S 2770119th CongressIn Committee

Share the Savings with Seniors Act

Introduced: Sep 11, 2025

Social Services

Standard Summary

Comprehensive overview in 1-2 paragraphs

The Share the Savings with Seniors Act would reshape Medicare Part D cost-sharing for chronic care drugs. Starting in plan year 2027, it requires a new framework where cost-sharing for chronic care drugs is tied to the drug’s net price (the negotiated price after manufacturer concessions not reflected in the negotiated price). Below deductible, cost-sharing cannot exceed the net price; above deductible and below the plan’s out-of-pocket threshold, coinsurance would be based on a percentage of the net price (with an exception for plans using fixed copays or price benchmarks). The bill also defines which drugs qualify as chronic care drugs, sets rules to protect low-income enrollees so their copayments don’t exceed the plan’s own cost-sharing, and directs the use of interim final regulations to implement these changes. The aim is to reduce out-of-pocket costs for seniors on chronic medications and align cost-sharing more closely with actual net prices.

Key Points

1New cost-sharing framework for chronic care drugs (Plan years 2027+):
2- Below the annual Medicare Part D deductible: cost-sharing for chronic care drugs cannot exceed the net price of the drug.
3- Above the deductible and below the out-of-pocket threshold: any coinsurance for the drug would be based on a percentage of the net price, with an exception described below.
4- Exception: if a plan’s cost-sharing for a chronic care drug is a fixed copayment not tied to a percentage of price (or uses a drug benchmark price or similar structure), the percentage-based rule does not apply.
5Definitions and scope:
6- Chronic care drug: a covered Part D drug in specified USP categories/classes (and any successor categories later identified by USP/Secretary) that meet the defined list (e.g., blood glucose regulators other than insulins, several respiratory/anticoagulant/cardiovascular categories, etc.).
7- Net price: negotiated price minus price concessions from manufacturers that are received or expected to be received by the plan or PBM and not already reflected in the negotiated price.
8Plan benefit design and low-income protections:
9- For plan year 2027 and beyond, copayments for chronic drugs furnished to low-income individuals cannot exceed the applicable cost-sharing under the individual’s enrolled prescription drug plan or MA-PD plan.
10Implementation:
11- The Secretary of Health and Human Services must begin implementing these amendments via interim final regulations.

Impact Areas

Primary affected group/area:- Medicare Part D enrollees who use chronic care drugs, particularly those who have been sensitive to high coinsurance or out-of-pocket costs.Secondary affected groups/areas:- Prescription drug plans, Medicare Advantage-Prescription Drug plans (MA-PD), and pharmacy benefit managers (PBMs), which would need to adjust cost-sharing structures and negotiation practices to align with net-price-based coinsurance and the defined chronic-care drug categories.- Drug manufacturers, whose concessions/pricing arrangements would influence the “net price” calculation that drives plan cost-sharing.Additional impacts:- Potential changes in plan design, premiums, and formulary management as plans adapt to the new cost-sharing rules to maintain or attract enrollment.- Regulatory and administrative workload due to interim final regulations and ongoing definitions of chronic-care drug categories under USP guidelines.Effective date is plan years beginning on or after January 1, 2027.The bill emphasizes transparency about net price and ties cost-sharing more closely to the actual price negotiated by plans/PBMs, rather than to list prices or benchmark prices alone.The act includes a guardrail for low-income beneficiaries to prevent excessive copays relative to their plan’s standard cost-sharing.

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