Protect Beneficiaries from Middlemen Act
Protect Beneficiaries from Middlemen Act
Plain Language Summary
# Protect Beneficiaries from Middlemen Act – Summary **What the Bill Does:** This bill aims to lower prescription drug costs for Medicare beneficiaries by changing how much they pay out-of-pocket for medications. Currently, Medicare drug plans can charge patients the full retail price, even when the plan negotiates lower prices behind the scenes. This bill would cap what patients pay at either the actual net price the plan pays for the drug (after rebates) or the cash price (what uninsured people pay), whichever is lower.
The goal is to prevent what sponsors call "middleman" markups between what insurance plans actually pay and what they charge patients. **Who It Affects:** The bill primarily impacts Medicare beneficiaries—seniors and disabled individuals covered under Medicare's prescription drug benefit (Part D) and Medicare Advantage plans. It could also indirectly affect drug manufacturers and pharmacy benefit managers (the companies that negotiate drug prices for insurance plans). **Current Status:** The bill was introduced in the 119th Congress and is currently in committee, meaning it has not yet been debated or voted on by the full House of Representatives. No action has been taken beyond the initial filing.
CRS Official Summary
Protect Beneficiaries from Middlemen ActThis bill limits cost-sharing for covered drugs under the Medicare prescription drug benefit and Medicare Advantage.Specifically, for costs above the deductible but below the annual out-of-pocket threshold, the bill limits cost-sharing to the average net price of the drug (i.e., the average amount paid less any rebates) or the cash price (i.e., the price charged to an individual without insurance), whichever is lower. The Government Accountability Office must report on the bill's implementation.
Latest Action
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.