Protect Beneficiaries from Middlemen Act
Summary
H.R. 5197, the "Protect Beneficiaries from Middlemen Act," aims to amend Title XVIII of the Social Security Act, specifically targeting Medicare Part D. The bill seeks to limit cost-sharing for prescription drugs to the 'net price' amount, effectively reducing out-of-pocket expenses for beneficiaries. This is achieved by ensuring that cost-sharing does not exceed the average net price of the drug, accounting for rebates and other remuneration received by the plan.
Expected Effects
If enacted, this bill would change how Medicare Part D beneficiaries pay for their prescription drugs. Starting in 2027, their cost-sharing would be capped at the average net price of the drug, potentially lowering their expenses. The Comptroller General would also be required to submit a report to Congress analyzing compliance and enforcement of these amendments by January 1, 2029.
Potential Benefits
- Potentially lower out-of-pocket costs for Medicare Part D beneficiaries.
- Increased transparency in drug pricing due to the focus on 'net price'.
- May incentivize pharmacy benefit managers (PBMs) and drug manufacturers to offer better rebates.
- Could improve medication adherence among beneficiaries due to affordability.
- The GAO report ensures accountability and identifies areas for improvement.
Most Benefited Areas:
Potential Disadvantages
- Potential for increased premiums for Medicare Part D plans to offset reduced cost-sharing.
- Pharmacies may adjust cash prices, impacting those without insurance.
- The definition of 'average net price' may be subject to interpretation and manipulation.
- Delayed implementation (2027) means beneficiaries won't see immediate relief.
- The impact on smaller pharmacies could be negative if they cannot negotiate favorable rebates.
Constitutional Alignment
The bill appears to align with the Constitution's general welfare clause (Preamble). Congress has the power to legislate on matters related to healthcare and social security under this clause. Article I, Section 8 grants Congress the power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States. The bill does not appear to infringe on any specific constitutional rights or limitations.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).