PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Congressional Research Service
Version 00 · Introduced in House · Feb 12, 2025
Reducing Drug Prices for Seniors Act
This bill requires the coinsurance amount for covered drugs under the Medicare prescription drug benefit to be based on the actual acquisition cost of the drug (i.e., the negotiated price under the prescription drug plan net of any manufacturer price concessions), rather than the wholesale acquisition cost of the drug, if the actual acquisition cost is lower.
People & committees
Rep. Davis, Donald G. [D-NC-1] · D–NC
Legislative record
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Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
Source last updated: Oct 18, 2025. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2025-02-12 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
The proposed Reducing Drug Prices for Seniors Act would change how Medicare Part D prescription-drug coverage calculates some patients’ coinsurance—the percentage of a drug’s cost they pay. For eligible drugs, it would require using a price that subtracts manufacturer price concessions when that price is lower than the wholesale acquisition cost. The rule would apply only within specified spending limits, with exceptions, and would not cover drugs subject to fixed copayments.
This Act may be cited as the Reducing Drug Prices for Seniors Act.
For plan years beginning on or after January 1, 2026, for costs above the annual deductible specified in paragraph (1) and below the annual out-of-pocket threshold specified in paragraph (4), any coinsurance amount for a covered part D drug (insofar as such covered part D drug is included on the formulary and subject to coinsurance rather than a copayment) shall be calculated based on the actual acquisition cost (and not the wholesale acquisition cost) of such covered part D drug if such actual acquisition cost is lower than the wholesale acquisition cost of such covered part D drug.
The preceding sentence shall not apply to a covered part D drug described in paragraph (8) or (9).
the negotiated price of the covered part D drug under the prescription drug plan or MA–PD plan, net of any manufacturer-provided price concessions
The proposed calculation rule would apply to plan years beginning on or after January 1, 2026. It would cover costs above the annual deductible, the lower boundary for this calculation rule, and below the annual out-of-pocket threshold. The bill does not supply dollar amounts for either boundary.
For plan years beginning on or after January 1, 2026, for costs above the annual deductible specified in paragraph (1) and below the annual out-of-pocket threshold specified in paragraph (4)
The proposed rule would apply only to covered drugs on the plan’s formulary, its list of covered drugs, and only when patients pay percentage-based coinsurance rather than a fixed copayment. It would require the alternative price calculation only when the defined actual acquisition cost is lower than the wholesale acquisition cost.
any coinsurance amount for a covered part D drug (insofar as such covered part D drug is included on the formulary and subject to coinsurance rather than a copayment) shall be calculated based on the actual acquisition cost (and not the wholesale acquisition cost) of such covered part D drug if such actual acquisition cost is lower than the wholesale acquisition cost of such covered part D drug.
Drugs described in existing paragraphs (8) or (9) would be excluded from the proposed calculation rule. Those paragraphs are not reproduced, so the supplied text does not identify which drugs the exceptions cover.
The preceding sentence shall not apply to a covered part D drug described in paragraph (8) or (9).
The bill would define actual acquisition cost as the plan’s negotiated drug price minus manufacturer-provided price concessions, using figures reported for the previous plan year. It would use the plan sponsor’s or organization’s Detailed DIR Report, or a successor report, and a federal regulatory definition of price concessions.
the term actual acquisition cost means, with respect to a covered part D drug, the negotiated price of the covered part D drug under the prescription drug plan or MA–PD plan, net of any manufacturer-provided price concessions (as defined under section 423.100 of title 42, Code of Federal Regulations (or any successor regulation)), as reported for such drug in the Detailed DIR Report (or any successor report) submitted by the sponsor or organization offering the plan for the previous plan year.
The bill would also add a requirement to subsection (c) of the existing law that coverage comply with the new coinsurance rule. The surrounding subsection is not supplied, limiting what can be established about this amendment’s additional scope.
in subsection (c), by adding at the end the following new paragraph: (7) Requirement that coinsurance for covered part D drugs be based on the net price of the drug The coverage is provided in accordance with subsection (b)(10).
The supplied actions snapshot, updated October 18, 2025, records House introduction on February 12, 2025, and referral that day to the Energy and Commerce and Ways and Means committees for provisions within their respective jurisdictions.
Source snapshot updated 2025-10-18T08:05:47Z.
2025-02-12: Introduced in House
2025-02-12: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
A closer look
Reviewed version: Introduced in House · 2025-02-12. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy change attached to appropriations was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for particular recipients or places was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials. Formal earmark disclosures and related materials were not supplied.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
Evidence is limited
Assessment of materially narrow preferential treatment is limited by missing incorporated statutory context. Ordinary coverage of the program’s intended beneficiaries alone does not warrant a finding.
Full text preserved for this analysis. Legislative record snapshot: Oct 18, 2025. How PlainBill uses AI