Lowering Medicare Part D Costs for Chronic Care Medications Using Net Price.
This bill aims to reduce out-of-pocket drug costs for seniors enrolled in Medicare Part D who take specific chronic care medications. Starting in 2025, patient cost-sharing (deductibles and coinsurance) for these drugs must be calculated based on the drug's actual "net price" after manufacturer rebates are applied, rather than the higher list price. This change is intended to ensure that savings from rebates are passed directly to the beneficiaries, lowering their financial burden.
Key points
Effective January 1, 2025, cost-sharing rules change for specific chronic care drugs (e.g., anticoagulants, glucose regulators, certain respiratory agents).
Patient coinsurance will be based on the "net price" of the drug—the price after all manufacturer rebates and concessions are factored in.
The maximum copayment for low-income individuals (LIS) receiving these chronic drugs will also be capped according to the new net cost-sharing rules.
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