How HR 4139 changes current law

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill amends the Social Security Act to adjust cost-sharing reductions for low-income individuals under Medicare Part D.

• 42 U.S.C. 1395w-114(a)

  that does not exceed $1 for → that does not exceed-- ``(I) for plan years before plan year 2026-- ``(aa) for a generic drug or a preferred drug that is a multiple source drug (as defined in section 1927(k)(7)(A)(i)), $1 or, if less, the copayment amount applicable to an individual under clause (iii); and ``(bb) for any other drug, $3 or, if less, the copayment amount applicable to an individual under clause (iii); and

  This change modifies the maximum copayment amounts for certain drugs under Medicare Part D for low-income individuals.

• 42 U.S.C. 1395w-114(a)

  ``(II) for plan year 2026-- ``(aa) for a generic drug, $0; and ``(bb) for any other drug, the dollar amount applied under this clause (after application of paragraph (4)(A)) for plan year 2023 for a drug described in subclause (I)(bb); and ``(III) for a subsequent year, the dollar amount applied under this clause for the previous year for the drug, increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.''.

  This addition specifies new copayment amounts for generic and other drugs for plan year 2026 and subsequent years, including adjustments based on the consumer price index.