I 
119TH CONGRESS 
1ST SESSION H. R. 5197 
To amend title XVIII of the Social Security Act to limit cost sharing for 
drugs under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 8, 2025 
Ms. MALLIOTAKIS 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Protect Beneficiaries 
from Middlemen Act’’. 
SEC. 2. LIMITATION ON COST SHARING TO NET PRICE 
AMOUNT UNDER MEDICARE PART D. 
(a) IN GENERAL.—Section 1860D–2 of the Social 
Security Act (42 U.S.C. 1395w–102) is amended— 
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(1) in subsection (b)— 
(A) in paragraph (2)(A), by striking ‘‘(8) 
and (9)’’ and inserting ‘‘(8), (9), and (10)’’; 
(B) in paragraph (9)(B)(ii), by striking 
‘‘For a plan year’’ and inserting ‘‘Subject to 
paragraph (10), for a plan year’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(10) LIMITATION ON COST SHARING TO NET 
PRICE AMOUNT.— 
‘‘(A) IN GENERAL.—For a plan year begin-
ning on or after January 1, 2027, the coverage 
provides benefits for a supply of a covered part 
D drug dispensed by a pharmacy, for costs in 
excess of the deductible specified in paragraph 
(1) and prior to an individual reaching the out- 
of-pocket threshold under paragraph (4), with 
cost-sharing for a month’s supply that does not 
exceed the average net price for such a supply 
of such drug during such plan year (or, if 
lower, the applicable cash price for such a sup-
ply of such drug so dispensed by such phar-
macy). 
‘‘(B) DEFINITIONS.—In this paragraph: 
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‘‘(i) APPLICABLE
CASH
PRICE.—The 
term ‘applicable cash price’ means, with 
respect to a supply of a covered part D 
drug dispensed by a pharmacy, the price 
that such pharmacy would charge for such 
supply of such drug dispensed to an indi-
vidual without benefits for such drug 
under any Federal health care program (as 
defined in section 1128B), a group health 
plan or group or individual health insur-
ance coverage (as such terms are defined 
in section 2791 of the Public Health Serv-
ice Act), or the program established under 
chapter 89 of title 5, United States Code. 
‘‘(ii) AVERAGE NET PRICE.—The term 
‘average net price’ means, with respect to 
a supply of a covered part D drug, a pre-
scription drug plan, and a plan year, the 
average amount paid under such plan (in-
cluding any amounts paid by an individual 
enrolled under such plan as cost sharing 
for such drug) as payment for such a sup-
ply of such drug dispensed during such 
year, less any rebates or other forms of re-
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muneration received under such plan with 
respect to such drug.’’; and 
(2) in subsection (c), by adding at the end the 
following new paragraph: 
‘‘(7) COST SHARING LIMITED TO NET PRICE.— 
The coverage is provided in accordance with sub-
section (b)(10).’’. 
(b) CONFORMING AMENDMENT 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 2027 and 
subsequent plan years, the copayment amount applicable 
under this clause to a supply of a covered part D drug 
dispensed to the individual may not exceed the amount 
provided under section 1860D–2(b)(10).’’. 
(c) GAO REPORT.—Not later than January 1, 2029, 
the Comptroller General of the United States shall submit 
to Congress a report containing— 
(1) an analysis of compliance with the amend-
ments made by this section; 
(2) an analysis of enforcement of such amend-
ments; 
(3) recommendations with respect to improving 
such enforcement; and 
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(4) recommendations relating to improving pub-
lic disclosure, and public awareness of, the require-
ments of such amendments. 
Æ 
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