H.R. 1244 — Reducing Drug Prices for Seniors Act

This section establishes the short title of the Act as the “Reducing Drug Prices for Seniors Act.”

This section revises the Medicare Part D prescription drug benefit under 42 U.S.C. § 1395w–102 by requiring that, for plan years beginning on or after January 1, 2026, coinsurance for covered Part D drugs between the annual deductible and the annual out-of-pocket threshold be calculated using the drug’s actual acquisition cost rather than its wholesale acquisition cost when the actual acquisition cost is lower. As background, Medicare Part D plans cover outpatient prescription drugs through prescription drug plans and Medicare Advantage prescription drug plans (MA-PD plans), and coinsurance is the percentage of a drug’s cost that enrollees pay. The section defines actual acquisition cost as the negotiated price of the drug under the plan, net of manufacturer-provided price concessions, as reported in the Detailed DIR Report (or successor report) for the previous plan year. It excludes drugs described in paragraphs (8) and (9) from this requirement and adds a conforming provision stating that coverage must be provided in accordance with the new coinsurance rule.