Lower Drug Costs for Families Act

I 118TH CONGRESS 1ST SESSION H. R. 4115 To amend title XVIII of the Social Security Act to apply prescription drug inflation rebates to drugs furnished in the commercial market and to change the base year for rebate calculations. IN THE HOUSE OF REPRESENTATIVES JUNE 14, 2023 Mr. GALLEGO (for himself and Ms. SLOTKIN) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subse- quently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to apply prescription drug inflation rebates to drugs furnished in the commercial market and to change the base year for rebate calculations. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Lower Drug Costs for 4 Families Act’’. 5 VerDate Sep 11 2014 04:56 Jul 15, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4115.IH H4115 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 4115 IH SEC. 2. APPLICATION OF PRESCRIPTION DRUG INFLATION 1 REBATES TO DRUGS FURNISHED IN THE 2 COMMERCIAL MARKET; CHANGE OF BASE 3 YEAR FOR REBATE CALCULATIONS. 4 (a) PART B DRUGS.— 5 (1) APPLICATION OF PRESCRIPTION DRUG IN- 6 FLATION REBATES TO DRUGS FURNISHED IN THE 7 COMMERCIAL MARKET.—Section 1847A(i) of the So- 8 cial Security Act (42 U.S.C. 1395w–3a(i)) is amend- 9 ed— 10 (A) in paragraph (1)(A)(i), by striking 11 ‘‘units’’ and inserting ‘‘billing units’’; 12 (B) in paragraph (2)(A), by striking ‘‘for 13 which payment is made under this part’’ and 14 inserting ‘‘that would be payable under this 15 part if such drug were furnished to an indi- 16 vidual enrolled under this part’’; 17 (C) in paragraph (3)— 18 (i) in subparagraph (A)(i), by striking 19 ‘‘units’’ and inserting ‘‘billing units’’; and 20 (ii) by striking subparagraph (B) and 21 inserting the following: 22 ‘‘(B) TOTAL NUMBER OF BILLING 23 UNITS.—For purposes of subparagraph (A)(i), 24 the total number of billing units with respect to 25 VerDate Sep 11 2014 04:56 Jul 15, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4115.IH H4115 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 4115 IH a part B rebatable drug is determined as fol- 1 lows: 2 ‘‘(i) Determine the total number of 3 units equal to— 4 ‘‘(I) the total number of units, as 5 reported under subsection (c)(1)(B) 6 for each National Drug Code of such 7 drug during the calendar quarter that 8 is two calendar quarters prior to the 9 calendar quarter as described in sub- 10 paragraph (A), minus 11 ‘‘(II) the total number of units 12 with respect to each National Drug 13 Code of such drug for which payment 14 was made under a State plan under 15 title XIX (or waiver of such plan), as 16 reported by States under section 17 1927(b)(2)(A) for the rebate period 18 that is the same calendar quarter as 19 described in subclause (I). 20 ‘‘(ii) Convert the units determined 21 under clause (i) to billing units for the bill- 22 ing and payment code of such drug, using 23 a methodology similar to the methodology 24 used under this section, by dividing the 25 VerDate Sep 11 2014 04:56 Jul 15, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4115.IH H4115 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 4115 IH units determined under clause (i) for each 1 National Drug Code of such drug by the 2 billing unit for the billing and payment 3 code of such drug. 4 ‘‘(iii) Compute the sum of the billing 5 units for each National Drug Code of such 6 drug in clause (ii).’’. 7 (2) CHANGE OF BASE YEAR FOR REBATE CAL- 8 CULATION.—Section 1847A(i) of the Social Security 9 Act (42 U.S.C. 1395w–3a(i)) is amended— 10 (A) in paragraph (3)— 11 (i) in subparagraph (D), by striking 12 ‘‘July 1, 2021’’ and inserting ‘‘July 1, 13 2016’’; and 14 (ii) in subparagraph (E), by striking 15 ‘‘January 2021’’ and inserting ‘‘January 16 2016’’; and 17 (B) in paragraph (4)— 18 (i) in subparagraph (A)— 19 (I) by striking ‘‘December 1, 20 2020’’ and inserting ‘‘December 31, 21 2015’’; and 22 (II) by striking ‘‘January 2021’’ 23 and inserting ‘‘January 2016’’; 24 VerDate Sep 11 2014 04:56 Jul 15, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4115.IH H4115 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 4115 IH (ii) in subparagraph (B), by striking 1 ‘‘December 1, 2020’’ and inserting ‘‘De- 2 cember 31, 2015’’; and 3 (iii) in subparagraph (C), by striking 4 ‘‘January 2021’’ and inserting ‘‘January 5 2016’’. 6 (3) EFFECTIVE DATE.—The amendments made 7 by this subsection shall take effect as if included in 8 the enactment of section 11101 of Public Law 117– 9 169. 10 (b) COVERED PART D DRUGS.— 11 (1) APPLICATION OF PRESCRIPTION DRUG IN- 12 FLATION REBATES TO DRUGS FURNISHED IN THE 13 COMMERCIAL MARKET.—Section 1860D–14B of the 14 Social Security Act (42 U.S.C. 1395w–114b) is 15 amended— 16 (A) in subsection (b)— 17 (i) in paragraph (1)— 18 (I) in subparagraph (A)(i), by 19 striking ‘‘the total number of units’’ 20 and all that follows through the semi- 21 colon and inserting the following: ‘‘the 22 total number of units that are used to 23 calculate the average manufacturer 24 price of such dosage form and 25 VerDate Sep 11 2014 04:56 Jul 15, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4115.IH H4115 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 4115 IH strength with respect to such part D 1 rebatable drug, as reported by the 2 manufacturer of such drug under sec- 3 tion 1927 for each month, with re- 4 spect to such period;’’; and 5 (II) by striking subparagraph (B) 6 and inserting the following: 7 ‘‘(B) EXCLUDED UNITS.—For purposes of 8 subparagraph (A)(i), the Secretary shall exclude 9 from the total number of units for a dosage 10 form and strength with respect to a part D 11 rebatable drug, with respect to an applicable pe- 12 riod, the following: 13 ‘‘(i) Units of each dosage form and 14 strength of such part D rebatable drug for 15 which payment was made under a State 16 plan under title XIX (or waiver of such 17 plan), as reported by States under section 18 1927(b)(2)(A). 19 ‘‘(ii) Units of each dosage form and 20 strength of such part D rebatable drug for 21 which a rebate is paid under section 22 1847A(i). 23 ‘‘(iii) Beginning with plan year 2026, 24 units of each dosage form and strength of 25 VerDate Sep 11 2014 04:56 Jul 15, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4115.IH H4115 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 4115 IH such part D rebatable drug for which the 1 manufacturer provides a discount under 2 the program under section 340B of the 3 Public Health Service Act.’’; and 4 (ii) in paragraph (6), by striking ‘‘IN- 5 FORMATION.—The Secretary’’ and all that 6 follows through ‘‘rebatable covered part D 7 drug dispensed’’ and inserting the fol- 8 lowing: ‘‘AMP REPORTS.—The Secretary 9 shall provide for a method and process 10 under which, in the case of a manufacturer 11 of a part D rebatable drug that submits 12 revisions to information submitted under 13 section 1927 by the manufacturer with re- 14 spect to such drug’’; and 15 (B) by striking subsection (d) and insert- 16 ing the following: 17 ‘‘(d) INFORMATION.—For purposes of carrying out 18 this section, the Secretary shall use information submitted 19 by manufacturers under section 1927(b)(3) and informa- 20 tion submitted by States under section 1927(b)(2)(A).’’. 21 (2) CHANGE OF BASE YEAR FOR REBATE CAL- 22 CULATION.—Section 1860D–14B of the Social Secu- 23 rity Act (42 U.S.C. 1395w–114b) is amended— 24 (A) in subsection (b)(5)— 25 VerDate Sep 11 2014 04:56 Jul 15, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4115.IH H4115 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 4115 IH (i) in subparagraph (A)— 1 (I) by striking ‘‘October 1, 2021’’ 2 and inserting ‘‘October 1, 2016’’; and 3 (II) by striking ‘‘January 2021’’ 4 and inserting ‘‘January 2016’’; and 5 (ii) in subparagraph (C), by striking 6 ‘‘January 2021’’ and inserting ‘‘January 7 2016’’; and 8 (B) in subsection (g)— 9 (i) in paragraph (3)— 10 (I) by striking ‘‘January 1, 11 2021’’ and inserting ‘‘January 1, 12 2016’’; and 13 (II) by striking ‘‘October 1, 14 2021’’ and inserting ‘‘October 1, 15 2016’’; and 16 (ii) in paragraph (4), by striking 17 ‘‘January 2021’’ and inserting ‘‘January 18 2016’’. 19 (3) EFFECTIVE DATE.—The amendments made 20 by this subsection shall take effect as if included in 21 the enactment of section 11102 of Public Law 117– 22 169. 23 Æ VerDate Sep 11 2014 04:56 Jul 15, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\H4115.IH H4115 pbinns on DSKJLVW7X2PROD with $$_JOB