I 

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. 

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 ‘‘Share the Savings with 

5 Seniors Act’’. 


pbinns on DSKJLVW7X2PROD with $$_JOB
2 

•HR 5376 IH

1 SEC. 2. APPROPRIATE COST-SHARING FOR CHRONIC CARE 

2 DRUGS UNDER MEDICARE PART D. 

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

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

5 (1) in subsection (b)— 

6 (A) in paragraph (1)(A), in the matter 

7 preceding clause (i), by striking ‘‘and (9)’’ and 

8 inserting ‘‘, (9), and (10)’’; 

9 (B) in paragraph (2)(A), in the matter 

10 preceding clause (i), by striking ‘‘and (9)’’ and 

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

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

13 paragraph: 

14 ‘‘(10) COST-SHARING FOR CHRONIC CARE

15 DRUGS.— 

16 ‘‘(A) IN GENERAL.—For plan years begin17 ning on or after January 1, 2025, in the case 

18 of a chronic care drug, the following shall 

19 apply: 

20 ‘‘(i) For costs below the annual de21 ductible specified in paragraph (1), cost22 sharing for such drug shall not exceed the 

23 net price of such drug. 

24 ‘‘(ii) Subject to subparagraph (B), for 

25 costs above the annual deductible specified 

26 in paragraph (1) and below the out-ofVerDate Sep 11 2014 15:47 Sep 09, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5376.IH H5376

pbinns on DSKJLVW7X2PROD with $$_JOB
3 

•HR 5376 IH

1 pocket threshold specified in paragraph 

2 (4), any coinsurance amount for such drug 

3 shall be based on a percentage of the net 

4 price of such drug. 

5 ‘‘(B) EXCEPTION.—The requirement under 

6 subparagraph (A)(ii) shall not apply to a chron7 ic care drug under a prescription drug plan if 

8 the cost-sharing amount for such drug under 

9 such plan is based on a copayment that is not 

10 tied to a percentage of a drug price (such as 

11 the negotiated price, list price, or wholesale ac12 quisition cost), a drug benchmark price (such 

13 as the average wholesale price), or a drug cost. 

14 ‘‘(C) DEFINITIONS.—In this paragraph: 

15 ‘‘(i) CHRONIC CARE DRUG.—The term 

16 ‘chronic care drug’ means a covered part D 

17 drug that is included under any of the fol18 lowing United States Pharmacopeia Con19 vention (USP) categories and classes of 

20 drugs, as included in the most recent 

21 version of the USP Medicare Model Guide22 lines: 

23 ‘‘(I) Blood glucose regulators, 

24 other than insulins. 


pbinns on DSKJLVW7X2PROD with $$_JOB
4 

•HR 5376 IH

1 ‘‘(II) Anti-inflammatories, in2 haled corticosteroids. 

3 ‘‘(III) Bronchodilators, anticho4 linergic. 

5 ‘‘(IV) Bronchodilators, 

6 sympathomimetic. 

7 ‘‘(V) Respiratory tract agents, 

8 other. 

9 ‘‘(VI) Anticoagulants. 

10 ‘‘(VII) Cardiovascular agents, 

11 other. 

12 ‘‘(VIII) Any category or class 

13 identified by the Secretary or USP as 

14 a successor to the categories and 

15 classes described in subclauses (I) 

16 through (VII) based on the most re17 cent USP Medicare Model Guidelines 

18 at the time of such identification. 

19 ‘‘(ii) NET PRICE.—The term ‘net 

20 price’ means the negotiated price of the 

21 drug net of all price concessions origi22 nating from manufacturers that are re23 ceived or expected to be received by the 

24 plan or pharmacy benefit manager on be25 half of the plan for such product and that 


pbinns on DSKJLVW7X2PROD with $$_JOB
5 

•HR 5376 IH

1 are not already reflected in the negotiated 

2 price.’’; and 

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

4 following new paragraph: 

5 ‘‘(7) COST-SHARING FOR COVERED CHRONIC

6 CARE DRUGS.—The coverage is provided in accord7 ance with subsection (b)(10).’’. 

8 (b) CONFORMING AMENDMENTS TO COST-SHARING

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

10 14(a)(1)(D)(iii) of the Social Security Act (42 U.S.C. 

11 1395w–114(a)(1)(D)(iii)) is amended by adding at the 

12 end the following new sentence: ‘‘For plan year 2025 and 

13 subsequent plan years, the copayment amount applicable 

14 under the first sentence of this subclause for a chronic 

15 drug (as defined in section 1860D–2(b)(10)(B)) furnished 

16 to the individual may not exceed the applicable cost-shar17 ing for such drug under the prescription drug plan or MA– 

18 PD plan in which the individual is enrolled.’’. 

19 (c) REGULATIONS.—Notwithstanding any other pro20 vision of law, the Secretary of Health and Human Services 

21 shall initially implement the amendments made by this 

22 section through interim final regulations. 

Æ 


pbinns on DSKJLVW7X2PROD with $$_JOB