Lower Drug Costs for Families Act

Subjects: Health


<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1139 Introduced in Senate (IS)]

&lt;DOC&gt;






118th CONGRESS
  1st Session
                                S. 1139

 To amend title XVIII of the Social Security Act to apply prescription 
drug inflation rebates to drugs furnished in the commercial market and 
            to change the base year for rebate calculations.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 30, 2023

 Ms. Cortez Masto (for herself, Ms. Klobuchar, Mr. Reed, Ms. Baldwin, 
  Mr. Brown, Ms. Stabenow, Ms. Smith, Mr. Welch, and Mr. Blumenthal) 
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 apply prescription 
drug inflation rebates to drugs furnished in the commercial market and 
            to change the base year for rebate calculations.

    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 ``Lower Drug Costs for Families Act''.

SEC. 2. APPLICATION OF PRESCRIPTION DRUG INFLATION REBATES TO DRUGS 
              FURNISHED IN THE COMMERCIAL MARKET; CHANGE OF BASE YEAR 
              FOR REBATE CALCULATIONS.

    (a) Part B Drugs.--
            (1) Application of prescription drug inflation rebates to 
        drugs furnished in the commercial market.--Section 1847A(i) of 
        the Social Security Act (42 U.S.C. 1395w-3a(i)) is amended--
                    (A) in paragraph (1)(A)(i), by striking ``units'' 
                and inserting ``billing units'';
                    (B) in paragraph (2)(A), by striking ``for which 
                payment is made under this part'' and inserting ``that 
                would be payable under this part if such drug were 
                furnished to an individual enrolled under this part''; 
                and
                    (C) in paragraph (3)--
                            (i) in subparagraph (A)(i), by striking 
                        ``units'' and inserting ``billing units''; and
                            (ii) by striking subparagraph (B) and 
                        inserting the following:
                    ``(B) Total number of billing units.--For purposes 
                of subparagraph (A)(i), the total number of billing 
                units with respect to a part B rebatable drug is 
                determined as follows:
                            ``(i) Determine the total number of units 
                        equal to--
                                    ``(I) the total number of units, as 
                                reported under subsection (c)(1)(B) for 
                                each National Drug Code of such drug 
                                during the calendar quarter that is two 
                                calendar quarters prior to the calendar 
                                quarter as described in subparagraph 
                                (A), minus
                                    ``(II) the total number of units 
                                with respect to each National Drug Code 
                                of such drug for which payment was made 
                                under a State plan under title XIX (or 
                                waiver of such plan), as reported by 
                                States under section 1927(b)(2)(A) for 
                                the rebate period that is the same 
                                calendar quarter as described in 
                                subclause (I).
                            ``(ii) Convert the units determined under 
                        clause (i) to billing units for the billing and 
                        payment code of such drug, using a methodology 
                        similar to the methodology used under this 
                        section, by dividing the units determined under 
                        clause (i) for each National Drug Code of such 
                        drug by the billing unit for the billing and 
                        payment code of such drug.
                            ``(iii) Compute the sum of the billing 
                        units for each National Drug Code of such drug 
                        in clause (ii).''.
            (2) Change of base year for rebate calculation.--Section 
        1847A(i) of the Social Security Act (42 U.S.C. 1395w-3a(i)) is 
        amended--
                    (A) in paragraph (3)--
                            (i) in subparagraph (D), by striking ``July 
                        1, 2021'' and inserting ``July 1, 2016''; and
                            (ii) in subparagraph (E), by striking 
                        ``January 2021'' and inserting ``January 
                        2016''; and
                    (B) in paragraph (4)--
                            (i) in subparagraph (A)--
                                    (I) by striking ``December 1, 
                                2020'' and inserting ``December 31, 
                                2015''; and
                                    (II) by striking ``January 2021'' 
                                and inserting ``January 2016'';
                            (ii) in subparagraph (B), by striking 
                        ``December 1, 2020'' and inserting ``December 
                        31, 2015''; and
                            (iii) in subparagraph (C), by striking 
                        ``January 2021'' and inserting ``January 
                        2016''.
            (3) Effective date.--The amendments made by this subsection 
        shall take effect as if included in the enactment of section 
        11101 of Public Law 117-169.
    (b) Covered Part D Drugs.--
            (1) Application of prescription drug inflation rebates to 
        drugs furnished in the commercial market.--Section 1860D-14B of 
        the Social Security Act (42 U.S.C. 1395w-114b) is amended--
                    (A) in subsection (b)--
                            (i) in paragraph (1)--
                                    (I) in subparagraph (A)(i), by 
                                striking ``the total number of units'' 
                                and all that follows through the 
                                semicolon and inserting the following: 
                                ``the total number of units that are 
                                used to calculate the average 
                                manufacturer price of such dosage form 
                                and strength with respect to such part 
                                D rebatable drug, as reported by the 
                                manufacturer of such drug under section 
                                1927 for each month, with respect to 
                                such period;''; and
                                    (II) by striking subparagraph (B) 
                                and inserting the following:
                    ``(B) Excluded units.--For purposes of subparagraph 
                (A)(i), the Secretary shall exclude from the total 
                number of units for a dosage form and strength with 
                respect to a part D rebatable drug, with respect to an 
                applicable period, the following:
                            ``(i) Units of each dosage form and 
                        strength of such part D rebatable drug for 
                        which payment was made under a State plan under 
                        title XIX (or waiver of such plan), as reported 
                        by States under section 1927(b)(2)(A).
                            ``(ii) Units of each dosage form and 
                        strength of such part D rebatable drug for 
                        which a rebate is paid under section 1847A(i).
                            ``(iii) Beginning with plan year 2026, 
                        units of each dosage form and strength of such 
                        part D rebatable drug for which the 
                        manufacturer provides a discount under the 
                        program under section 340B of the Public Health 
                        Service Act.''; and
                            (ii) in paragraph (6), by striking 
                        ``information.--The Secretary'' and all that 
                        follows through ``rebatable covered part D drug 
                        dispensed'' and inserting the following: ``AMP 
                        reports.--The Secretary shall provide for a 
                        method and process under which, in the case of 
                        a manufacturer of a part D rebatable drug that 
                        submits revisions to information submitted 
                        under section 1927 by the manufacturer with 
                        respect to such drug''; and
                    (B) by striking subsection (d) and inserting the 
                following:
    ``(d) Information.--For purposes of carrying out this section, the 
Secretary shall use information submitted by manufacturers under 
section 1927(b)(3) and information submitted by States under section 
1927(b)(2)(A).''.
            (2) Change of base year for rebate calculation.--Section 
        1860D-14B of the Social Security Act (42 U.S.C. 1395w-114b) is 
        amended--
                    (A) in subsection (b)(5)--
                            (i) in subparagraph (A)--
                                    (I) by striking ``October 1, 2021'' 
                                and inserting ``October 1, 2016''; and
                                    (II) by striking ``January 2021'' 
                                and inserting ``January 2016''; and
                            (ii) in subparagraph (C), by striking 
                        ``January 2021'' and inserting ``January 
                        2016''; and
                    (B) in subsection (g)--
                            (i) in paragraph (3)--
                                    (I) by striking ``January 1, 2021'' 
                                and inserting ``January 1, 2016''; and
                                    (II) by striking ``October 1, 
                                2021'' and inserting ``October 1, 
                                2016''; and
                            (ii) in paragraph (4), by striking 
                        ``January 2021'' and inserting ``January 
                        2016''.
            (3) Effective date.--The amendments made by this subsection 
        shall take effect as if included in the enactment of section 
        11102 of Public Law 117-169.
                                 &lt;all&gt;
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