The Access to Birth Control Act (S 2302) requires pharmacies to provide contraception without delay when available and to help customers obtain it if out of stock - either by referring to another pharmacy or expediting an order. It prohibits pharmacies from intimidating customers, misrepresenting availability, breaching confidentiality, or refusing to return valid prescriptions for contraception. Exceptions allow pharmacists to decline service only if a prescription is missing, the customer cannot pay, or they use professional clinical judgment. Violations may result in civil penalties of up to $1,000 per day or private lawsuits by affected individuals.
This bill temporarily allows doctors to prescribe and dispense certain Medicare-covered medications directly to seniors in their offices from 2026 to 2030, under specific conditions. It requires prior in-person visits, limits dispensing to group practices, and mandates billing through the physician’s practice. The bill also directs the GAO to study whether physician-owned pharmacies are becoming common and how such arrangements might affect prescribing. It directly affects seniors receiving Medicare Part D drugs and physician practices participating in these arrangements. The exception expires in 2030, with no changes to Medicare Part D program rules.
This bill creates a process for the Secretary of Health and Human Services to determine if brand name drug prices exceed those in five reference countries (Canada, UK, Germany, France, and Japan). If a drug is deemed excessively priced, the government will terminate the manufacturer's exclusivity rights and allow any company to produce a generic version under an open, non-exclusive license with a reasonable royalty. Drug manufacturers must submit detailed annual reports on pricing, costs, and revenues, with penalties for noncompliance. The Secretary will maintain a public database of excessive price determinations and report annually to Congress. This directly impacts brand name drug manufacturers, generic producers, and patients who purchase prescription drugs.
This bill amends a federal drug pricing program to better support manufacturers of drugs for rare diseases. It clarifies that time periods when a drug was designated as an "orphan drug" (for rare diseases) will not count toward the timeline for price negotiations under the program. This change directly affects pharmaceutical companies developing treatments for rare conditions by potentially delaying when their drug prices become subject to federal negotiation. The policy adjustment aims to provide more time for these specialized treatments to reach the market without immediate price constraints.
HR 6255, the Affordable Insulin Now Act, requires health insurance plans (including employer-sponsored and individual plans) to cover specific insulin products starting in 2026. It caps out-of-pocket costs for these insulin products at $35 per 30-day supply or 25% of the negotiated price, whichever is lower, with no deductibles applied. The bill defines "selected insulin products" to include at least one of each dosage form (like vials or pumps) and type (such as rapid-acting or long-acting) available from the plan. This directly affects people with diabetes who rely on insulin, ensuring more predictable and affordable access to essential medications under their health coverage.
This bill expands Medicare Part B coverage to include specific pharmacist services, directly affecting Medicare beneficiaries and pharmacists who provide these services. It defines "pharmacist services" as evaluations and treatments for illnesses like COVID-19, flu, RSV, or strep throat, or services addressing public health emergencies, requiring collaboration with physicians as state law permits. Medicare would pay 80% of the lower of the actual charge or 85% of the physician payment rate (100% for public health emergencies), and prohibits balance billing for these services. The changes take effect January 1, 2026.
This bill requires the HHS Secretary to create drug adherence guidelines aiming for 90% medication adherence among Medicare Part B and D drug users. It mandates using AI and machine learning technologies in developing these guidelines and prioritizes promoting generic and biosimilar drugs where possible. The policy directly affects Medicare beneficiaries and providers by setting a measurable adherence target for covered drugs. Key changes include new federal guidelines focused on improving medication consistency through technology and cost-effective drug options.
HR 4139, the Cutting Copays Act, lowers out-of-pocket prescription drug costs for low-income Medicare Part D beneficiaries. It reduces the maximum copay for generic drugs to $0 starting in 2026 and caps copays for other drugs at $3 before 2026, with future adjustments tied to inflation. The bill directly affects Medicare Part D enrollees who qualify for low-income subsidies, ensuring their annual drug costs stay below set limits. These changes modify existing Medicare Part D cost-sharing rules without creating new programs or altering eligibility.
The Short on Competition Act creates a new process to address prescription drug shortages by allowing temporary imports of certain drugs. It permits the Secretary of Health and Human Services to authorize imports of drugs with the same active ingredient as a shortage drug, provided they are legally marketed in specific foreign countries and manufacturers commit to seeking U.S. approval. The bill also defines a "marginally competitive market" (fewer than five available drugs for two months, the drug approved over 10 years ago, and all patents expired) as triggering the importation process. Additionally, it requires annual reporting on the number of drugs approved for temporary importation.
This bill expands Medicare's drug price negotiation program to cover 50 drugs (up from 20) and requires health insurers to apply negotiated prices to cost-sharing for beneficiaries. It establishes annual out-of-pocket cost-sharing limits for prescription drugs under group health plans and insurance coverage, with specific limits of $2,000 for self-only coverage in 2027 that will increase annually. The bill also sets specific cost-sharing limits for insulin products, requiring coverage with no deductible and cost-sharing of no more than $35 per 30-day supply or 25% of the negotiated price. These provisions affect Medicare beneficiaries, people with group health plans, and health insurers across the country. The bill applies to plan years beginning on or after January 1, 2027.
