Protecting Patient Access to Cancer and Complex Therapies Act
Summary
The "Protecting Patient Access to Cancer and Complex Therapies Act" aims to lower drug costs for patients by requiring manufacturers to provide rebates for selected drugs and biological products subject to maximum fair price negotiation under Medicare Part B. This bill amends Title XVIII of the Social Security Act to implement these rebates. The rebates are intended to ensure that beneficiary coinsurance is based on the maximum fair price (MFP) plus 6%, potentially reducing out-of-pocket costs for patients.
Expected Effects
The primary effect will be to lower the cost of selected drugs and biological products for Medicare beneficiaries. This is achieved by mandating rebates from manufacturers when the ASP+6 payment amount exceeds the MFP+6 payment amount. The bill also changes how beneficiary coinsurance is calculated, basing it on the lower MFP+6 amount, further reducing patient expenses.
Potential Benefits
- Reduced out-of-pocket costs for Medicare beneficiaries needing expensive drugs.
- Incentivizes drug manufacturers to negotiate fair prices.
- Ensures coinsurance is based on a lower, negotiated price.
- Potentially improves access to cancer and complex therapies for patients with limited incomes.
- Deposits rebates into the Federal Supplementary Medical Insurance Trust Fund, strengthening Medicare.
Potential Disadvantages
- Drug manufacturers may reduce investment in research and development due to decreased revenue.
- Potential for manufacturers to increase prices of other drugs to offset rebate losses.
- Possible administrative complexities in calculating and processing rebates.
- The bill's effectiveness depends on the selection of drugs subject to negotiation; if too narrow, the impact will be limited.
- Potential legal challenges from pharmaceutical companies.
Most Disadvantaged Areas:
Constitutional Alignment
The bill aligns with the Constitution's general welfare clause (Preamble). Congress has the power to tax and spend for the general welfare, and this bill uses that power to lower drug costs for seniors. The bill operates within the scope of powers granted to Congress under Article I, Section 8, which includes the power to regulate commerce and provide for the general welfare.
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).