To amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program.

1/6/2025, 11:41 PM

This bill limits cost-sharing for covered drugs under the Medicare prescription drug benefit and Medicare Advantage.

Specifically, for costs above the deductible but below the annual out-of-pocket threshold, the bill limits cost-sharing to the average net price of the drug (i.e., the average amount paid less any rebates) or the cash price (i.e., the price charged to an individual without insurance), whichever is lower. 

The Government Accountability Office must report on the bill's implementation.

Bill 118 hr 4881, also known as the "Medicare Drug Cost Sharing Limitation Act," aims to make changes to the Medicare program in order to limit the amount that beneficiaries have to pay for prescription drugs. The bill specifically focuses on amending title XVIII of the Social Security Act, which governs Medicare.

Under the proposed legislation, there would be a cap placed on the amount of cost sharing that Medicare beneficiaries would have to pay for their prescription drugs. This would help to alleviate the financial burden that many seniors and individuals with disabilities face when trying to afford necessary medications.

The bill is designed to ensure that Medicare beneficiaries have access to affordable prescription drugs, while also working to control overall healthcare costs. By limiting cost sharing for drugs, the hope is that individuals will be more likely to adhere to their prescribed medication regimens, leading to better health outcomes and potentially reducing the need for more costly medical interventions down the line. Overall, the "Medicare Drug Cost Sharing Limitation Act" seeks to improve the affordability and accessibility of prescription drugs for Medicare beneficiaries, ultimately aiming to improve the overall health and well-being of those enrolled in the program.
Congress
118
Number
HR - 4881
Introduced on
2023-07-25
# Amendments
0
Sponsors
+5
Cosponsors
+5

Variations and Revisions

7/25/2023
Text
PDF
XML

Status of Legislation

Bill Introduced
Introduced to House
House to Vote
Introduced to Senate
Senate to Vote

Purpose and Summary

This bill limits cost-sharing for covered drugs under the Medicare prescription drug benefit and Medicare Advantage.

Specifically, for costs above the deductible but below the annual out-of-pocket threshold, the bill limits cost-sharing to the average net price of the drug (i.e., the average amount paid less any rebates) or the cash price (i.e., the price charged to an individual without insurance), whichever is lower. 

The Government Accountability Office must report on the bill's implementation.

Bill 118 hr 4881, also known as the "Medicare Drug Cost Sharing Limitation Act," aims to make changes to the Medicare program in order to limit the amount that beneficiaries have to pay for prescription drugs. The bill specifically focuses on amending title XVIII of the Social Security Act, which governs Medicare.

Under the proposed legislation, there would be a cap placed on the amount of cost sharing that Medicare beneficiaries would have to pay for their prescription drugs. This would help to alleviate the financial burden that many seniors and individuals with disabilities face when trying to afford necessary medications.

The bill is designed to ensure that Medicare beneficiaries have access to affordable prescription drugs, while also working to control overall healthcare costs. By limiting cost sharing for drugs, the hope is that individuals will be more likely to adhere to their prescribed medication regimens, leading to better health outcomes and potentially reducing the need for more costly medical interventions down the line. Overall, the "Medicare Drug Cost Sharing Limitation Act" seeks to improve the affordability and accessibility of prescription drugs for Medicare beneficiaries, ultimately aiming to improve the overall health and well-being of those enrolled in the program.
Alternative Names
Official Title as IntroducedTo amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program.
Policy Areas
Health
Potential Impact
Congressional oversight•
Government studies and investigations•
Health care costs and insurance•
Medicare•
Prescription drugs

Comments

Recent Activity

Latest Summary10/16/2024

This bill limits cost-sharing for covered drugs under the Medicare prescription drug benefit and Medicare Advantage.

Specifically, for costs above the deductible but below the annual out-of-pocket threshold, the bill limits cost-sharing to t...

Latest Action12/17/2024
Referred to the Subcommittee on Health.