This bill changes how Medicare calculates what seniors pay for prescription drugs under Medicare Part D, starting in 2026. Right now, your coinsurance (the percentage of drug costs you pay) is based on the "wholesale acquisition cost" — basically the list price that drugmakers set. This bill says that if the actual price the insurance company negotiated with the drug manufacturer is lower than that list price, your coinsurance should be calculated based on the lower, actual price instead.

Here's what this means in practice: Let's say a drug has a wholesale list price of $100, but your insurance plan negotiated to pay only $60 for it. Currently, your coinsurance might be calculated as 20% of $100 (so you'd owe $20). Under this bill, it would be 20% of $60 (so you'd owe $12). Essentially, you benefit from the discounts your insurance company gets from drug manufacturers, rather than paying based on inflated list prices.

This applies to most covered drugs where you pay coinsurance rather than a flat copay, and it kicks in after you've paid your annual deductible but before you hit your out-of-pocket spending limit. The goal is straightforward: help seniors pay less for their medications by making sure they benefit from the real prices insurance companies negotiate, not the higher sticker prices.

Reducing Drug Prices for Seniors Act

Davis, Donald G.

Reducing Drug Prices for Seniors ActThis bill requires the coinsurance amount for covered drugs under the Medicare prescription drug benefit to be based on the actual acquisition cost of the drug (i.e., the negotiated price under the prescription drug plan net of any manufacturer price concessions), rather than the wholesale acquisition cost of the drug, if the actual acquisition cost is lower.