Protect Beneficiaries from Middlemen Act

The Protect Beneficiaries from Middlemen Act (HR 5197) limits out-of-pocket costs for Medicare Part D beneficiaries on prescription drugs. Starting in 2027, the bill caps the amount a beneficiary pays for a month’s supply of a covered drug (after meeting the deductible but before reaching the out-of-pocket threshold) at either the drug’s average net price (actual cost to the plan after rebates) or the pharmacy’s standard cash price (what a patient would pay without insurance), whichever is lower. This applies to all Medicare Part D drug plans and aims to prevent beneficiaries from paying more than the drug’s actual cost. The bill also requires a GAO report by January 2029 to evaluate compliance and enforcement of these cost-sharing limits.