United States 117th Congress Status: In Committee 1 D cosponsors

HR 3554 — Pharmacy DIR Reform To Reduce Senior Drug Costs Act

Last action — Referred to the Subcommittee on Health.

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  1. ✓
    Introduced
  2. 2
    In Committee
  3. 3
    Passed House
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 117th Congress. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Summary

Pharmacy DIR Reform To Reduce Senior Drug Costs Act This bill establishes certain requirements for prescription drug plans and the prices of covered drugs under the Medicare prescription drug benefit. Specifically, the bill requires price concessions, payments, and fees that are negotiated with a pharmacy to be included in a drug's negotiated price, excluding incentive payments, and for this price to be provided at the point of sale. Additionally, prescription drug plans must report price concessions or incentive payments that are made after payment for covered drugs at the point of sale, including by contracted intermediaries, to the pharmacy at least annually. The Centers for Medicare & Medicaid Services must establish standardized pharmacy performance measures with respect to incentive payments and price concessions; such measures must account for all pharmacy types, including specialty pharmacies, and focus on patient health outcomes and other targeted areas.

Bill Text

Sections of law this bill changes

1 section in 1 law

From the bill's own amending language, matched to the official United States Code (current through Public Law 119-121).

Social security · 42 U.S.C. ch. 7 1 section
  • § 1395w-102 Prescription drug benefits Amends

    42 U.S.C. § 1395w-102 — at 1395w-102(d)(1)(B)

    The law today

    (a) Requirements (1) In general For purposes of this part and part C, the term “qualified prescription drug coverage” means either of the following: (A) Standard prescription drug coverage with access to negotiated prices Standard prescription drug coverage (as defined in subsection (b)) and access to negotiated prices under subsection (d). (B) Alternative prescription drug coverage with at least actuarially equivalent benefits and access to negotiated prices Coverage of covered part D drugs which meets the alternative prescription drug coverage requirements of subsection (c) and access to negotiated prices under subsection (d), but only if the benefit design of such coverage is approved by the Secretary, as provided under subsection (c). (2) Permitting supplemental prescription drug coverage (A) In general Subject to subparagraph (B), qualified prescription drug coverage may include supplemental prescription drug coverage consisting of either or both of the following: (i) Certain reductions in cost-sharing (I) In general A reduction in the annual deductible, a reduction in the coinsurance percentage or, for a year preceding 2025, an increase in the initial coverage limit with respect to covered part D drugs, or any combination thereof, insofar as such a reduction or increase increases the actuarial value of benefits above the actuarial value of basic prescription drug coverage. (II) Construction Nothing in this paragraph shall be construed as affecting the application of subsection (c)(3). (ii) Optional drugs Coverage of any product that would be a covered part D drug but for the application of subsection (e)(2)(A). (B) Requirement A PDP sponsor may not offer a prescription drug plan that provides supplemental prescription drug coverage pursuant to subparagraph (A) in an area unless the sponsor also offers a prescription drug plan in the area that only provides basic prescription drug coverage. (3) Basic prescription drug coverage For purposes of this part and part C, the term “basic prescription drug coverage” means either of the following: (A) Coverage that meets the requirements of paragraph (1)(A). (B) Coverage that meets the requirements of paragraph (1)(B) but does not have any supplemental prescription drug coverage described in paragraph (2)(A). (4) Application of secondary payor provisions The provisions of section 1395w–22(a)(4) of this title shall apply under this part in the same manner as they apply under part C. (5) Construction Nothing in this subsection shall be construed as changing the computation of incurred costs under subsection (b)(4). (b) Standard prescription drug coverage For purposes of this part and part C, the term “standard prescription drug coverage” means coverage of covered part D drugs that meets the following requirements: (1) Deductible (A) In general Subject to paragraphs (8) and (9), the coverage has an annual deductible— (i) for 2006, that is equal to $250; or (ii) for a subsequent year, that is equal to the amount specified under this paragraph for the previous year increased by the percentage specified in paragraph (6) for the year involved. (B) Rounding Any amount determined under subparagraph (A)(ii) that is not a multiple of $5 shall be rounded to the nearest multiple of $5. (2) Benefit structure (A) 25 percent coinsurance Subject to subparagraphs (C), (D), and (E) and paragraphs (8) and (9), the coverage has coinsurance (for costs above the annual deductible specified in paragraph (1) and up to the initial coverage limit under paragraph (3) for a year preceding 2025 and for costs above the annual deductible specified in paragraph (1) and up to the annual out-of-pocket threshold specified in paragraph (4)(B) for 2025 and each subsequent year) that is— (i) equal to 25 percent; or (ii) actuarially equivalent (using processes and methods established under section 1395w–111(c) of this title) to an average expected payment of 25 percent of such costs. (B) Use of tiers Nothing in this p...

    147 other bills also change this section · Follow it → Official text at uscode.house.gov ↗

Also cites: 42 U.S.C. § 1395w

Action History

  1. Referred to the Subcommittee on Health.

  2. Introduced in House

  3. Introduced in House

  4. 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.

  5. 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.

Sponsors

Sponsorship breakdown

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1 sponsors · 0 co-sponsors · 546 not signed on

Sponsors (1)

Co-sponsors (0)

None.

Not signed on (546)

546 members have not signed on to this bill.

Show all 546 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does HR 3554 do?
Pharmacy DIR Reform To Reduce Senior Drug Costs Act This bill establishes certain requirements for prescription drug plans and the prices of covered drugs under the Medicare prescription drug benefit. Specifically, the bill requires price concessions, payments, and fees that are negotiated with a pharmacy to be included in a drug's negotiated price, excluding incentive payments, and for this price to be provided at the point of sale. Additionally, prescription drug plans must report price concessions or incentive payments that are made after payment for covered drugs at the point of sale, including by contracted intermediaries, to the pharmacy at least annually. The Centers for Medicare & Medicaid Services must establish standardized pharmacy performance measures with respect to incentive payments and price concessions; such measures must account for all pharmacy types, including specialty pharmacies, and focus on patient health outcomes and other targeted areas.
Who sponsors HR 3554?
HR 3554 is sponsored by Welch, Peter (Democratic).
What is the current status of HR 3554?
This bill died with 117th Congress. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track HR 3554?
Track HR 3554 free on One Click Politics — get push/email alerts when it moves.

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