PLASMA Act

Bill: 119-s-694
Sponsor: full_name: Sen. Tillis, Thomas [R-NC]
Introduced: 2025-02-24
Policy area: Health
Subjects: Blood and blood diseases

Drug therapy

Health care costs and insurance

Manufacturing

Medicare

Prescription drugs
Latest action: action_date: 2025-02-24
text: Read twice and referred to the Committee on Finance.

Summaries:
action_date: 2025-02-24
action_desc: Introduced in Senate
text: <p><strong>Preserving Life-saving Access to Specialty Medicines in America Act or the PLASMA Act</strong></p><p>This bill phases-in certain price adjustments for plasma-derived products under the Medicare prescription drug benefit's Manufacturer Discount Program.</p><p>Current law requires manufacturers of covered drugs under the Medicare prescription drug benefit to provide a 10% discount for covered drugs during the initial coverage phase (i.e., before a beneficiary reaches the out-of-pocket spending threshold) and a 20% discount during the catastrophic coverage phase (i.e., after a beneficiary reaches the out-of-pocket spending threshold).&nbsp;</p><p>The bill phases-in discounts for plasma-derived products over several years, starting with a 1% discount in 2026 for both the initial and catastrophic coverage phases, and ending with a 10% discount beginning in 2030 for the initial coverage phase and a 20% discount beginning in 2032 for the catastrophic coverage phase.</p>

tv_txt: II 119th CONGRESS 1st Session S. 694 IN THE SENATE OF THE UNITED STATES February 24, 2025 Mr. Tillis (for himself and Mr. Kelly ) 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 provide a phase-in for plasma-derived products under the manufacturer discount program.

1. Short title This Act may be cited as the Preserving Life-saving Access to Specialty Medicines in America Act or the PLASMA Act . 2. Phase-in for plasma-derived products under manufacturer discount program Section 1860D–14C(g)(4) of the Social Security Act (42 U.S.C. 1395w–114c(g)(4)) is amended— (1) in subparagraph (A), in the matter preceding clause (i), by striking and (C) and inserting , (C), and (D) ; (2) by redesignating subparagraphs (D) and (E) as subparagraphs (E) and (F), respectively; and (3) by inserting after subparagraph (C) the following: (D) Phase-in for plasma-derived products (i) In general For 2026 and subsequent years, subject to clause (iv), in the case of an applicable drug of a manufacturer that is a plasma-derived product (as defined in clause (ii) ), and that is marketed as of August 16, 2022, and dispensed for an applicable beneficiary, the term discounted price means the specified plasma-derived product percent (as defined in clause (iii) ) of the negotiated price of the applicable drug of the manufacturer. (ii) Plasma-derived product In this subparagraph, the term plasma-derived product means an applicable drug that is a biological product that is derived from human whole blood or plasma. (iii) Specified plasma-derived product percent In this subparagraph, the term specified plasma-derived product percent means, with respect to a year— (I) for an applicable drug that is a plasma-derived product dispensed for an applicable beneficiary who has not incurred costs, as determined in accordance with section 1860D–2(b)(4)(C), for covered part D drugs in the year that are equal to or exceed the annual out-of-pocket threshold specified in section 1860D–2(b)(4)(B)(i) for the year— (aa) for 2026, 99 percent; (bb) for 2027, 98 percent; (cc) for 2028, 95 percent; (dd) for 2029, 92 percent; and (ee) for 2030 and each subsequent year, 90 percent; and (II) for an applicable drug that is a plasma-derived product dispensed for an applicable beneficiary who has incurred costs, as determined in accordance with section 1860D–2(b)(4)(C), for covered part D drugs in the year that are equal to or exceed the annual out-of-pocket threshold specified in section 1860D–2(b)(4)(B)(i) for the year— (aa) for 2026, 99 percent; (bb) for 2027, 98 percent; (cc) for 2028, 95 percent; (dd) for 2029, 92 percent; (ee) for 2030, 90 percent; (ff) for 2031, 85 percent; and (gg) for 2032 and each subsequent year, 80 percent. (iv) Limitations This subparagraph shall not apply with respect to the following: (I) Certain drugs dispensed to LIS beneficiaries An applicable drug described in subparagraph (B)(i). (II) Specified small manufacturers An applicable drug described in subparagraph (C)(i). .