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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5376 Introduced in House (IH)]

<DOC>

118th CONGRESS
  1st Session
                                H. R. 5376

 To amend title XVIII of the Social Security Act to ensure appropriate 
       cost-sharing for chronic care drugs under Medicare part D.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           September 8, 2023

 Mrs. Miller-Meeks (for herself, Ms. Ross, Mr. Carter of Georgia, and 
 Mr. Peters) 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 ensure appropriate 
       cost-sharing for chronic care drugs under Medicare part D.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Share the Savings with Seniors 
Act''.

SEC. 2. APPROPRIATE COST-SHARING FOR CHRONIC CARE DRUGS UNDER MEDICARE 
              PART D.

    (a) In General.--Section 1860D-2 of the Social Security Act (42 
U.S.C. 1395w-102) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (1)(A), in the matter preceding 
                clause (i), by striking ``and (9)'' and inserting ``, 
                (9), and (10)'';
                    (B) in paragraph (2)(A), in the matter preceding 
                clause (i), by striking ``and (9)'' and inserting ``, 
                (9), and (10)''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(10) Cost-sharing for chronic care drugs.--
                    ``(A) In general.--For plan years beginning on or 
                after January 1, 2025, in the case of a chronic care 
                drug, the following shall apply:
                            ``(i) For costs below the annual deductible 
                        specified in paragraph (1), cost-sharing for 
                        such drug shall not exceed the net price of 
                        such drug.
                            ``(ii) Subject to subparagraph (B), for 
                        costs above the annual deductible specified in 
                        paragraph (1) and below the out-of-pocket 
                        threshold specified in paragraph (4), any 
                        coinsurance amount for such drug shall be based 
                        on a percentage of the net price of such drug.
                    ``(B) Exception.--The requirement under 
                subparagraph (A)(ii) shall not apply to a chronic care 
                drug under a prescription drug plan if the cost-sharing 
                amount for such drug under such plan is based on a 
                copayment that is not tied to a percentage of a drug 
                price (such as the negotiated price, list price, or 
                wholesale acquisition cost), a drug benchmark price 
                (such as the average wholesale price), or a drug cost.
                    ``(C) Definitions.--In this paragraph:
                            ``(i) Chronic care drug.--The term `chronic 
                        care drug' means a covered part D drug that is 
                        included under any of the following United 
                        States Pharmacopeia Convention (USP) categories 
                        and classes of drugs, as included in the most 
                        recent version of the USP Medicare Model 
                        Guidelines:
                                    ``(I) Blood glucose regulators, 
                                other than insulins.
                                    ``(II) Anti-inflammatories, inhaled 
                                corticosteroids.
                                    ``(III) Bronchodilators, 
                                anticholinergic.
                                    ``(IV) Bronchodilators, 
                                sympathomimetic.
                                    ``(V) Respiratory tract agents, 
                                other.
                                    ``(VI) Anticoagulants.
                                    ``(VII) Cardiovascular agents, 
                                other.
                                    ``(VIII) Any category or class 
                                identified by the Secretary or USP as a 
                                successor to the categories and classes 
                                described in subclauses (I) through 
                                (VII) based on the most recent USP 
                                Medicare Model Guidelines at the time 
                                of such identification.
                            ``(ii) Net price.--The term `net price' 
                        means the negotiated price of the drug net of 
                        all price concessions originating from 
                        manufacturers that are received or expected to 
                        be received by the plan or pharmacy benefit 
                        manager on behalf of the plan for such product 
                        and that are not already reflected in the 
                        negotiated price.''; and
            (2) in subsection (c), by adding at the end the following 
        new paragraph:
            ``(7) Cost-sharing for covered chronic care drugs.--The 
        coverage is provided in accordance with subsection (b)(10).''.
    (b) Conforming Amendments to Cost-Sharing for Low-Income 
Individuals.--Section 1860D-14(a)(1)(D)(iii) of the Social Security Act 
(42 U.S.C. 1395w-114(a)(1)(D)(iii)) is amended by adding at the end the 
following new sentence: ``For plan year 2025 and subsequent plan years, 
the copayment amount applicable under the first sentence of this 
subclause for a chronic drug (as defined in section 1860D-2(b)(10)(B)) 
furnished to the individual may not exceed the applicable cost-sharing 
for such drug under the prescription drug plan or MA-PD plan in which 
the individual is enrolled.''.
    (c) Regulations.--Notwithstanding any other provision of law, the 
Secretary of Health and Human Services shall initially implement the 
amendments made by this section through interim final regulations.
                                 <all>
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