Reducing Drug Prices for Seniors Act

HR 1244, the "Reducing Drug Prices for Seniors Act," requires Medicare Part D plans to calculate coinsurance for covered drugs based on the plan's actual acquisition cost (the negotiated net price paid by the plan) rather than the drug's wholesale price, starting in 2026. This change directly affects Medicare Part D beneficiaries who pay coinsurance after meeting their deductible but before reaching the out-of-pocket threshold. The bill mandates that plans use the actual cost reported in the Detailed DIR Report, excluding certain drugs covered under specific exceptions. This policy aims to lower out-of-pocket costs for seniors by aligning coinsurance with the price the plan actually pays for medications.