Fairness for Patient Medications Act

HR 3285, the Fairness for Patient Medications Act, requires health insurance plans and pharmacy benefit managers to limit patient cost-sharing for "highly rebated drugs" (drugs where manufacturers rebate over 50% of annual spending). Starting January 2025, plans must cap out-of-pocket costs per 30-day supply at 1/12 of the drug’s net price (after rebates), calculated annually. The bill also prohibits hidden discounts from drug manufacturers when plans add previously excluded drugs to coverage, requiring price reductions to be visible at checkout or limited to flat service fees. This directly affects health insurance plans, insurers, and pharmacy benefit managers managing prescription drug coverage.