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Protect Beneficiaries from Middlemen Act

USA119th CongressHR-5197| House 
| Updated: 9/8/2025
Nicole Malliotakis

Nicole Malliotakis

Republican Representative

New York

Ways and Means Committee, Energy and Commerce Committee

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
The "Protect Beneficiaries from Middlemen Act" proposes significant changes to Medicare Part D , aiming to reduce out-of-pocket drug costs for beneficiaries. Its primary goal is to amend the Social Security Act to limit the amount individuals pay for prescription drugs under the Medicare program. Beginning January 1, 2027, the bill mandates that beneficiary cost-sharing for covered Part D drugs, between the deductible and the out-of-pocket threshold, cannot exceed the average net price of the drug. The average net price is defined as the amount paid for the drug minus any rebates or other remuneration received by the plan, effectively passing these savings to the consumer at the point of sale. Alternatively, the cost-sharing cannot exceed the applicable cash price if that amount is lower. This legislation also includes a conforming amendment to ensure that cost-sharing for low-income individuals under Medicare Part D is similarly capped. Furthermore, it requires the Comptroller General of the United States to submit a report by January 1, 2029, analyzing compliance and enforcement of these new provisions and recommending improvements for public disclosure.
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Timeline
Sep 8, 2025
Introduced in House
Sep 8, 2025
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.
  • September 8, 2025
    Introduced in House


  • September 8, 2025
    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.

Health

Protect Beneficiaries from Middlemen Act

USA119th CongressHR-5197| House 
| Updated: 9/8/2025
The "Protect Beneficiaries from Middlemen Act" proposes significant changes to Medicare Part D , aiming to reduce out-of-pocket drug costs for beneficiaries. Its primary goal is to amend the Social Security Act to limit the amount individuals pay for prescription drugs under the Medicare program. Beginning January 1, 2027, the bill mandates that beneficiary cost-sharing for covered Part D drugs, between the deductible and the out-of-pocket threshold, cannot exceed the average net price of the drug. The average net price is defined as the amount paid for the drug minus any rebates or other remuneration received by the plan, effectively passing these savings to the consumer at the point of sale. Alternatively, the cost-sharing cannot exceed the applicable cash price if that amount is lower. This legislation also includes a conforming amendment to ensure that cost-sharing for low-income individuals under Medicare Part D is similarly capped. Furthermore, it requires the Comptroller General of the United States to submit a report by January 1, 2029, analyzing compliance and enforcement of these new provisions and recommending improvements for public disclosure.
View Full Text

Suggested Questions

Get AI-generated questions to help you understand this bill better

Timeline
Sep 8, 2025
Introduced in House
Sep 8, 2025
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.
  • September 8, 2025
    Introduced in House


  • September 8, 2025
    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.
Nicole Malliotakis

Nicole Malliotakis

Republican Representative

New York

Ways and Means Committee, Energy and Commerce Committee

Health

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted