I 

118TH CONGRESS 

1ST SESSION H. R. 4881 

To amend title XVIII of the Social Security Act to limit cost sharing for 

drugs under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 25, 2023 

Ms. MALLIOTAKIS (for herself and Mr. WENSTRUP) introduced the following 

bill; which was referred to the Committee on Energy and Commerce, and 

in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of 

such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to limit 

cost sharing for drugs under the Medicare program. 

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

3 SECTION 1. LIMITATION ON COST SHARING TO NET PRICE 

4 AMOUNT UNDER MEDICARE PART D. 

5 (a) IN GENERAL.—Section 1860D–2 of the Social 

6 Security Act (42 U.S.C. 1395w–102) is amended— 

7 (1) in subsection (b)— 

8 (A) in paragraph (2)(A), by striking ‘‘(8) 

9 and (9)’’ and inserting ‘‘(8), (9), and (10)’’; 


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1 (B) in paragraph (9)(B)(ii), by striking 

2 ‘‘For a plan year’’ and inserting ‘‘Subject to 

3 paragraph (10), for a plan year’’; and 

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

5 paragraph: 

6 ‘‘(10) LIMITATION ON COST SHARING TO NET

7 PRICE AMOUNT.— 

8 ‘‘(A) IN GENERAL.—For a plan year begin9 ning on or after January 1, 2027, the coverage 

10 provides benefits for a supply of a covered part 

11 D drug dispensed by a pharmacy, for costs in 

12 excess of the deductible specified in paragraph 

13 (1) and prior to an individual reaching the out14 of-pocket threshold under paragraph (4), with 

15 cost-sharing for a month’s supply that does not 

16 exceed the average net price for such a supply 

17 of such drug during such plan year (or, if 

18 lower, the applicable cash price for such a sup19 ply of such drug so dispensed by such phar20 macy). 

21 ‘‘(B) DEFINITIONS.—In this paragraph: 

22 ‘‘(i) APPLICABLE CASH PRICE.—The 

23 term ‘applicable cash price’ means, with 

24 respect to a supply of a covered part D 

25 drug dispensed by a pharmacy, the price 


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1 that such pharmacy would charge for such 

2 supply of such drug dispensed to an indi3 vidual without benefits for such drug 

4 under any Federal health care program (as 

5 defined in section 1128B), a group health 

6 plan or group or individual health insur7 ance coverage (as such terms are defined 

8 in section 2791 of the Public Health Serv9 ice Act), or the program established under 

10 chapter 89 of title 5, United States Code. 

11 ‘‘(ii) AVERAGE NET PRICE.—The term 

12 ‘average net price’ means, with respect to 

13 a supply of a covered part D drug, a pre14 scription drug plan, and a plan year, the 

15 average amount paid under such plan (in16 cluding any amounts paid by an individual 

17 enrolled under such plan as cost sharing 

18 for such drug) as payment for such a sup19 ply of such drug dispensed during such 

20 year, less any rebates or other forms of re21 muneration received under such plan with 

22 respect to such drug.’’; and 

23 (2) in subsection (c), by adding at the end the 

24 following new paragraph: 


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1 ‘‘(7) COST SHARING LIMITED TO NET PRICE.— 

2 The coverage is provided in accordance with sub3 section (b)(10).’’. 

4 (b) CONFORMING AMENDMENT TO COST-SHARING

5 FOR LOW-INCOME INDIVIDUALS.—Section 1860D– 

6 14(a)(1)(D)(iii) of the Social Security Act (42 U.S.C. 

7 1395w–114(a)(1)(D)(iii)) is amended by adding at the 

8 end the following new sentence: ‘‘For plan year 2027 and 

9 subsequent plan years, the copayment amount applicable 

10 under this clause to a supply of a covered part D drug 

11 dispensed to the individual may not exceed the amount 

12 provided under section 1860D–2(b)(10).’’. 

13 (c) GAO REPORT.—Not later than January 1, 2029, 

14 the Comptroller General of the United States shall submit 

15 to Congress a report containing— 

16 (1) an analysis of compliance with the amend17 ments made by this section; 

18 (2) an analysis of enforcement of such amend19 ments; 

20 (3) recommendations with respect to improving 

21 such enforcement; and 

22 (4) recommendations relating to improving pub23 lic disclosure, and public awareness of, the require24 ments of such amendments. 

Æ 


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