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Medicare Part D Cost Sharing Cannot Exceed Net Price In House PBM, Transparency Bill

 
• By Cathy Kelly

The legislation’s pharmacy benefit manager-related provisions emphasize reporting over more direct reforms, which is similar to other PBM transparency bills circulating in Congress.

The Ways and Means Committee moved Relatively Modest PBM Oversight Legislation. • Source: Shutterstock

Medicare Part D beneficiaries cannot be subject to cost sharing greater than the net cost of a drug after rebates under legislation passed by the House Ways and Means Committee during a markup 26 July.

Key Takeaways

  • House Ways and Means Committee bill’s cost-sharing protections would begin in Medicare Part D in 2027.

The cost sharing protection would begin “on or after” 1 January 2027 and apply to beneficiaries who have met their...

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