Washington, D.C. – On Friday, U.S. Senators Bob Casey (D-PA) and John Cornyn (R-TX) introduced the Protecting Seniors from High Drug Costs Act.
The bipartisan bill would help bring down drug costs by prohibiting health plans and pharmacy benefit managers (PBMs) from charging Medicare Part D beneficiaries more in cost-sharing than the net cost of the drug.
“There is no reason why health plans and pharmacy benefit managers should be able to overcharge American seniors just because they’re enrolled in Medicare Part D,” Casey said.
“The Protecting Seniors from High Drug Costs Act will end this unfair practice. We cannot allow corporate profiteering to continue getting in the way of our seniors being able to afford the prescription drugs they need.”
“Far too often, patients unknowingly pay a much higher insurance copay than the actual out-of-pocket cost of a prescription drug,” Cornyn said.
“This commonsense legislation would put an end to the harmful practice of ‘copay clawbacks’ and prevent third-party pharmacy benefit managers from cutting a profit at the expense of patients’ pocketbooks.”
A recent report from the Medicare Payment Advisory Commission (MedPAC) found that almost eight percent of total spending in the Part D benefit, the cost-sharing amounts set by plan sponsors (in many cases PBMs) exceeded net drug costs after deducting rebates from the original price of the drug.
This means that for that eight percent of spending, the enrollee’s cost-sharing paid to the PBMs was more than the cost of the drug itself.
The bill prohibits health plans and PBMs from engaging in this practice of charging patients more than the net price of the drug.
It will lower cost-sharing for patients and help them afford all the prescriptions they need while ensuring that PBMs and plans are not engaging in unfair practices.
Earlier this year, Casey sent a letter highlighting how the Inflation Reduction Act has reduced drug costs for American seniors and families, due to provisions included from the Lowering Medicare Premiums and Prescription Drug Costs Act, which he championed.
The Protecting Seniors from High Drug Costs Act will continue progress towards ensuring seniors can afford the prescription drugs they need.