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 c…
This bill amends Medicare Part D to require that, for plan years beginning January 1, 2026, coinsurance (not copayments) for covered Part D drugs between the deductible and out-of-pocket threshold be calculated using the drug's "actual acquisition cost" rather than its wholesale acquisition cost when the actual acquisition cost is lower. "Actual acquisition cost" is defined as the negotiated price net of manufacturer-provided price concessions reported in the plan sponsor's Detailed DIR Report for the previous plan year. The change excludes drugs described in existing paragraphs (8) or (9) of the statute and adds a cross-reference in subsection (c).
Liberal emphasizes lower out-of-pocket costs; conservatives warn about market disruption.
Relative to its intended legislative type, this bill is a targeted substantive amendment to Medicare Part D statute that is reasonably specific about the operative change and the pricing definition but leaves important implementation, fiscal, and oversight details to existing administrative processes.
This bill amends Medicare Part D to require that, for plan years beginning January 1, 2026, coinsurance (not copayments) for covered Part D drugs between the deductible and out-of-pocket threshold be calculated using the drug's "actual acquisition cost" rather than its wholesale acquisition cost when the actual acquisition cost is lower. "Actual acquisition cost" is defined as the negotiated price net of manufacturer-provided price concessions reported in the plan sponsor's Detailed DIR Report for the previous plan year.
The change excludes drugs described in existing paragraphs (8) or (9) of the statute and adds a cross-reference in subsection (c).
Narrow, administrable change that benefits beneficiaries but triggers industry resistance and budget questions; plausible in scaled or packaged form, less likely as standalone.
Relative to its intended legislative type, this bill is a targeted substantive amendment to Medicare Part D statute that is reasonably specific about the operative change and the pricing definition but leaves important implementation, fiscal, and oversight details to existing administrative processes.
Liberal emphasizes lower out-of-pocket costs; conservatives warn about market disruption.
These are examples from the analysis, not a ranked list of the most-affected groups.
Liberal emphasizes lower out-of-pocket costs; conservatives warn about market disruption.
Likely broadly supportive because the bill lowers seniors' out-of-pocket costs when net prices are below list prices.
It aligns patient cost-sharing with the true net price and uses plan-reported net figures to calculate coinsurance.
Cautiously favorable but pragmatic: the bill targets a clear problem (coinsurance based on list price) yet raises implementation and cost-allocation questions.
Support contingent on evidence about premium or taxpayer effects.
Likely opposed as an unnecessary federal interference in private negotiations that could disrupt rebate systems and raise overall program costs.
Views it as regulatory micromanagement of plan pricing mechanisms.
Reached or meaningfully advanced
Reached or meaningfully advanced
Still ahead
Still ahead
Still ahead
Narrow, administrable change that benefits beneficiaries but triggers industry resistance and budget questions; plausible in scaled or packaged form, less likely as standalone.
The bill has not accumulated any surfaced votes yet.
Liberal emphasizes lower out-of-pocket costs; conservatives warn about market disruption.
Narrow, administrable change that benefits beneficiaries but triggers industry resistance and budget questions; plausible in scaled or pack…
Relative to its intended legislative type, this bill is a targeted substantive amendment to Medicare Part D statute that is reasonably specific about the operative change and the pricing definition but leaves important…
Go beyond the headline summary with full stakeholder mapping, legislative design analysis, passage barriers, and lens-by-lens tradeoff breakdowns.