Protect Beneficiaries from Middlemen Act

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.