14 (II) by adding at the end the fol15 lowing new sentence: ‘‘The Secretary 

16 shall continue to calculate the dollar 

17 amounts specified in clause (i)(I)(aa), 

18 including with the adjustment under 

19 this clause, after 2024 for purposes of 

20 section 1860D–14(a)(1)(D)(iii).’’; 

21 (B) in subparagraph (B)— 

22 (i) in clause (i)— 

23 (I) in subclause (V), by striking 

24 ‘‘or’’ at the end; 

25 (II) in subclause (VI)— 


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1 (aa) by striking ‘‘for a sub2 sequent year’’ and inserting ‘‘for 

3 each of years 2021 through 

4 2024’’; and 

5 (bb) by striking the period 

6 at the end and inserting a semi7 colon; and 

8 (III) by adding at the end the 

9 following new subclauses: 

10 ‘‘(VII) for 2025, is equal to 

11 $2,000; or 

12 ‘‘(VIII) for a subsequent year, is 

13 equal to the amount specified in this 

14 subparagraph for the previous year, 

15 increased by the annual percentage in16 crease described in paragraph (6) for 

17 the year involved.’’; and 

18 (ii) in clause (ii), by striking ‘‘clause 

19 (i)(II)’’ and inserting ‘‘clause (i)’’; 

20 (C) in subparagraph (C)(i), by striking 

21 ‘‘and for amounts’’ and inserting ‘‘and, for a 

22 year preceding 2025, for amounts’’; and 

23 (D) in subparagraph (E), by striking ‘‘In 

24 applying’’ and inserting ‘‘For each of years 

25 2011 through 2024, in applying’’. 


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1 (b) REINSURANCE PAYMENT AMOUNT.—Section 

2 1860D–15(b)(1) of the Social Security Act (42 U.S.C. 

3 1395w–115(b)(1)) is amended— 

4 (1) by striking ‘‘equal to 80 percent’’ and in5 serting ‘‘equal to— 

6 ‘‘(A) for a year preceding 2025, 80 per7 cent’’; 

8 (2) in subparagraph (A), as added by subpara9 graph (A), by striking the period at the end and in10 serting ‘‘; and’’; and 

11 (3) by adding at the end the following new sub12 paragraph: 

13 ‘‘(B) for 2025 and each subsequent year, 

14 the sum of— 

15 ‘‘(i) with respect to applicable drugs 

16 (as defined in section 1860D–14B(g)(2)), 

17 an amount equal to 20 percent of such al18 lowable reinsurance costs attributable to 

19 that portion of gross covered prescription 

20 drug costs as specified in paragraph (3) in21 curred in the coverage year after such indi22 vidual has incurred costs that exceed the 

23 annual out-of-pocket threshold specified in 

24 section 1860D–2(b)(4)(B); and 


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1 ‘‘(ii) with respect to covered part D 

2 drugs that are not applicable drugs (as so 

3 defined), an amount equal to 40 percent of 

4 such allowable reinsurance costs attrib5 utable to that portion of gross covered pre6 scription drug costs as specified in para7 graph (3) incurred in the coverage year 

8 after such individual has incurred costs 

9 that exceed the annual out-of-pocket 

10 threshold specified in section 1860D– 

11 2(b)(4)(B).’’. 

12 (c) MANUFACTURER DISCOUNT PROGRAM.— 

13 (1) IN GENERAL.—Part D of title XVIII of the 

14 Social Security Act (42 U.S.C. 1395w–101 et seq.) 

15 is amended by inserting after section 1860D–14A 

16 the following new section: 

17 ‘‘SEC. 1860D–14B. MANUFACTURER DISCOUNT PROGRAM. 

18 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab19 lish a manufacturer discount program (in this section re20 ferred to as the ‘program’). Under the program, the Sec21 retary shall enter into agreements described in subsection 

22 (b) with manufacturers and provide for the performance 

23 of the duties described in subsection (c). 

24 ‘‘(b) TERMS OF AGREEMENT.— 

25 ‘‘(1) IN GENERAL.— 


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1 ‘‘(A) AGREEMENT.—An agreement under 

2 this section shall require the manufacturer to 

3 provide, in accordance with this section, access 

4 to discounted prices for applicable drugs of the 

5 manufacturer that are dispensed to applicable 

6 beneficiaries on or after January 1, 2025. 

7 ‘‘(B) CLARIFICATION.—Nothing in this 

8 section shall be construed as affecting— 

9 ‘‘(i) the application of a coinsurance 

10 of 25 percent of the negotiated price, as 

11 applied under paragraph (2)(A) of section 

12 1860D–2(b), for costs described in such 

13 paragraph; or 

14 ‘‘(ii) the application of the copayment 

15 amount described in paragraph (4)(A) of 

16 such section, with respect to costs de17 scribed in such paragraph. 

18 ‘‘(C) TIMING OF AGREEMENT.— 

19 ‘‘(i) SPECIAL RULE FOR 2025.—In 

20 order for an agreement with a manufac21 turer to be in effect under this section with 

22 respect to the period beginning on January 

23 1, 2025, and ending on December 31, 

24 2025, the manufacturer shall enter into 


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1 such agreement not later than March 1, 

2 2024. 

3 ‘‘(ii) 2026 AND SUBSEQUENT

4 YEARS.—In order for an agreement with a 

5 manufacturer to be in effect under this 

6 section with respect to plan year 2026 or 

7 a subsequent plan year, the manufacturer 

8 shall enter into such agreement (or such 

9 agreement shall be renewed under para10 graph (4)(A)) not later than a calendar 

11 quarter or semi-annual deadline estab12 lished by the Secretary. 

13 ‘‘(2) PROVISION OF APPROPRIATE DATA.—Each 

14 manufacturer with an agreement in effect under this 

15 section shall collect and have available appropriate 

16 data, as determined by the Secretary, to ensure that 

17 it can demonstrate to the Secretary compliance with 

18 the requirements under the program. 

19 ‘‘(3) COMPLIANCE WITH REQUIREMENTS FOR

20 ADMINISTRATION OF PROGRAM.—Each manufac21 turer with an agreement in effect under this section 

22 shall comply with requirements imposed by the Sec23 retary for purposes of administering the program, 

24 including any determination under subparagraph (A) 


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1 of subsection (c)(1) or procedures established under 

2 such subsection (c)(1). 

3 ‘‘(4) LENGTH OF AGREEMENT.— 

4 ‘‘(A) IN GENERAL.—An agreement under 

5 this section shall be effective for an initial pe6 riod of not less than 12 months and shall be 

7 automatically renewed for a period of not less 

8 than 1 year unless terminated under subpara9 graph (B). 

10 ‘‘(B) TERMINATION.— 

11 ‘‘(i) BY THE SECRETARY.—The Sec12 retary may provide for termination of an 

13 agreement under this section for a knowing 

14 and willful violation of the requirements of 

15 the agreement or other good cause shown. 

16 Such termination shall not be effective ear17 lier than 30 days after the date of notice 

18 to the manufacturer of such termination. 

19 The Secretary shall provide, upon request, 

20 a manufacturer with a hearing concerning 

21 such a termination, and such hearing shall 

22 take place prior to the effective date of the 

23 termination with sufficient time for such 

24 effective date to be repealed if the Sec25 retary determines appropriate. 


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1 ‘‘(ii) BY A MANUFACTURER.—A man2 ufacturer may terminate an agreement 

3 under this section for any reason. Any 

4 such termination shall be effective, with re5 spect to a plan year— 

6 ‘‘(I) if the termination occurs be7 fore January 31 of a plan year, as of 

8 the day after the end of the plan year; 

9 and 

10 ‘‘(II) if the termination occurs on 

11 or after January 31 of a plan year, as 

12 of the day after the end of the suc13 ceeding plan year. 

14 ‘‘(iii) EFFECTIVENESS OF TERMI15 NATION.—Any termination under this sub16 paragraph shall not affect discounts for 

17 applicable drugs of the manufacturer that 

18 are due under the agreement before the ef19 fective date of its termination. 

20 ‘‘(c) DUTIES DESCRIBED.—The duties described in 

21 this subsection are the following: 

22 ‘‘(1) ADMINISTRATION OF PROGRAM.—Admin23 istering the program, including— 


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1 ‘‘(A) the determination of the amount of 

2 the discounted price of an applicable drug of a 

3 manufacturer; 

4 ‘‘(B) the establishment of procedures to 

5 ensure that, not later than the applicable num6 ber of calendar days after the dispensing of an 

7 applicable drug by a pharmacy or mail order 

8 service, the pharmacy or mail order service is 

9 reimbursed for an amount equal to the dif10 ference between— 

11 ‘‘(i) the negotiated price of the appli12 cable drug; and 

13 ‘‘(ii) the discounted price of the appli14 cable drug; 

15 ‘‘(C) the establishment of procedures to 

16 ensure that the discounted price for an applica17 ble drug under this section is applied before any 

18 coverage or financial assistance under other 

19 health benefit plans or programs that provide 

20 coverage or financial assistance for the pur21 chase or provision of prescription drug coverage 

22 on behalf of applicable beneficiaries as the Sec23 retary may specify; and 

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1 tween manufacturers and applicable bene2 ficiaries. 

3 ‘‘(2) MONITORING COMPLIANCE.—The Sec4 retary shall monitor compliance by a manufacturer 

5 with the terms of an agreement under this section. 

6 ‘‘(3) COLLECTION OF DATA FROM PRESCRIP7 TION DRUG PLANS AND MA–PD PLANS.—The Sec8 retary may collect appropriate data from prescrip9 tion drug plans and MA–PD plans in a timeframe 

10 that allows for discounted prices to be provided for 

11 applicable drugs under this section. 

12 ‘‘(d) ADMINISTRATION.— 

13 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

14 the Secretary shall provide for the implementation of 

15 this section, including the performance of the duties 

16 described in subsection (c). 

17 ‘‘(2) LIMITATION.—In providing for the imple18 mentation of this section, the Secretary shall not re19 ceive or distribute any funds of a manufacturer 

20 under the program. 

21 ‘‘(3) IMPLEMENTATION.—The Secretary may 

22 implement the program under this section by pro23 gram instruction or otherwise. 


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1 ‘‘(4) ADMINISTRATION.—Chapter 35 of title 44, 

2 United States Code, shall not apply to the program 

3 under this section. 

4 ‘‘(e) ENFORCEMENT.— 

5 ‘‘(1) AUDITS.—Each manufacturer with an 

6 agreement in effect under this section shall be sub7 ject to periodic audit by the Secretary. 

8 ‘‘(2) CIVIL MONEY PENALTY.— 

9 ‘‘(A) IN GENERAL.—The Secretary may 

10 impose a civil money penalty on a manufacturer 

11 that fails to provide discounts for applicable 

12 drugs of the manufacturer dispensed to applica13 ble beneficiaries in accordance with such agree14 ment for each such failure in an amount the 

15 Secretary determines is equal to the sum of— 

16 ‘‘(i) the amount that the manufac17 turer would have paid with respect to such 

18 discounts under the agreement, which will 

19 then be used to pay the discounts which 

20 the manufacturer had failed to provide; 

21 and 

22 ‘‘(ii) 25 percent of such amount. 

23 ‘‘(B) APPLICATION.—The provisions of 

24 section 1128A (other than subsections (a) and 

25 (b)) shall apply to a civil money penalty under 


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1 this paragraph in the same manner as such 

2 provisions apply to a penalty or proceeding 

3 under section 1128A(a). 

4 ‘‘(f) CLARIFICATION REGARDING AVAILABILITY OF

5 OTHER COVERED PART D DRUGS.—Nothing in this sec6 tion shall prevent an applicable beneficiary from pur7 chasing a covered part D drug that is not an applicable 

8 drug (including a generic drug or a drug that is not on 

9 the formulary of the prescription drug plan or MA–PD 

10 plan that the applicable beneficiary is enrolled in). 

11 ‘‘(g) DEFINITIONS.—In this section: 

12 ‘‘(1) APPLICABLE BENEFICIARY.—The term 

13 ‘applicable beneficiary’ means an individual who, on 

14 the date of dispensing a covered part D drug— 

15 ‘‘(A) is enrolled in a prescription drug plan 

16 or an MA–PD plan; 

17 ‘‘(B) is not enrolled in a qualified retiree 

18 prescription drug plan; and 

19 ‘‘(C) has incurred costs, as determined in 

20 accordance with section 1860D–2(b)(4)(C), for 

21 covered part D drugs in the year that exceed 

22 the annual deductible for such year, as specified 

23 in section 1860D–2(b)(1). 


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1 ‘‘(2) APPLICABLE DRUG.—The term ‘applicable 

2 drug’, with respect to an applicable beneficiary, 

3 means a covered part D drug— 

4 ‘‘(A) approved under a new drug applica5 tion under section 505(c) of the Federal Food, 

6 Drug, and Cosmetic Act or, in the case of a bio7 logic product, licensed under section 351 of the 

8 Public Health Service Act; and 

9 ‘‘(B)(i) if the PDP sponsor of the prescrip10 tion drug plan or the MA organization offering 

11 the MA–PD plan uses a formulary, which is on 

12 the formulary of the prescription drug plan or 

13 MA–PD plan that the applicable beneficiary is 

14 enrolled in; 

15 ‘‘(ii) if the PDP sponsor of the prescrip16 tion drug plan or the MA organization offering 

17 the MA–PD plan does not use a formulary, for 

18 which benefits are available under the prescrip19 tion drug plan or MA–PD plan that the appli20 cable beneficiary is enrolled in; or 

21 ‘‘(iii) is provided through an exception or 

22 appeal. 

23 ‘‘(3) APPLICABLE NUMBER OF CALENDAR

24 DAYS.—The term ‘applicable number of calendar 

25 days’ means— 


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1 ‘‘(A) with respect to claims for reimburse2 ment submitted electronically, 14 days; and 

3 ‘‘(B) with respect to claims for reimburse4 ment submitted otherwise, 30 days. 

5 ‘‘(4) DISCOUNTED PRICE.— 

6 ‘‘(A) IN GENERAL.—The term ‘discounted 

7 price’ means, with respect to an applicable drug 

8 of a manufacturer dispensed during a year to 

9 an applicable beneficiary— 

10 ‘‘(i) who has not incurred costs, as de11 termined in accordance with section 

12 1860D–2(b)(4)(C), for covered part D 

13 drugs in the year that are equal to or ex14 ceed the annual out-of-pocket threshold 

15 specified in section 1860D–2(b)(4)(B)(i) 

16 for the year, 90 percent of the negotiated 

17 price of such drug; and 

18 ‘‘(ii) who has incurred such costs, as 

19 so determined, in the year that are equal 

20 to or exceed such threshold for the year, 

21 80 percent of the negotiated price of such 

22 drug. 

23 ‘‘(B) CLARIFICATION.—Nothing in this 

24 section shall be construed as affecting the reVerDate Sep 11 2014 04:58 Apr 07, 2022 Jkt 029200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S4011.IS S4011

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1 sponsibility of an applicable beneficiary for pay2 ment of a dispensing fee for an applicable drug. 

3 ‘‘(C) SPECIAL CASE FOR CERTAIN

4 CLAIMS.— 

5 ‘‘(i) CLAIMS SPANNING DEDUCT6 IBLE.—In the case where the entire 

7 amount of the negotiated price of an indi8 vidual claim for an applicable drug with re9 spect to an applicable beneficiary does not 

10 fall above the annual deductible specified 

11 in section 1860D–2(b)(1) for the year, the 

12 manufacturer of the applicable drug shall 

13 provide the discounted price under this 

14 section on only the portion of the nego15 tiated price of the applicable drug that 

16 falls above such annual deductible. 

17 ‘‘(ii) CLAIMS SPANNING OUT-OF-POCK18 ET THRESHOLD.—In the case where the 

19 entire amount of the negotiated price of an 

20 individual claim for an applicable drug 

21 with respect to an applicable beneficiary 

22 does not fall entirely below or entirely 

23 above the annual out-of-pocket threshold 

24 specified in section 1860D–2(b)(4)(B)(i) 

25 for the year, the manufacturer of the apVerDate Sep 11 2014 04:58 Apr 07, 2022 Jkt 029200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S4011.IS S4011

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1 plicable drug shall provide the discounted 

2 price— 

3 ‘‘(I) in accordance with subpara4 graph (A)(i) on the portion of the ne5 gotiated price of the applicable drug 

6 that falls below such threshold; and 

7 ‘‘(II) in accordance with subpara8 graph (A)(ii) on the portion of such 

9 price of such drug that falls at or 

10 above such threshold. 

11 ‘‘(5) MANUFACTURER.—The term ‘manufac12 turer’ means any entity which is engaged in the pro13 duction, preparation, propagation, compounding, 

14 conversion, or processing of prescription drug prod15 ucts, either directly or indirectly by extraction from 

16 substances of natural origin, or independently by 

17 means of chemical synthesis, or by a combination of 

18 extraction and chemical synthesis. Such term does 

19 not include a wholesale distributor of drugs or a re20 tail pharmacy licensed under State law. 

21 ‘‘(6) NEGOTIATED PRICE.—The term ‘nego22 tiated price’ has the meaning given such term for 

23 purposes of section 1860D–2(d)(1)(B), except that 

24 such negotiated price shall not include any dis25 pensing fee for the applicable drug. 


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1 ‘‘(7) QUALIFIED RETIREE PRESCRIPTION DRUG

2 PLAN.—The term ‘qualified retiree prescription drug 

3 plan’ has the meaning given such term in section 

4 1860D–22(a)(2).’’. 

5 (2) SUNSET OF MEDICARE COVERAGE GAP DIS6 COUNT PROGRAM.—Section 1860D–14A of the So7 cial Security Act (42 U.S.C. 1395–114a) is amend8 ed— 

9 (A) in subsection (a), in the first sentence, 

10 by striking ‘‘The Secretary’’ and inserting 

11 ‘‘Subject to subsection (h), the Secretary’’; and 

12 (B) by adding at the end the following new 

13 subsection: 

14 ‘‘(h) SUNSET OF PROGRAM.— 

15 ‘‘(1) IN GENERAL.—The program shall not 

16 apply with respect to applicable drugs dispensed on 

17 or after January 1, 2025, and, subject to paragraph 

18 (2), agreements under this section shall be termi19 nated as of such date. 

20 ‘‘(2) CONTINUED APPLICATION FOR APPLICA21 BLE DRUGS DISPENSED PRIOR TO SUNSET.—The 

22 provisions of this section (including all responsibil23 ities and duties) shall continue to apply after Janu24 ary 1, 2025, with respect to applicable drugs dis25 pensed prior to such date.’’. 


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1 (3) INCLUSION OF ACTUARIAL VALUE OF MANU2 FACTURER DISCOUNTS IN BIDS.—Section 1860D–11 

3 of the Social Security Act (42 U.S.C. 1395w–111) 

4 is amended— 

5 (A) in subsection (b)(2)(C)(iii)— 

6 (i) by striking ‘‘assumptions regarding 

7 the reinsurance’’ an inserting ‘‘assump8 tions regarding— 

9 ‘‘(I) the reinsurance’’; and 

10 (ii) by adding at the end the fol11 lowing: 

12 ‘‘(II) for 2025 and each subse13 quent year, the manufacturer dis14 counts provided under section 1860D– 

15 14B subtracted from the actuarial 

16 value to produce such bid; and’’; and 

17 (B) in subsection (c)(1)(C)— 

18 (i) by striking ‘‘an actuarial valuation 

19 of the reinsurance’’ and inserting ‘‘an ac20 tuarial valuation of— 

21 ‘‘(i) the reinsurance’’; 

22 (ii) in clause (i), as inserted by clause 

23 (i) of this subparagraph, by adding ‘‘and’’ 

24 at the end; and 


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1 (iii) by adding at the end the fol2 lowing: 

3 ‘‘(ii) for 2025 and each subsequent 

4 year, the manufacturer discounts provided 

5 under section 1860D–14B;’’. 

6 (d) CONFORMING AMENDMENTS.— 

7 (1) Section 1860D–2 of the Social Security Act 

8 (42 U.S.C. 1395w–102) is amended— 

9 (A) in subsection (a)(2)(A)(i)(I), by strik10 ing ‘‘, or an increase in the initial’’ and insert11 ing ‘‘or, for a year preceding 2025, an increase 

12 in the initial’’; 

13 (B) in subsection (c)(1)(C)— 

14 (i) in the subparagraph heading, by 

15 striking ‘‘AT INITIAL COVERAGE LIMIT’’; 

16 and 

17 (ii) by inserting ‘‘for a year preceding 

18 2025 or the annual out-of-pocket threshold 

19 specified in subsection (b)(4)(B) for the 

20 year for 2025 and each subsequent year’’ 

21 after ‘‘subsection (b)(3) for the year’’ each 

22 place it appears; and 

23 (C) in subsection (d)(1)(A), by striking ‘‘or 

24 an initial’’ and inserting ‘‘or, for a year pre25 ceding 2025, an initial’’. 


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1 (2) Section 1860D–4(a)(4)(B)(i) of the Social 

2 Security Act (42 U.S.C. 1395w–104(a)(4)(B)(i)) is 

3 amended by striking ‘‘the initial’’ and inserting ‘‘for 

4 a year preceding 2025, the initial’’. 

5 (3) Section 1860D–14(a) of the Social Security 

6 Act (42 U.S.C. 1395w–114(a)) is amended— 

7 (A) in paragraph (1)— 

8 (i) in subparagraph (C), by striking 

9 ‘‘The continuation’’ and inserting ‘‘For a 

10 year preceding 2025, the continuation’’; 

11 (ii) in subparagraph (D)(iii), by strik12 ing ‘‘1860D–2(b)(4)(A)(i)(I)’’ and insert13 ing ‘‘1860D–2(b)(4)(A)(i)(I)(aa)’’; and 

14 (iii) in subparagraph (E), by striking 

15 ‘‘The elimination’’ and inserting ‘‘For a 

16 year preceding 2025, the elimination’’; and 

17 (B) in paragraph (2)— 

18 (i) in subparagraph (C), by striking 

19 ‘‘The continuation’’ and inserting ‘‘For a 

20 year preceding 2025, the continuation’’; 

21 and 

22 (ii) in subparagraph (E), by striking 

23 ‘‘1860D–2(b)(4)(A)(i)(I)’’ and inserting 

24 ‘‘1860D–2(b)(4)(A)(i)(I)(aa) (for a year 

25 preceding 2025)’’. 


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1 (4) Section 1860D–21(d)(7) of the Social Secu2 rity Act (42 U.S.C. 1395w–131(d)(7)) is amended 

3 by striking ‘‘section 1860D–2(b)(4)(B)(i)’’ and in4 serting ‘‘section 1860D–2(b)(4)(C)(i)’’. 

5 (5) Section 1860D–22(a)(2)(A) of the Social 

6 Security Act (42 U.S.C. 1395w–132(a)(2)(A)) is 

7 amended— 

8 (A) by striking ‘‘the value of any discount’’ 

9 and inserting the following: ‘‘the value of— 

10 ‘‘(i) for years prior to 2025, any dis11 count’’; 

12 (B) in clause (i), as inserted by subpara13 graph (A) of this paragraph, by striking the pe14 riod at the end and inserting ‘‘; and’’; and 

15 (C) by adding at the end the following new 

16 clause: 

17 ‘‘(ii) for 2025 and each subsequent 

18 year, any discount provided pursuant to 

19 section 1860D–14B.’’. 

20 (6) Section 1860D–41(a)(6) of the Social Secu21 rity Act (42 U.S.C. 1395w–151(a)(6)) is amended— 

22 (A) by inserting ‘‘for a year before 2025’’ 

23 after ‘‘1860D–2(b)(3)’’; and 

24 (B) by inserting ‘‘for such year’’ before the 

25 period. 


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25 

•S 4011 IS

1 (7) Section 1860D–43 of the Social Security 

2 Act (42 U.S.C. 1395w–153) is amended— 

3 (A) in subsection (a)— 

4 (i) by striking paragraph (1) and in5 serting the following: 

6 ‘‘(1) participate in— 

7 ‘‘(A) for 2011 through 2024, the Medicare 

8 coverage gap discount program under section 

9 1860D–14A; and 

10 ‘‘(B) for 2025 and each subsequent year, 

11 the manufacturer discount program under sec12 tion 1860D–14B;’’; 

13 (ii) by striking paragraph (2) and in14 serting the following: 

15 ‘‘(2) have entered into and have in effect— 

16 ‘‘(A) for 2011 through 2024, an agreement 

17 described in subsection (b) of section 1860D– 

18 14A with the Secretary; and 

19 ‘‘(B) for 2025 and each subsequent year, 

20 an agreement described in subsection (b) of sec21 tion 1860D–14B with the Secretary; and’’; and 

22 (iii) in paragraph (3), by striking 

23 ‘‘such section’’ and inserting ‘‘section 

24 1860D–14A’’; and 


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26 

•S 4011 IS

1 (B) by striking subsection (b) and insert2 ing the following: 

3 ‘‘(b) EFFECTIVE DATE.—Paragraphs (1)(A), (2)(A), 

4 and (3) of subsection (a) shall apply to covered part D 

5 drugs dispensed under this part on or after January 1, 

6 2011, and before January 1, 2025, and paragraphs (1)(B) 

7 and (2)(B) of such subsection shall apply to covered part 

8 D drugs dispensed under this part on or after January 

9 1, 2025.’’. 

10 (8) Section 1927 of the Social Security Act (42 

11 U.S.C. 1396r–8) is amended— 

12 (A) in subsection (c)(1)(C)(i)(VI), by in13 serting before the period at the end the fol14 lowing: ‘‘or under the manufacturer discount 

15 program under section 1860D–14B’’; and 

16 (B) in subsection (k)(1)(B)(i)(V), by in17 serting before the period at the end the fol18 lowing: ‘‘or under section 1860D–14B’’. 

19 (e) EFFECTIVE DATE.—The amendments made by 

20 this section shall apply with respect to plan year 2025 and 

21 subsequent plan years. 

Æ 


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