Reducing Drug Prices for Seniors Act.

This bill, the Reducing Drug Prices for Seniors Act, would change how Medicare Part D determines patient cost-sharing for covered drugs. Starting in plan year 2026, it would require coinsurance (the share of drug costs paid by the beneficiary) to be based on the drug’s net price rather than its list price for most Part D drugs that are on the formulary and subject to coinsurance (not copayments). The net price means the negotiated price under the beneficiary’s prescription drug plan or MA-PD plan, after subtracting manufacturer-provided price concessions, as reported in the Detailed DIR Report for the previous plan year. If the net price is lower than the drug’s list price, the coinsurance would be calculated using the net price; if the net price is not lower than the list price, the existing pricing would apply. The bill also specifies that the net-price-based calculation would not apply to certain drugs described in paragraphs (8) or (9) of the relevant statute. The change would be delivered through amendments to the Social Security Act (title XVIII) and is intended to reduce out-of-pocket costs for seniors when negotiated discounts lower the net price. In short, the bill aims to ensure that Medicare Part D beneficiaries pay coinsurance based on the lower negotiated price rather than the higher list price, starting in 2026, for most applicable drugs.